USING GPS DATA TO EXPLORE DEMOGRAPHIC PREDICTORS OF LIFE-SPACE: A POOLED ANALYSIS

Thesis (Master's)--University of Washington, 2016-06

Concurrent validity of the Swedish version of the life-space assessment questionnaire

BACKGROUND: The Life-Space Assessment (LSA), developed in the USA, is an instrument focusing on mobility with respect to reaching different areas defined as life-spaces, extending from the room where the person sleeps to mobility outside one's hometown. A newly translated Swedish version of the LSA (LSA-S) has been tested for test-retest reliability, but the validity remains to be tested. The purpose of the present study was to examine the concurrent validity of the LSA-S, by comparing and correlating the LSA scores to other measures of mobility. METHOD: The LSA was included in a population-based study of health, functioning and mobility among older persons in Sweden, and the present analysis comprised 312 community-dwelling participants. To test the concurrent validity, the LSA scores were compared to a number of other mobility-related variables, including the Short Physical Performance Battery (SPPB) as well as "stair climbing", "transfers", "transportation", "food shopping", "travel for pleasure" and "community activities". The LSA total mean scores for different levels of the other mobility-related variables, and measures of correlation were calculated. RESULTS: Higher LSA total mean scores were observed with higher levels of all the other mobility related variables. Most of the correlations between the LSA and the other mobility variables were large (r = 0.5-1.0) and significant at the 0.01 level. The LSA total score, as well as independent life-space and assistive life-space correlated with transportation (0.63, 0.66, 0.64) and food shopping (0.55, 0.58, 0.55). Assistive life-space also correlated with SPPB (0.47). With respect to maximal life-space, the correlations with the mobility-related variables were generally lower (below 0.5), probably since this aspect of life-space mobility is highly influenced by social support and is not so dependent on the individual's own physical function. CONCLUSION: LSA was shown to be a valid measure of mobility when using the LSA total, independent LS or assistive LSA.

A neuropsychological instrument measuring age-related cerebral decline in older drivers: development, reliability, and validity of MedDrive.

When facing age-related cerebral decline, older adults are unequally affected by cognitive impairment without us knowing why. To explore underlying mechanisms and find possible solutions to maintain life-space mobility, there is a need for a standardized behavioral test that relates to behaviors in natural environments. The aim of the project described in this paper was therefore to provide a free, reliable, transparent, computer-based instrument capable of detecting age-related changes on visual processing and cortical functions for the purposes of research into human behavior in computational transportation science. After obtaining content validity, exploring psychometric properties of the developed tasks, we derived (Study 1) the scoring method for measuring cerebral decline on 106 older drivers aged ≥70 years attending a driving refresher course organized by the Swiss Automobile Association to test the instrument's validity against on-road driving performance (106 older drivers). We then validated the derived method on a new sample of 182 drivers (Study 2). We then measured the instrument's reliability having 17 healthy, young volunteers repeat all tests included in the instrument five times (Study 3) and explored the instrument's psychophysical underlying functions on 47 older drivers (Study 4). Finally, we tested the instrument's responsiveness to alcohol and effects on performance on a driving simulator in a randomized, double-blinded, placebo, crossover, dose-response, validation trial including 20 healthy, young volunteers (Study 5). The developed instrument revealed good psychometric properties related to processing speed. It was reliable (ICC = 0.853) and showed reasonable association to driving performance (R (2) = 0.053), and responded to blood alcohol concentrations of 0.5 g/L (p = 0.008). Our results suggest that MedDrive is capable of detecting age-related changes that affect processing speed. These changes nevertheless do not necessarily affect driving behavior.

Toiminnan kehittäminen ohutlevykonepajassa

Yritysmaailma elää jatkuvassa muutoksessa. Yrityksen kehittäminen on yrityksen menestymisen kannalta välttämätöntä. Mikäli yritystä ei aktiivisesti kehitetä, kilpailijat valtaavat yrityksen elintilan ja yritys taantuu ja lopulta yrityksen toiminta lakkaa. Tämän työn tarkoituksena oli kehittää Compusteel Oy:n toimintaa ja edistää yhtiön kilpailukykyä lähitulevaisuudessa. Compusteel Oy on luonteeltaan alihankkija / komponenttitoimittaja. Tällaisen yrityksen tärkein kilpailutekijä on tehokas tuotanto. Tässä työssä keskityttiin tutkimaan erityisesti keinoja, millä tuotantoa voidaan tehostaa. Useissa työn lähteenä käytetyissä tutkimuksissa on havaittu tiedon välittämisen merkitys nykyaikaisen yrityksen kilpailutekijänä. Tyypillisimmillään toiminnan virheet johtuvat tiedon puutteellisesta välittämisestä sekä tiedon käytettävyyden heikosta tasosta tarvetilanteessa. Tutkimus toteutettiin kirjallisuuden ja muun lähdeaineiston kuten koulutusten avulla. Tutkimuksessa paneuduttiin erityisesti erilaisten tuotannonohjausmenetelmien kartoittamiseen sekä niiden hyödyntämiseen yrityksen toiminnassa. Työn tuloksena syntyi Compusteel Oy:öön uusi toimintamalli tiettyihin yrityksen ydin prosesseihin. Erityisen tärkeänä nähtiin uuden ajattelumallin omaksuminen tuotannonohjaushenkilöstössä. Uutta ajattelumallia voidaan tulevaisuudessa soveltaa useissa yrityksen kehittämishankkeissa. Lisäksi työn tuloksena käyttöönotettiin uusi toiminnanohjausjärjestelmä, joka tukee uutta toimintamallia.

Becoming a caring nurse : the heart of the matter in nurse education

This thesis in caring science didactics is based on a thinking, where the fundamental basis for the didactic is science-based, i.e. it does not emanate from the nursing profession but brings forward a didactic that grows out of caring science and its core substance and ethos. This view on didactics arises from the caritative theory developed by Eriksson. The overall aim of the study is to clarify the meaning and essence of understanding, as well as to explore and deepen the understanding of student nurses' processes of understanding and becoming with the intention of developing a theory model for caring didactics. The overarching research questions are: What is the essence of understanding (of caring science knowledge)? What are the possibilities and importance of understanding in the appropriation of caring science? What characterizes and impels the process of becoming? The thesis consists of four sub studies and a summary section. The overall methodological approach is hermeneutic involving quantitative as well as qualitative methods. The data for the study has been collected through a longitudinal research project that followed student nurses at three universities during their entire education. The empirical sub studies form the basis for the interpreted knowledge that is formulated in the new understanding. This new understanding have, through additional theory-charging with the theory fragments from Gadamer, generated the heuristic synthesis which is illustrated in the theory model. The findings shows that understanding can be described as something unlimited, as an endless movement, which can be illustrated as a lying eighth, a lemniscate. The lemiscate of understanding is characterized by seeing, knowing and becoming and consists of seven differently named phases; the acquired horizon of understanding, the encounter of horizons, the dialogue of horizons, the fusion of horizons, application, reflection and shaping a new horizon of understanding. Bildung (formation), is the ultimate imprint of the endless spiral movement of understanding. Ethos and arête constitute the hubs around which the lemniscate of understanding circles. These include the spirit and driving force that the student carries within. The caring culture encloses the lemniscate of understanding. The caring culture provides the life space of understanding and the prevailing basic values are evinced in the culture.

Évaluation des effets de l'utilisation des aides à la mobilité motorisées chez les personnes âgées de plus de 50 ans

Le vieillissement démographique augmente rapidement la représentation des personnes âgées de plus de 50 ans parmi les utilisateurs d’aides à la mobilité motorisées (AMMs), telles que le fauteuil roulant motorisé et le quadriporteur. Le but général de la thèse est de rendre compte d’une démarche d’analyse des effets des AMMs au cours des premiers 18 mois d’utilisation chez les adultes d’âge moyen et les aînés. Notre question de recherche concerne la nature et l'importance des effets sur le fonctionnement, la pertinence sociale et le bien-être subjectif, ainsi que les liens entre les divers facteurs impliqués dans leur impact optimal. La thèse s’articule en trois volets, synthétique, méthodologique et analytique, dont les principaux résultats sont présentés dans quatre articles scientifiques. Le volet synthétique comprend une recension systématique qui révèle la représentation marginale des personnes âgées de plus de 50 ans dans les publications scientifiques sur les effets des AMMs et le faible niveau de preuve dans ce champ d’études. Les travaux liés à ce volet proposent également un cadre d’analyse reliant l’intention d’utiliser l’AMM, les habitudes de déplacements, les dimensions d’effets des AMMs sur le fonctionnement, la pertinence sociale et le bien-être subjectif, ainsi que quatre catégories de cofacteurs associés à l’utilisation (personne, aide technique, intervention, environnement). Le volet méthodologique assemble un dispositif de mesure comprenant 5 questionnaires et 18 indicateurs arrimés au cadre d’analyse et démontre l’applicabilité de l’ensemble des questionnaires pour une administration téléphonique. La validation transculturelle de deux questionnaires implique deux études réalisées auprès d’utilisateurs d’AMMs âgés de 50 à 84 ans (n=45). Ces travaux confirment la fidélité test-retest et l’équivalence des questionnaires traduits avec la version d’origine. Finalement, le volet analytique se concentre sur l’étude des habitudes de déplacements chez 3 cohortes (n=116) de personnes âgées de 50 à 89 ans, recrutées en fonction du stade d’utilisation de l’AMM. Les résultats suggèrent une amélioration de l’aire de mobilité après l’utilisation initiale ou long terme de l’AMM en comparaison avec une cohorte en attente de l’AMM, ainsi qu’une augmentation significative de la fréquence des déplacements autour du domicile et dans le voisinage. Trois facteurs associés à une aire de mobilité optimale, à savoir le genre, la nature des objectifs de participation de l’utilisateur et le type d’appareil utilisé, sont identifiés par des analyses de régression linéaires contrôlant pour l’âge. La thèse soutient l’importance de tenir compte de l’environnement et d’une combinaison de facteurs reliés à la personne et à l’aide technique pour saisir les effets des AMMs au cours des premiers mois d’utilisation. Ces résultats ouvrent la voie au suivi systématique des utilisateurs d’AMMs par les professionels de réadaptation, puisqu’ils confirment l’utilité du dispositif pour en mesurer les effets et ciblent les déterminants de la mobilité des utilisateurs d’AMMs âgés de plus de 50 ans.

Eye disease and mobility limitations in older adults

Objectif: Évaluer les défis de la mobilité chez les personnes âgées atteintes de dégénérescence maculaire reliée à l’âge (DMLA), de glaucome ou de dystrophie cornéenne de Fuchs et les comparer avec les personnes âgées n’ayant pas de maladie oculaire. Devis: Étude transversale de population hospitalière Participants: 253 participants (61 avec la DMLA, 45 avec la dystrophie cornéenne de Fuchs, 79 avec le glaucome et 68 contrôles) Méthodes: Nous avons recruté les patients parmi ceux qui se font soigner dans les cliniques d’ophtalmologie de l’Hôpital Maisonneuve-Rosemont (Montréal, Canada) de septembre 2009 à octobre 2010. Les patients atteints de la DMLA ou de la maladie de Fuchs ont une acuité visuelle inférieure à 20/40 dans les deux yeux, tandis que les patients avec du glaucome ont un champ visuel dans le pire oeil inférieur ou égal à -4dB. Les patients contrôles, qui ont été recrutés à partir des mêmes cliniques, ont une acuité visuelle et un champ visuel normaux. Nous avons colligé des données concernant la mobilité à partir des questionnaires (aire de mobilité et chutes) et des tests (test de l’équilibre monopodal, timed Up and Go (TUG) test). Pour mesurer la fonction visuelle nous avons mesuré l’acuité visuelle, la sensibilité au contraste et le champ visuel. Nous avons également révisé le dossier médical. Pour les analyses statistiques nous avons utilisé les régressions linéaire et logistique. Critères de jugement principaux: aire de mobilité, équilibre, test timed Up and Go, chutes Résultats: Les trois maladies oculaires ont été associées à des patrons différents de limitation de la mobilité. Les patients atteints de glaucome ont eu le type le plus sévère de restriction de mobilité; ils ont une aire de mobilité plus réduite, des scores plus bas au test TUG et ils sont plus enclins à avoir un équilibre faible et à faire plus de chutes que les contrôles (p < 0.05). De plus, comparativement aux contrôles, les patients ayant de la DMLA ou la dystrophie cornéenne de Fuchs ont eu une aire de mobilité réduite (p < 0.05). Les chutes n’ont pas été associées aux maladies oculaires dans cette étude. Conclusions: Nos résultats suggèrent que les maladies oculaires, et surtout le glaucome, limitent la mobilité chez les personnes âgées. De futures études sont nécessaires pour évaluer l’impact d’une mobilité restreinte chez cette population pour pouvoir envisager des interventions ciblées qui pourraient les aider à maintenir leur indépendance le plus longtemps possible.

Adaptación inicial del instrumento Espacio de Vida de la Familia (FLS) : Localidad de Kennedy , Bogotá, D.C.

El propósito de la presente investigación fue realizar la adaptación inicial del instrumento Espacio de Vida de la Familia (FLS) en el contexto de la localidad de Kennedy. La investigación tomó desde la teoría los pasos para la adaptación de pruebas e instrumentos sugeridos por autores reconocidos, además definió las dimensiones y factores del instrumento; contó con el concepto de tres jueces expertos para determinar el nivel de acuerdo de los factores del mismo; en la aplicación piloto se administraron los instrumentos espacio de vida de la familia FLS y el Inventario de satisfacción marital en la versión adaptada ACI para esta investigación; esto permitió hacer los ajustes para la aplicación en la muestra de 5 parejas en crisis y en 5 parejas que no estaban en crisis. Los resultados obtenidos mostraron una asociación fuerte entre los 2 instrumentos y al realizar la prueba de U de Mann-Whitney se evidenciaron diferencias significativas entre los dos grupos salvo en el factor de relaciones con otras personas. Concluyendo que el instrumento espacio de vida de la familia FLS no permite diferenciar el factor de relación con otras personas y por tanto no se ajusta al contexto local. Finalmente la investigación estableció unas normas de administración y aplicación del instrumento espacio de vida de la familia FLS.

Retenção de talentos por meio de reconhecimento e recompença

Esta dissertação objetivou verificar até que ponto os mecanismos de reconhecimento e recompensa são motivadores à retenção de talentos. Considerou que há pessoas que fazem o diferencial das organizações por deterem competências de difícil aquisição e de importância estratégica. No entanto, essas competências serão perdidas se não estiverem vinculadas aos objetivos das organizações e se não forem estabelecidas relações entre o desempenho e as práticas de reconhecimento e recompensa adotadas. Como base, buscou-se em disciplinas como a Psicologia, a Sociologia e as ciências da Administração, fundamentos teóricos que viessem auxiliar na resposta ao problema formulado. Este referencial mostrou a importância da retenção do talento, assim como descreveu e analisou algumas das muitas variáveis que poderiam impactar a construção de vínculos psicológicos entre o talento e a organização, ressaltando os principais componentes do processo motivacional na retenção. Também, permitiu identificar e analisar os principais mecanismos de reconhecimento e recompensa que poderiam ser adotados na valorização e retenção de talentos e relacionou-os com três correntes da motivação, criando um modelo conceitual de avaliação da retenção. Os resultados deste estudo serviram de orientadores à pesquisa de campo, que buscou conhecer quais os mecanismos de reconhecimento e recompensa que mais motivam os talentos a permanecerem em uma organização, bem como, avaliou se os mecanismos ditos motivadores, quando efetivamente praticados, causariam impacto na motivação do talento no decorrer do tempo. iii A análise dos resultados da pesquisa validou o modelo conceitual, concluindo que dos trinta e um mecanismos estudados apenas oito têm força de retenção, estando sete deles associados a formas de reconhecimento, aprovação e crescimento profissional. Os resultados não rejeitam as hipóteses e concluem que reconhecer e recompensar talentos vai muito além de abonos e prêmios pecuniários e materiais. Embora estímulos externos contribuam, a motivação em permanecer em uma organização é intrínseca ao talento e está associada ao seu espaço de vida, no momento em que ele se percebe integrado ao grupo, e respeitado, tendo seu esforço reconhecido e recompensado de forma justa.

Lugar de mulher é em casa?: cotidiano, espaço e tempo entre mulheres de famílias de pescadores

Trata da compreensão da participação de homens e mulheres na manutenção doméstica de famílias de pescadores no Distrito de Icoaraci, município de Belém/PA. Para isso, observei, analisei e interpretei como organizam as atividades em casa e na pesca, partindo das expectativas que influenciam suas práticas cotidianas por gênero e dando atenção, especialmente, para os espaços freqüentados e organização do tempo pelas mulheres. Como procedimento metodológico, utilizei dados do Anuário Estatístico do Município de Belém e do diagnóstico sobre a pesca artesanal no Estado do Pará, elaborado pelo Sistema Nacional de Emprego, para caracterização da área de estudo e para o entendimento sobre tendências ocupacionais e demográficas em que estas famílias estão inseridas. Além disso, realizei trabalho de campo, com entrevistas a sete mulheres de famílias de pescadores, abordando questões sobre a organização, classificação e distribuição das atividades domésticas e da pesca entre os moradores do domicílio nos dias atuais e na infância. As relações sociais são organizadas a partir de sua importância para a reprodução do grupo doméstico, em que homens, mulheres e crianças recebem atribuições diferentes e complementares. No desenrolar das atividades diárias, as mulheres assumem responsabilidades na manutenção do grupo, conciliando e, muitas vezes, acumulando tarefas domésticas e extra-domésticas, e usufruindo de um status específico para escolhas, acordos e tomadas de decisão, dados que permitem questionar e refletir sobre o lugar da mulher em casa.

Exobiology in earth orbit : the results of science workshops held at NASA Ames Research Center /

Mode of access: Internet.

Mobility changes in older age: neuropsychological, neurophysiological and cognitive predictors of successful adaptation in a real world scenario

The aims of this thesis were to investigate the neuropsychological, neurophysiological, and cognitive contributors to mobility changes with increasing age. In a series of studies with adults aged 45-88 years, unsafe pedestrian behaviour and falls were investigated in relation to i) cognitive functions (including response time variability, executive function, and visual attention tests), ii) mobility assessments (including gait and balance and using motion capture cameras), iii) motor initiation and pedestrian road crossing behavior (using a simulated pedestrian road scene), iv) neuronal and functional brain changes (using a computer based crossing task with magnetoencephalography), and v) quality of life questionnaires (including fear of falling and restricted range of travel). Older adults are more likely to be fatally injured at the far-side of the road compared to the near-side of the road, however, the underlying mobility and cognitive processes related to lane-specific (i.e. near-side or far-side) pedestrian crossing errors in older adults is currently unknown. The first study explored cognitive, motor initiation, and mobility predictors of unsafe pedestrian crossing behaviours. The purpose of the first study (Chapter 2) was to determine whether collisions at the near-side and far-side would be differentially predicted by mobility indices (such as walking speed and postural sway), motor initiation, and cognitive function (including spatial planning, visual attention, and within participant variability) with increasing age. The results suggest that near-side unsafe pedestrian crossing errors are related to processing speed, whereas far-side errors are related to spatial planning difficulties. Both near-side and far-side crossing errors were related to walking speed and motor initiation measures (specifically motor initiation variability). The salient mobility predictors of unsafe pedestrian crossings determined in the above study were examined in Chapter 3 in conjunction with the presence of a history of falls. The purpose of this study was to determine the extent to which walking speed (indicated as a salient predictor of unsafe crossings and start-up delay in Chapter 2), and previous falls can be predicted and explained by age-related changes in mobility and cognitive function changes (specifically within participant variability and spatial ability). 53.2% of walking speed variance was found to be predicted by self-rated mobility score, sit-to-stand time, motor initiation, and within participant variability. Although a significant model was not found to predict fall history variance, postural sway and attentional set shifting ability was found to be strongly related to the occurrence of falls within the last year. Next in Chapter 4, unsafe pedestrian crossing behaviour and pedestrian predictors (both mobility and cognitive measures) from Chapter 2 were explored in terms of increasing hemispheric laterality of attentional functions and inter-hemispheric oscillatory beta power changes associated with increasing age. Elevated beta (15-35 Hz) power in the motor cortex prior to movement, and reduced beta power post-movement has been linked to age-related changes in mobility. In addition, increasing recruitment of both hemispheres has been shown to occur and be beneficial to perform similarly to younger adults in cognitive tasks (Cabeza, Anderson, Locantore, & McIntosh, 2002). It has been hypothesised that changes in hemispheric neural beta power may explain the presence of more pedestrian errors at the farside of the road in older adults. The purpose of the study was to determine whether changes in age-related cortical oscillatory beta power and hemispheric laterality are linked to unsafe pedestrian behaviour in older adults. Results indicated that pedestrian errors at the near-side are linked to hemispheric bilateralisation, and neural overcompensation post-movement, 4 whereas far-side unsafe errors are linked to not employing neural compensation methods (hemispheric bilateralisation). Finally, in Chapter 5, fear of falling, life space mobility, and quality of life in old age were examined to determine their relationships with cognition, mobility (including fall history and pedestrian behaviour), and motor initiation. In addition to death and injury, mobility decline (such as pedestrian errors in Chapter 2, and falls in Chapter 3) and cognition can negatively affect quality of life and result in activity avoidance. Further, number of falls in Chapter 3 was not significantly linked to mobility and cognition alone, and may be further explained by a fear of falling. The objective of the above study (Study 2, Chapter 3) was to determine the role of mobility and cognition on fear of falling and life space mobility, and the impact on quality of life measures. Results indicated that missing safe pedestrian crossing gaps (potentially indicating crossing anxiety) and mobility decline were consistent predictors of fear of falling, reduced life space mobility, and quality of life variance. Social community (total number of close family and friends) was also linked to life space mobility and quality of life. Lower cognitive functions (particularly processing speed and reaction time) were found to predict variance in fear of falling and quality of life in old age. Overall, the findings indicated that mobility decline (particularly walking speed or walking difficulty), processing speed, and intra-individual variability in attention (including motor initiation variability) are salient predictors of participant safety (mainly pedestrian crossing errors) and wellbeing with increasing age. More research is required to produce a significant model to explain the number of falls.

Les effets d’un Accompagnement-citoyen personnalisé d’intégration communautaire (APIC) sur les déplacements et l’espace perçu d’aînés en perte d’autonomie vivant à domicile

Déterminant d’un vieillissement actif et en santé, la mobilité permet aux aînés de maintenir et de développer des liens sociaux significatifs, et de demeurer intégrés dans leur communauté. Malgré ces bienfaits, les interventions offertes aux aînés visant à favoriser leurs déplacements restent rares et discontinues. Un accompagnement-citoyen personnalisé d’intégration communautaire (APIC) pourrait favoriser les déplacements et améliorer la perception des lieux des aînés en perte d’autonomie. Cette étude visait à : 1) vérifier les effets de l’APIC sur les déplacements et l’espace perçu des aînés en perte d’autonomie et 2) identifier les facilitateurs et les obstacles à l’utilisation de l’espace dans l’APIC. Un devis mixte incluant un dispositif pré-expérimental a été utilisé auprès de 16 participants (11 femmes) âgés entre 66 et 91 ans. Les déplacements ont été mesurés à l’aide du Life Space Assessment. Un entretien individuel semi-structuré d’environ 30 minutes a été réalisé 2 à 4 semaines après la fin de l’intervention. À la suite de l’APIC, les déplacements des participants se sont améliorés (p < 0,01). Selon les participants âgés, l’APIC constitue un facilitateur important qui a permis de découvrir des lieux de participation et d’améliorer leur capacité à se déplacer seul. L’APIC est une intervention prometteuse qui permet d’améliorer les déplacements et l’utilisation de l’espace d’aînés en perte d’autonomie.