| 1. |
- Carlsson, Annika, et al.
(author)
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Flytande väte som ett logistiskt bränsle – En förstudie
- 2022
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Reports (other academic/artistic)abstract
- Energibolagen gör stora investeringar för att tillhandahålla infrastruktur för produktion, distribution och tankning av vätgas. Det är därför viktigt att hitta de mest effektiva och genomförbara scenarierna för väte i samhället. Detta innebär att välja mellan värdekedjor för flytande väte (LH2) eller komprimerad vätgas (CGH2) i stegen från produktion till lagring ombord på fordon inom transportsegment, till exempel tunga lastbilar. Under projektet övervägdes också det ännu oetablerade konceptet med kryo-komprimerad vätgas (CcH2). Projektet syftade till att identifiera de kritiska utmaningarna och nuvarande begränsningar som påverkar den utbredda användningen av väte som bränsle för transporttillämpningar. Det har fokuserat på att öka kunskapen om teknologier som kan göra LH2- eller CGH2-infrastruktur och fordonsanvändning effektivare och säkrare, genom att bedöma den aktuella teknikens nivå såväl som mognad samt potential för ny teknik. I detta ingick också ett segment fokuserat på säkerhetsrisker kring alternativen längs de senare delarna av värdekedjan. Projektet som helhet genomfördes som en litteraturstudie. För teknologimognaden i olika delar av värdekedjan har projektet sammanfattat resultaten i ett kategoriseringssystem på mycket hög nivå, se tabell nedan. Definitionerna är huvudsakligen kvalitativa i följande kategorier: • Etablerad (används i större skala, ~TRL 9-10) • Beprövat koncept (demonstranter eller snart det här stadiet, ~TRL 7-8) • Initial design (inga offentliga demonstratorer tillgängliga, ~TRL 3-6) • Osäker tillämplighet (tillämpligheten fastställdes inte i detta arbete) • Ej tillämpbart (Kan inte användas för detta tillstånd av väte) Tabellen ovan ger också en översikt över de segment som ingår i rapporten. I kombination med den tekniska utvärderingen gjordes också en kvalitativ kostnadsanalys av de olika fastillstånden för väte. Här indikeras att även om LH2 har en högre kostnad i den inledande delen av värdekedjan, har den lägre kostnader i slutsegmenten. Därför är det möjligt att slutpriset för användaren blir liknande för både LH2 och CGH2. Hela kostnaden kan jämföras först när LH2 tankstationer och fordon byggs offentligt och kostnadsinformation är tillgänglig. Detsamma gäller för CcH2. Under förstudien för säkerhet, föreskrifter och standarder kom följande slutsats: Ur ett säkerhetsperspektiv finns det inga oöverstigliga barriärer med avseende på användningen av LH2 ombord på tunga vägfordon på medellång sikt, men det finns flera utmaningar att övervinna, inte minst på kort sikt. Inom EU finns regler som tillåter typgodkännande av tunga vägfordon med LH2 lagringssystem. Dessa är dock baserade på arbete som utfördes för 15 - 20 år sedan och är allmänt erkända som i behov av att uppdateras och valideras på samma sätt som CGH2 vägfordonsreglerna har varit. Det finns även en brist på uppdaterade industristandarder för LH2-lagringssystem för vägfordon. En särskild lucka är avsaknaden av en uppdaterad standard som kan refereras till i föreskrifter för munstycket i tanköppningens geometri. För LH2-påfyllningsstationer som helhet finns det dessutom inga lämpliga, uppdaterade internationella standarder, så det finns en risk att enskilda länder ställer sina egna krav. Sammantaget drog projektet slutsatsen att det inte finns några oöverkomliga hinder för implementeringen av LH2. Det är en genomförbar värdekedja ur både teknologiska-, kostnads- och säkerhetsperspektiv. Den kan också i framtiden bli jämförbar med den mer beprövade värdekedjan CGH2, men vissa initiala hinder och investeringar måste övervinnas.
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| 2. |
- Fjellman-Wiklund, Anncristine, et al.
(author)
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Reach the Person behind the Dementia Physical Therapists' Reflections and Strategies when Composing Physical Training
- 2016
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In: PLOS ONE. - : Public library science. - 1932-6203. ; 11:12
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Journal article (peer-reviewed)abstract
- Dementia is a disease characterized by cognitive impairment and physical decline that worsens over time. Exercise is one lifestyle factor that has been identified as a potential means of reducing or delaying progression of the symptoms of dementia, maximizing function and independence. The purpose of this study was to explore physical therapists' (PTs) experiences and reflections on facilitating high-intensity functional exercise with older people living with dementia, in residential care home settings. The study used a qualitative design based on interviews, individually or in small groups, with seven PTs engaged as leaders in the training of older people with dementia. The interviews were analyzed with a modified Grounded Theory method with focus on constant comparisons. To increase trustworthiness the study used triangulation within investigators and member checking. The core category "Discover and act in the moment-learn over time" reflects how the PTs continuously developed their own learning in an iterative process. They built on previous knowledge to communicate with residents and staff and to tailor the high intensity training in relation to each individual at that time point. The category "Be on your toes" highlights how the PTs searched for sufficient information about each individual, before and during training, by eliciting the person's current status from staff and by interpreting the person's body language. The category "Build a bond with a palette of strategies" describes the importance of confirmation to build up trust and the use of group members and the room to create an interplay between exercise and social interaction. These findings highlight the continuous iterative process of building on existing knowledge, sharing and reflecting, being alert to any alterations needed for individuals that day, communication skills (both with residents and staff) and building a relationship and trust with residents in the effective delivery of high intensity functional exercise to older people living with dementia in care settings.
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| 3. |
- Holmgren, Eva, 1972-, et al.
(author)
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The impact of an high intensive exercise program on gait after stroke : a randomized controlled trial
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Other publication (other academic/artistic)abstract
- Stroke often results in asymmetric gait with disturbed balance, which may increase the risk of accidental falls. The purpose of this study was to evaluate the impact of a high intensive exercise program after stroke on gait. 34 post-stroke individuals with risk of falls were included in the five week randomized controlled trial. The participants were assessed, included and randomized to the intervention group (IG) or control group (CG) at 3 to 6 months after stroke onset. The IG received a high intensive strength and balance exercise program along with a weekly educational group discussion on fall risk and security aspects, whereas the CG received weekly group discussions on hidden dysfunctions after stroke. Assessments were made before, post-intervention and at 3-months follow-up. Statistically significant (p<0.05) improvements were seen in the IG vs. the CG at post intervention compared with baseline in double support time for the non-paretic leg (DSTnp), variability (measured as coefficient of variation, CV) in Step Time for the paretic leg (STCVp) and the non-paretic leg (STCVnp), and in variability in Cycle Time for the paretic (CTCVp) and non-paretic leg (CTCVnp); at 3-months follow-up compared with baseline in DSTnp, STCVp, CTCVp and CTCVnp, and DSTCVp. At 3-months follow-up, the decrease in the STCVnp and the variability in Step Length of the non-paretic leg (SLCVnp) were more pronounced in the CG than in the IG. The findings suggest that high intensive exercise programs have a positive effect on gait, and can be useful in diminishing gait asymmetry as a fall-risk factor in people after stroke.
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| 4. |
- Klockare, Ellinor, et al.
(author)
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An interpretative phenomenological analysis of how professional dance teachers implement psychological skills training in practice
- 2011
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In: Research in Dance Education. - : Informa UK Limited. - 1464-7893 .- 1470-1111. ; 12:3, s. 277-293
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Journal article (peer-reviewed)abstract
- The aim of this study was to examine how dance teachers work with psychological skills with their students in class. Semi-structured interviews were conducted with six female professional teachers in jazz, ballet and contemporary dance. The interview transcripts were analyzed using interpretative phenomenological analysis (Smith 1996). Results revealed that all teachers used psychological skills training techniques such as goal setting and imagery and worked toward the following outcomes: group cohesion, self-confidence, and anxiety management. They strove to create a task-involving climate in their classes and the students were encouraged to participate in, for instance, the goal setting process and imagery applications. The teachers also placed significant emphasis on performance preparation, evaluation, and feedback, although some found it difficult to give positive feedback. Many of the findings can be associated with contemporary theories in sport psychology. However, the dance teachers had almost no formal training in performance psychology, but had instead developed their teaching methodology through their own experiences. Further skills development and suggestions for future research are discussed.
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| 5. |
- Moe-Nilssen, Rolf, et al.
(author)
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Criteria for evaluation of measurement properties of clinical balance measures for use in fall prevention studies
- 2007
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In: Journal of Evaluation In Clinical Practice. - : Blackwell Publishing. - 1356-1294 .- 1365-2753. ; 14:2, s. 236-240
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Journal article (peer-reviewed)abstract
- Work Package 3 of the Prevention of Falls Network Europe has evaluated measurement properties of clinical balance measures to be used to: (1) select participants for interventions with the goal to prevent falls in older people, and (2) assess the results of such intervention on balance function.Inclusion in a fall prevention study may be based on measures identifying subjects who have impaired balance or increased risk of future falls. We propose that an appropriate statistical method to analyse discriminative ability of a balance measure is discriminant analysis or logistic regression analysis. The optimal cut‐off score is best determined by plotting a receiver‐operating‐characteristic curve for different cut‐off values. The evaluation of predictors for risk of future falls should be based on a study design with a prospective data collection of falls.Sensitivity to change is a measurement property needed to evaluate the outcome of an intervention. The standardized response mean is frequently encountered in the literature and is recommended as a statistical measure of sensitivity to change in the context of an intervention study.Adequate reliability is a prerequisite for consistent measurement. Relative reliability may be reported as an intraclass correlation coefficient and absolute reliability as the within‐subject standard deviation (sw), also called standard error of measurement. When measurement error is proportional to the score, calculation of a coefficient of variation can be considered.In a second paper, the authors will evaluate clinical balance measures for use in fall prevention studies based upon criteria recommended in this report.
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| 6. |
- Nordin, Ellinor, 1959-
(author)
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Assessment of balance control in relation to fall risk among older people
- 2008
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Doctoral thesis (other academic/artistic)abstract
- Falls and their consequences among older people are a serious medical and public health problem. Identifying individuals at risk of falling is therefore a major concern. The purpose of this thesis was to evaluate measurement tools of balance control and their predictive value when screening for fall risk in physically dependent individuals ≥65 years old living in residential care facilities, and physically independent individuals ≥75 years old living in the community. Following baseline assessments falls were monitored during six months in physically dependent individuals based on staff reports, and during one year in physically independent individuals based on self reports. In physically dependent individuals test-retest reliability of the Timed Up&Go test (TUG) was established in relation to cognitive impairment. Absolute reliability measures exposed substantial day-to-day variability in mobility performance at an individual level despite excellent relative reliability (ICC 1.1 >0.90) regardless of cognitive function (MMSE ≥10). Fifty-three percent of the participants fell at least once during follow-up. Staff judgement of their residents’ fall risk had the best prognostic value for ruling in a fall risk in individuals judged with ‘high risk’ (positive Likelihood ratio, LR+ 2.8). Timed, and subjective rating of fall risk (modified Get Up&Go test, GUG-m) were useful for ruling out a high fall risk in individuals with TUG scores <15 seconds (negative LR, LR- 0.1) and GUG-m scores of ‘no fall risk’ (LR- 0.4), however few participants achieved such scores. In physically independent individuals balance control was challenged by dual-task performances. Subsequent dual-task costs in gait (DTC), i.e. the difference between single walking and walking with a simultaneous second task, were registered using an electronic mat. Forty-eight percent of the participants fell at least once during follow-up. A small prognostic guidance for ruling in a high fall risk was found for DTC in mean step width of ≤3.7 mm with a manual task (LR+ 2.3), and a small guidance for ruling out a high fall risk with DTC in mean step width of ≤3.6 mm with a cognitive task (LR- 0.5). In cross-sectional evaluations DTC related to an increased fall risk were associated with: sub-maximal physical performance stance scores (Odds Ratio, OR, 3.2 to 3.8), lower self-reported balance confidence (OR 2.6), higher activity avoidance (OR 2.1), mobility disability (OR 4.0), and cautious walking out-door (OR 3.0). However, these other measures of physical function failed to provide any guidance to fall risk in this population of seemingly able older persons. In conclusion – Fall risk assessments may guide clinicians in two directions, either in ruling in or in ruling out a high fall risk. A single cut-off score, however, does not necessarily give guidance in both directions. Staff experienced knowledge is superior to a single assessment of mobility performance for ruling in a high fall risk. Clinicians need to consider the day-to-day variability in mobility when interpreting the TUG score of a physically dependent individual. DTC of gait can, depending on the type of secondary task, indicate a functional limitation related to an increased fall risk or a flexible capacity related to a decreased fall risk. DTC in mean step width seems to be a valid measure of balance control in physically independent older people and may be a valuable part of the physical examination of balance and gait when screening for fall risk as other measures of balance control may fail to provide any guidance of fall risk in this population.
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| 7. |
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| 8. |
- Nordin, Ellinor, et al.
(author)
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Changes in step-width during dual-task walking predicts falls
- 2010
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In: Gait & Posture. - : Elsevier BV. - 0966-6362 .- 1879-2219. ; 32:1, s. 92-97
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Journal article (peer-reviewed)abstract
- The aim was to evaluate whether gait pattern changes between single- and dual-task conditions were associated with risk of falling in older people. Dual-task cost (DTC) of 230 community living, physically independent people, 75 years or older, was determined with an electronic walkway. Participants were followed up each month for 1 year to record falls. Mean and variability measures of gait characteristics for 5 dual-task conditions were compared to single-task walking for each participant. Almost half (48%) of the participants fell at least once during follow-up. Risk of falling increased in individuals where DTC for performing a subtraction task demonstrated change in mean step-width compared to single-task walking. Risk of falling decreased in individuals where DTC for carrying a cup and saucer demonstrated change compared to single-task walking in mean step-width, mean step-time, and step-length variability. Degree of change in gait characteristics related to a change in risk of falling differed between measures. Prognostic guidance for fall risk was found for the above DTCs in mean step-width with a negative likelihood ratio of 0.5 and a positive likelihood ratio of 2.3, respectively. Findings suggest that changes in step-width, step-time, and step-length with dual tasking may be related to future risk of falling. Depending on the nature of the second task, DTC may indicate either an increased risk of falling, or a protective strategy to avoid falling.
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| 9. |
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| 10. |
- Nordin, Ellinor, et al.
(author)
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Prognostic validity of the Timed Up-and-Go test : a modified Get-Up-and-Go test, staff's global judgement and fall history in evaluating fall risk in residential care facilities
- 2008
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In: Age and Ageing. - : Oxford University Press (OUP). - 0002-0729 .- 1468-2834. ; 37:4, s. 442-448
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Journal article (peer-reviewed)abstract
- Objectives: to evaluate and compare the prognostic validity relative to falls of the Timed Up-and-Go test (TUG), a modified Get-Up-and-Go test (GUG-m), staff's judgement of global rating of fall risk (GLORF) and fall history among frail older people. Design: cohort study, 6-month prospective follow-up for falls. Participants: 183 frail persons living in residential care facilities in Sweden, mean age 84 years, 73% women. Methods: the occurrence of falls during the follow-up period were compared to the following assessments at baseline: the TUG at normal speed; the GUG-m, a rating of fall risk scored from 1 (no risk) to 5 (very high risk); the GLORF, staff's rating of fall risk as 'high' or 'low'; a history of falls in the previous 6 months. These assessment tools were evaluated using sensitivity, specificity and positive and negative likelihood ratios (LR+ to rule in and LR- to rule out a high fall risk). Results: 53% of the participants fell at least once. Various cut-off values of the TUG (12, 15, 20, 25, 30, 35, 40 s) and the GUG-m showed LR+ between 0.9 and 2.6 and LR- between 0.1 and 1.0. The GLORF showed an LR+ of 2.8 and an LR- of 0.6 and fall history showed an LR+ of 2.4 and an LR- of 0.6. Conclusions: in this population of frail older people, staff judgement of their residents' fall risk as well as previous falls both appear superior to the performance-based measures TUG and GUG-m in ruling in a high fall risk. A TUG score of less than 15 s gives guidance in ruling out a high fall risk but insufficient information in ruling in such a risk. The grading of fall risk by GUG-m appears of very limited value.
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| 11. |
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| 12. |
- Nordin, Ellinor, et al.
(author)
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Timed Up&Go Test : Reliability in Older People dependent in Activities of Daily Living - Focus on Cognitive State
- 2006
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Conference paper (other academic/artistic)abstract
- Background and Purpose: It is unknown how cognitive impairment affects the reliability of Timed Up&Go Test (TUG). The aim of the present study was to investigate the expected variability of Timed Up&Go in older persons, dependent in activities of daily living (ADL), and with different levels of cognitive state. The hypothesis was that cognitive impairment would increase the variability of TUG scores.Subjects: Seventy-eight persons with multiple impairments, dependent in ADL and living in residential-care facilities were included in this study. The subjects were 84.8±5.7 (mean±SD) years old, and their Mini-mental State Examination score was 18.7±5.6. Methods: TUG assessments were performed on three different days. Intra- and inter rater analyses were carried out. Results: Cognitive impairment was not related to the size of the variability of TUG scores. There was a significant relationship between the variability and the time taken to perform TUG (p<0.001). The intraclass correlation were greater than .90, and were similar within and between raters. In repeated measurements at the individual level, an observed value of 10 seconds was expected to vary from 7 to 15 seconds, and an observed value of 40 seconds was expected to vary from 26 to 61 seconds for 95% of the observations. Discussion and Conclusions: The measurement error of a TUG assessment is substantial for a frail, older person dependent in ADL, regardless of the level of cognitive function, when verbal cuing is permitted during testing. The variability increases with the time to perform TUG. Despite high intraclass correlation coefficients, the ranges of expected variability can be wide and are similar within and between raters. Physical therapists should be aware of this variability before they interpret the TUG score for a particular patient.
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| 13. |
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| 14. |
- Pettersson, Beatrice, et al.
(author)
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Neither Timed Up and Go test nor Short Physical Performance Battery predict future falls among independent adults aged ≥75 years living in the community
- 2020
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In: Journal of frailty, sarcopenia and falls. - : Hylonome Publications. - 2459-4148. ; 5:2, s. 24-30
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Journal article (peer-reviewed)abstract
- Objectives: Previous research has shown that balance and gait difficulties are predictors of falls. The aim of this study was to evaluate the predictive validity of two tools reporting on balance and gait among older community living adults independent in personal activities of daily living (p-ADL).Methods: Prospective study design. Baseline assessment included the Timed Up and Go test (TUG) and the Short Physical Performance Battery (SPPB). Following baseline, falls were recorded monthly for one year by 202 participants (70.1% women) who were independent in p-ADL, and at least 75 years old (79.2±3.5). ROC-curves were made and AUC were calculated.Results: Fortyseven percent of the participants reported falls. AUCs calculated for TUG were 0.5 (95% CI: 0.5-0.6) for those with at least one fall, and 0.5 (95% CI: 0.5-0.6) for recurrent fallers. Corresponding figures for SPPB were 0.5 (95% CI: 0.5-0.6) and 0.5 (95% CI: 0.5-0.6).Conclusion: This study does not support a recommendation to use the Timed Up and Go test or the Short Physical Performance Battery as tools for the identification of fall-prone persons among older adults living in the community. These results reinforce the need for further research into appropriate tools for identifying independent but fall-prone older adults.
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| 15. |
- Pettersson, Beatrice, et al.
(author)
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Proposals for continued research to determine older adults’ falls risk
- 2020
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In: Journal of Frailty, Sarcopenia and Falls. - : Hylonome Publications. - 2459-4148. ; 5:4, s. 89-91
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Journal article (other academic/artistic)abstract
- Early detection of older adults with an increased risk of falling could enable early onset of preventative measures. Currently used fall risk assessment tools have not proven sufficiently effective in differentiating between high and low fall risk in community-living older adults. There are a number of tests and measures available, but many timed and observation-based tools are performed on a flat floor without interaction with the surrounding. To improve falls prediction, measurements in other areas that challenge mobility in dynamic conditions and that take a persons’ own perception of steadiness into account should be further developed and evaluated as single or combined measures. The tools should be easy to apply in clinical practice or used as a self-assessment by the older adults themselves.
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| 16. |
- Pohl, Petra, et al.
(author)
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Community-dwelling older people with an injurious fall are likely to sustain new injurious falls within 5 years : a prospective long-term follow-up study
- 2014
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In: BMC Geriatrics. - : BioMed Central. - 1471-2318. ; 14:1, s. 120-
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Journal article (peer-reviewed)abstract
- BACKGROUND: Fall-related injuries in older people are a leading cause of morbidity and mortality. Self-reported fall events in the last year is often used to estimate fall risk in older people. However, it remains to be investigated if the fall frequency and the consequences of the falls have an impact on the risk for subsequent injurious falls in the long term. The objective of this study was to investigate if a history of one single non-injurious fall, at least two non-injurious falls, or at least one injurious fall within 12 months increases the risk of sustaining future injurious falls.METHODS: Community-dwelling individuals 75-93 years of age (n = 230) were initially followed prospectively with monthly calendars reporting falls over a period of 12 months. The participants were classified into four groups based on the number and type of falls (0, 1, ≥2 non-injurious falls, and ≥1 injurious fall severe enough to cause a visit to a hospital emergency department). The participants were then followed for several years (mean time 5.0 years ±1.1) regarding injurious falls requiring a visit to the emergency department. The Andersen-Gill method of Cox regression for multiple events was used to estimate the risk of injurious falls.RESULTS: During the long-term follow-up period, thirty per cent of the participants suffered from at least one injurious fall. Those with a self-reported history of at least one injurious fall during the initial 12 months follow-up period showed a significantly higher risk for sustaining subsequent injurious falls in the long term (hazard ratio 2.78; 95% CI, 1.40-5.50) compared to those with no falls. No other group showed an increased risk.CONCLUSIONS: In community-dwelling people over 75 years of age, a history of at least one self-reported injurious fall severe enough to cause a visit to the emergency department within a period of 12 months implies an increased risk of sustaining future injurious falls. Our results support the recommendations to offer a multifactorial fall-risk assessment coupled with adequate interventions to community-dwelling people over 75 years who present to the ED due to an injurious fall.
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| 17. |
- Pohl, Petra, et al.
(author)
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Gender perspective on fear of falling using the classification of functioning as the model
- 2015
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In: Disability and Rehabilitation. - : Informa Healthcare. - 0963-8288 .- 1464-5165. ; 37:3, s. 214-222
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Journal article (peer-reviewed)abstract
- Abstract Purpose: To investigate associations between fear of falling (FOF) and recurrent falls among women and men, and gender differences in FOF with respect to International Classification of Functioning (ICF). Methods: Community-dwelling people (n = 230, 75-93 years, 72% women) were included and followed 1 year regarding falls. Data collection included self-reported demographics, questionnaires, and physical performance-based tests. FOF was assessed with the question "Are you afraid of falling?". Results were discussed with a gender relational approach. Results: At baseline 55% women (n = 92) and 22% men (n = 14) reported FOF. During the follow-up 21% women (n = 35) and 30% men (n = 19) experienced recurrent falls. There was an association between gender and FOF (p = 0.001), but not between FOF and recurrent falls (p = 0.79), or between gender and recurrent falls (p = 0.32). FOF was related to Personal factors and Activity and Participation. The relationship between FOF and Personal factors was in opposite directions for women and men. Conclusions: Results did not support the prevailing paradigm that FOF increases rate of recurrent falls in community-dwelling people, and indicated that the answer to "Are you afraid of falling?" might be highly influenced by gendered patterns.Implications for RehabilitationThe question "Are you afraid of falling?" has no predictive value when screening for the risk of falling in independent community-dwelling women or men over 75 years of age.Gendered patterns might influence the answer to the question "Are you afraid of falling?" Healthcare personnel are recommended to be aware of this when asking older women and men about fear of falling.
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| 18. |
- Rosendahl, Erik, et al.
(author)
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A randomised controlled trial of fall prevention by a high-intensity functional exercise program for older people in residential care facilities
- 2008
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In: Aging Clinical and Experimental Research. - Milan : Editrice Kurtis SRL. - 1594-0667 .- 1720-8319. ; 20:1, s. 67-75
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Journal article (peer-reviewed)abstract
- BACKGROUND AND AIMS: Falls are particularly common among older people living in residential care facilities. The aim of this randomized controlled trial was to evaluate the effectiveness of a high-intensity functional exercise program in reducing falls in residential care facilities.METHODS: Participants comprised 191 older people, 139 women and 52 men, who were dependent in activities of daily living. Their mean+/-SD score on the Mini-Mental State Examination was 17.8+/-5.1 (range 10-30). Participants were randomized to a high-intensity functional exercise program or a control activity, consisting of 29 sessions over 3 months. The fall rate and proportion of participants sustaining a fall were the outcome measures, subsequently analysed using negative binominal analysis and logistic regression analysis, respectively.RESULTS: During the 6-month follow-up period, when all participants were compared, no statistically significant differences between groups were found for fall rate (exercise group 3.6 falls per person years [PY], control group 4.6 falls per PY), incidence rate ratio (95% CI) 0.82 (0.49-1.39), p=0.46, or the proportion of participants sustaining a fall (exercise 53%, control 51%), odds ratio (95% CI) 0.95 (0.52-1.74), p=0.86. A subgroup interaction analysis revealed that, among participants who improved their balance during the intervention period, the exercise group had a lower fall rate than the control group (exercise 2.7 falls per PY, control 5.9 falls per PY), incidence rate ratio (95% CI) 0.44 (0.21-0.91), p=0.03.CONCLUSIONS: In older people living in residential care facilities, a high-intensity functional exercise program may prevent falls among those who improve their balance.
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| 19. |
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| 20. |
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| 21. |
- Rosendahl, Erik, et al.
(author)
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High-intensity functional exercise program for older people dependent in ADL : a randomized controlled trial evaluating the effects on falls
- 2008
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Conference paper (other academic/artistic)abstract
- PURPOSE: To determine if a high-intensity functional exercise program improves balance, gait ability, and lower-limb strength in older people dependent in activities of daily living (ADL), if an intake of protein-enriched energy supplement immediately after the exercises increases these effects of the training, and if the exercise program reduces falls. RELEVANCE: Impairments in physical functions among older people can lead to dramatic consequences for the individual such as admission to nursing home, falls and fractures. High-intensity exercise programs are effective to improve physical functions among older people but knowledge is limited concerning the effects for older people with severe cognitive or physical impairments. PARTICIPANTS: 191 older people dependent in ADL, living in residential care facilities, and with a Mini-Mental State Examination (MMSE) score of ≥ 10 participated in this study (the FOPANU Study). METHODS: The participants were randomized to a high-intensity functional weight-bearing exercise program (the HIFE Program) or a control activity, including 29 sessions over 3 months, as well as to protein-enriched energy supplement or placebo. Berg Balance Scale, usual and maximum gait speed, and one-repetition maximum in lower-limb strength were followed-up at 3 and 6 months by assessors blinded to group allocation. Fall rate and the proportion of participants sustaining a fall during the six months following the intervention were the outcome measures of the fall preventive effect of the exercise program. ANALYSIS: The intention-to-treat principle was used. Balance, gait ability, and lower-limb strength: 2 x 2 factorial ANCOVA. Falls: Negative binominal analysis and logistic regression analysis. RESULTS: At 3 months, the exercise group had improved significantly in usual gait speed compared with the control group (mean difference 0.04 m/s, P = 0.02). At 6 months, there were significant improvements favoring the exercise group for Berg Balance Scale (1.9 points, P = 0.05), usual gait speed (0.05 m/s, P = 0.009), and lower-limb strength (10.8 kg, P = 0.03). No interaction effects were seen between the exercise and nutrition interventions. When all participants were compared, no statistically significant differences between groups were found for fall rate (exercise group 3.6 falls per person years and control group 4.6 fall per person years) or the proportion of participants sustaining a fall (exercise 53% and control 51%). A subgroup interaction analysis revealed that among participants who improved their balance during the intervention period, the exercise group had a lower fall rate than the control group (exercise 2.7 falls per person years and control 5.9 falls per person years, incidence rate ratio 0.44, P = 0.03). CONCLUSIONS: A high-intensity functional exercise program has positive long-term effects in balance, gait ability, and lower-limb strength for older people who are dependent in ADL. An intake of protein-enriched energy supplement immediately after the exercises does not appear to increase these effects of the training. In addition, the high-intensity functional exercise program may have an effect in preventing falls among those who respond to the intervention. IMPLICATIONS: High-intensity functional exercise can be offered to improve physical functions among older people who are living in residential care facilities and have severe cognitive or physical impairments.
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| 22. |
- Tibbelin, Anna, et al.
(author)
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Vätgasproduktion för ellagring efter elnätsnytta och affärsmodeller
- 2022
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Reports (other academic/artistic)abstract
- Detta projekt genomfördes av RISE – Research Institutes of Sweden, i samarbete med Mariestads kommun (ElectriVillage) och VänerEnergi. Studien utgår från vätgastankstationen i Mariestad i ett framtidsscenario med ett ökat transportbehov och större dimensioner på komponenter i systemet. Genom att kombinera vätgas och batterier för att lagra energi har det studerats möjliga affärsmodeller för elhandel, syrgasproduktion och spillvärme. Även legala och tekniska aspekter med lagring har utvärderats. Studien har kommit fram till att nuvarande regelverk inte är anpassade för till exempel energilagring, samt att hantering av syrgas utgör den största säkerhetsrisken. Dessutom är värdet på intäktskällorna mycket svåra att uppskatta, då de till stor del påverkas av elpriser. Både syrgas och lågtempererad spillvärme är lätta att framställa på flera sätt och deras ekonomiska värde är därför förhållandevis lågt. Att använda syrgas från elektrolys till reningsverk har potential att minska reningsverkets energianvändning samtidigt som det också underlättar vid eventuell introduktion av rening av läkemedelsrester. För tankstationen hade det varit möjligt att få viss intäkt från detta som inte är försumbar. Studien kom även fram till att spillvärmen från elektrolysen har potential att bidra som uppvärmning för bostäder och växthus. En simuleringsmodell upprättades av vätgastankstationen i MATLAB/Simulink©. Där analyserades möjligheter att minska överuttag på Mariestads regionnät för åren 2020 och 2021. Med överuttag menas de effekter som överstiger abonnerad effekt (idag 26 MW) vilket leder till extra kostnader för det lokala elnätsbolaget VänerEnergi. Resultaten visade att tankstationen har möjlighet att sänka överuttag och i vissa fall även sänka abonnerad effekt, vilket leder till besparingar. Storleken på bränslecellen, elektrolys och vätgaslager är avgörande för hur stor effekt som systemet kan hjälpa elnätet med och under hur lång tid. Nätnyttan frekvensreglering är också möjlig med hjälp av tankstationen. Intäkten från frekvensregleringen är mycket osäker då den bygger på en marknad med budgivningssystem. I detta arbete är det uppskattat att frekvensreglering är den mest signifikanta intäktskällan för tankstationen efter drivmedelsförsäljning.
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| 23. |
- Toots, Annika, et al.
(author)
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The Effects of Exercise on Falls in Older People With Dementia Living in Nursing Homes : A Randomized Controlled Trial
- 2019
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In: Journal of the American Medical Directors Association. - : Elsevier. - 1525-8610 .- 1538-9375. ; 20:7, s. 835-842
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Journal article (peer-reviewed)abstract
- OBJECTIVES: To investigate exercise effects on falls in people with dementia living in nursing homes, and whether effects were dependent on sex, dementia type, or improvement in balance. A further aim was to describe the occurrence of fall-related injuries.DESIGN: A cluster-randomized controlled trial.SETTING AND PARTICIPANTS: The Umeå Dementia and Exercise study was set in 16 nursing homes in Umeå, Sweden and included 141 women and 45 men, a mean age of 85 years, and with a mean Mini-Mental State Examination score of 15.INTERVENTION: Participants were randomized to the high-intensity functional exercise program or a seated attention control activity; each conducted 2-3 times per week for 4 months.MEASURES: Falls and fall-related injuries were followed for 12 months (after intervention completion) by blinded review of medical records. Injuries were classified according to severity.RESULTS: During follow-up, 118(67%) of the participants fell 473 times in total. At the interim 6-month follow-up, the incidence rate was 2.7 and 2.8 falls per person-year in exercise and control group, respectively, and at 12-month follow-up 3.0 and 3.2 falls per person-year, respectively. Negative binomial regression analyses indicated no difference in fall rate between groups at 6 or 12 months (incidence rate ratio 0.9, 95% confidence interval (CI) 0.5-1.7, P = .838 and incidence rate ratio 0.9, 95% CI 0.5-1.6, P = .782, respectively). No differences in exercise effects were found according to sex, dementia type, or improvement in balance. Participants in the exercise group were less likely to sustain moderate/serious fall-related injuries at 12-month follow-up (odds ratio 0.31, 95% CI 0.10-0.94, P = .039).CONCLUSIONS/IMPLICATIONS: In older people with dementia living in nursing homes, a high-intensity functional exercise program alone did not prevent falls when compared with an attention control group. In high-risk populations, in which multimorbidity and polypharmacy are common, a multifactorial fall-prevention approach may be required. Encouraging effects on fall-related injuries were observed, which merits future investigations.
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