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This diploma investigates how changing the way we design housing for the elderly can respond to the demographic shift, by proposing a shift from institutionalized, age-segregated housing to an age-inclusive and social way of living. Through an architectural project focused on sharing and intergenerational relations, an alternative way of living for students in early adulthood with senior citizens in the later years after retirement is proposed. The goal is to enhance quality of life for two age groups particularly prone to loneliness in their current housing situations. By investigating different levels of sharing in an intergenerational housing community, the idea is to facilitate a social framework that can provide a safe, active, and lively everyday life for its residents.

Purpose Cystic fibrosis (CF), caused by pathogenic variants in the CF transmembrane conductance regulator (CFTR), affects multiple organs including the exocrine pancreas, which is a causal contributor to cystic fibrosis–related diabetes (CFRD). Untreated CFRD causes increased CF-related mortality whereas early detection can improve outcomes. Methods Using genetic and easily accessible clinical measures available at birth, we constructed a CFRD prediction model using the Canadian CF Gene Modifier Study (CGS; n = 1,958) and validated it in the French CF Gene Modifier Study (FGMS; n = 1,003). We investigated genetic variants shown to associate with CF disease severity across multiple organs in genome-wide association studies. Results The strongest predictors included sex, CFTR severity score, and several genetic variants including one annotated to PRSS1, which encodes cationic trypsinogen. The final model defined in the CGS shows excellent agreement when validated on the FGMS, and the risk classifier shows slightly better performance at predicting CFRD risk later in life in both studies. Conclusion We demonstrated clinical utility by comparing CFRD prevalence rates between the top 10% of individuals with the highest risk and the bottom 10% with the lowest risk. A web-based application was developed to provide practitioners with patient-specific CFRD risk to guide CFRD monitoring and treatment.

SAMMENDRAG Tittel: Skader i kombinerte- vs. enkeltidretter – en komparativ analyse av skadeomfanget i triatlon, svømming, sykling og løping. Hensikt: Å kartlegge skadeomfanget i triatlon sammenlignet med skadeomfanget i enkeltidrettene som inngår i triatlon: Svømming, sykling og løping. Metode: Systematisk review. Det ble utført litteratursøk i databasene “Pubmed”, “Sportdiscus” og “Google Scholar” i perioden 2.11.21 til 15.11.21. Resultat: Inkluderte 13 studier med totalt 3816 utøvere: Triatlon (4 studier, samlet n = 811), svømming (3 studier, samlet n = 628), sykling (3 studier, samlet n = 225) og løping (3 studier, samlet n = 2152). Totalt 2566 av utøverne var skadet i de studerte tidsperiodene. Skadeforekomsten varierte fra 0,2 til 0,8 skader per utøver per år i triatlon, med unntak av én studie som rapporterte 2,9. Denne ene studien skilte seg fra de andre studiene, og vil sannsynligvis være mindre representativ. I svømming var det registrert fra 0,1 til 1,4, i sykling fra 0,3 til 0,9 og fra 0,6 til 1,6 skader per utøver per år i løping. Skadefrekvensen var noenlunde lik i alle idrettene, men det var rapportert noe høyere insidens av skader blant utøverne i løping, og noe lavere i triatlon. Skadelokalisasjonene varierte mellom idretter, hvor størst andel skader relatert til underekstremiteten var rapportert av utøverne i triatlon og løping. Skulderskader var hyppigst rapportert i svømming og andelen bruddskader var høyest i sykling. Konklusjon: Resultatene viser at studier som rapporterte skader over en lengre periode har registrert lavere skadeforekomst blant utøverne. Dette kan forklares av at de fleste studiene benyttet retrospektiv metode, og utøverne måtte derfor huske skader fra en gitt periode. Det så ut til at utøverne husket færre skader desto lengre tilbake i tid skadene ble registrert fra. Sammenligning av skaderapporteringen og den faktiske forekomsten i idrettene kan være problematisk da flere av studiene benyttet ulike skadedefinisjoner og metoder. Mer forskning med standardiserte metoder vil være nødvendig i fremtiden. ABSTRACT Title: Injuries in multi- vs. single sports – a comparable analysis of injury incidence in triathlon, swimming, cycling and running Aim: The aim of this study was to create an overview of the current scientific literature about injuries in triathlon and its disciplines: Swimming, cycling and running. Method: Systematic review. A search of the literature was conducted during the period of 2.11.21 to 15.11.21 in the following databases: Pubmed, SportDiscus and Google Scholar. Results: A total of 13 studies with a population n=3816 athletes were included in this research: Triathlon (4 studies, total n = 811), swimming (3 studies, total n = 628), cycling (3 studies, total n = 225) and running (3 studies, total n = 2152), where 2566 athletes were injured during the period of research. The studies reported an injury occurrence from 0.1 to 0.8 injuries per athlete per year in triathlon, except a single study with a reported incidence of 2.9 injuries per athlete per year. This study differed from the other studies included and is probably less representative. In swimming, the reported incidents varied from 0.1 to 1.4, a frequency of 0.3 to 0.9 in cycling was presented and a variety of 0.6 to 1.6 injuries per athlete per year was reported by runners. The frequency of injury was similar in the sports included, but there was reported a slightly higher incidence of injuries in running, and slightly lower in triathlon. The locations of injuries were different in the sports, but the highest incidents of injuries related to the lower extremity were reported in triathlon and running. A majority of shoulder injuries were reported by elite swimmers, and the highest incidence of fractures was related to elite cyclists. Conclusion: The results found that studies reporting injuries for a longer period, also reported a smaller number of injuries among the athletes. An explanation may be that most studies included used a retrospective method, where the athletes had to remember injuries from the past. The athletes seem to remember less injuries as longer the period of reporting. The studies used different definitions of injury and methods to locate them, which may lead to difficulties when comparing reports among the different studies and the actual number of injuries. Further development of standardized guidelines of identifying and defining injuries is necessary to ensure that results are more likely to be compared with other studies.

Cystic fibrosis (CF), caused by pathogenic variants in the CF transmembrane conductance regulator (CFTR), affects multiple organs including the exocrine pancreas, which is a causal contributor to cystic fibrosis-related diabetes (CFRD). Untreated CFRD causes increased CF-related mortality whereas early detection can improve outcomes.Using genetic and easily accessible clinical measures available at birth, we constructed a CFRD prediction model using the Canadian CF Gene Modifier Study (CGS; n = 1,958) and validated it in the French CF Gene Modifier Study (FGMS; n = 1,003). We investigated genetic variants shown to associate with CF disease severity across multiple organs in genome-wide association studies.The strongest predictors included sex, CFTR severity score, and several genetic variants including one annotated to PRSS1, which encodes cationic trypsinogen. The final model defined in the CGS shows excellent agreement when validated on the FGMS, and the risk classifier shows slightly better performance at predicting CFRD risk later in life in both studies.We demonstrated clinical utility by comparing CFRD prevalence rates between the top 10% of individuals with the highest risk and the bottom 10% with the lowest risk. A web-based application was developed to provide practitioners with patient-specific CFRD risk to guide CFRD monitoring and treatment.

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Background A significant problem during continuous renal replacement therapy is premature circuit failure, affecting efficacy and molecular clearance. Techniques to improve circuit failure are anticoagulation, access site and modality. A modality change was introduced, moving from continuous veno-venous haemofiltration to continuous veno-venous haemodiafiltration as a result of existing issues with failing circuit times and failure rates. Aim The aim of this service evaluation was to ascertain if the use of continuous veno-venous haemodiafiltration compared to continuous veno-venous haemofiltration had affected failed circuit survival times and rates. Methods A service evaluation was chosen because the focus was to ascertain what effect a practice change had had on a particular service. The service evaluation was registered with the local trust's audit department and gained university ethical approval. It was anticipated that the data generated would be used to inform, question and improve practices. Patients who received renal replacement therapy (RRT) from May 2012 to January 2013 were retrospectively identified. Patients received continuous veno-venous haemofiltration for the duration of their treatment before September 2012 and continuous veno-venous haemodiafiltration after. A total of 78 patients were identified as receiving RRT; 41 of these patients had failed circuits. Results A total of 182 failed circuits were analysed. The median duration of failed circuits during continuous veno-venous haemofiltration was shorter (2·75 h, standard deviation (SD) = 13·82) when compared to continuous veno-venous haemodiafiltration (11 h, SD = 15·26, p 0·007) more likely chance of failure. Conclusion The use of continuous veno-venous haemodiafiltration has had an overall positive effect on the haemofiltration service by reducing the number of failed circuits and increasing circuit survival times, which may have improved the efficacy of the service. Continuous veno-venous haemodiafiltration may be a more appropriate modality of choice in non-septic patients requiring prolonged continuous RRT episodes.

Patients and caregivers living with advanced chronic obstructive pulmonary disease (COPD) have complex care needs and may benefit from palliative care intervention. Little is known about how best to implement and evaluate such initiatives.To determine the feasibility of: 1) implementing a customized home-based palliative care service for patients and caregivers living with advanced COPD and 2) measuring outcomes of providing such services.Single-centre cohort longitudinal observational study.Patients with advanced COPD and their caregivers were followed in their homes for 6 months.Health-related quality of life (HRQoL), caregiver burden, symptom severity, patient/caregiver satisfaction, utilization of acute care services, end-of-life (EOL) outcomes.30 patients and 18 caregivers were enrolled over 33 months. 25 patients (83%) and 14 caregivers (77%) reached our study endpoint. 13 patients (52%) and 5 caregivers (36%) completed outcome measurements at baseline and endpoint. HRQoL, caregiver burden and symptom severity did not change. Palliative care services were welcomed and valued, yet, despite a stated preference to die at home, 16 patients who died within 18 months of study enrollment died in hospital.Providing home-based palliative care services for patients with advanced COPD is feasible but completing repeated questionnaires is impractical. Despite significant palliative supports, managing terminal symptoms exceeded caregivers' capacity to cope and forced hospital admission. Insights into systemic barriers and limitations of current palliative care service models can provide opportunities for local program innovation aimed at improving care for advanced COPD.

A significant problem during continuous renal replacement therapy is premature circuit failure, affecting efficacy and molecular clearance. Techniques to improve circuit failure are anticoagulation, access site and modality. A modality change was introduced, moving from continuous veno-venous haemofiltration to continuous veno-venous haemodiafiltration as a result of existing issues with failing circuit times and failure rates.The aim of this service evaluation was to ascertain if the use of continuous veno-venous haemodiafiltration compared to continuous veno-venous haemofiltration had affected failed circuit survival times and rates.A service evaluation was chosen because the focus was to ascertain what effect a practice change had had on a particular service. The service evaluation was registered with the local trust's audit department and gained university ethical approval. It was anticipated that the data generated would be used to inform, question and improve practices. Patients who received renal replacement therapy (RRT) from May 2012 to January 2013 were retrospectively identified. Patients received continuous veno-venous haemofiltration for the duration of their treatment before September 2012 and continuous veno-venous haemodiafiltration after. A total of 78 patients were identified as receiving RRT; 41 of these patients had failed circuits.A total of 182 failed circuits were analysed. The median duration of failed circuits during continuous veno-venous haemofiltration was shorter (2·75 h, standard deviation (SD) = 13·82) when compared to continuous veno-venous haemodiafiltration (11 h, SD = 15·26, p0·001, 95% confidence interval (CI) 2·5-10). Circuit failure rate in continuous veno-venous haemofiltration was 56% compared to 43% in continuous veno-venous haemodiafiltration. After performing a Cox regression analysis, continuous veno-venous haemofiltration appeared to have a 1·87 times (CI 1·18-2·82, p0·007) more likely chance of failure.The use of continuous veno-venous haemodiafiltration has had an overall positive effect on the haemofiltration service by reducing the number of failed circuits and increasing circuit survival times, which may have improved the efficacy of the service. Continuous veno-venous haemodiafiltration may be a more appropriate modality of choice in non-septic patients requiring prolonged continuous RRT episodes.

Background Advanced resuscitation skills training is an important and enjoyable part of medical training, but requires small group instruction to ensure active participation of all students. Increases in student numbers have made this increasingly difficult to achieve. Methods A single-blind randomised controlled trial of peer-led vs. expert-led resuscitation training was performed using a group of sixth-year medical students as peer instructors. The expert instructors were a senior and a middle grade doctor, and a nurse who is an Advanced Life Support (ALS) Instructor. A power calculation showed that the trial would have a greater than 90% chance of rejecting the null hypothesis (that expert-led groups performed 20% better than peer-led groups) if that were the true situation. Secondary outcome measures were the proportion of High Pass grades in each groups and safety incidents. The peer instructors designed and delivered their own course material. To ensure safety, the peer-led groups used modified defibrillators that could deliver only low-energy shocks. Blinded assessment was conducted using an Objective Structured Clinical Examination (OSCE). The checklist items were based on International Liaison Committee on Resuscitation (ILCOR) guidelines using Ebel standard-setting methods that emphasised patient and staff safety and clinical effectiveness. The results were analysed using Exact methods, chi-squared and t-test. Results A total of 132 students were randomised: 58 into the expert-led group, 74 into the peer-led group. 57/58 (98%) of students from the expert-led group achieved a Pass compared to 72/74 (97%) from the peer-led group: Exact statistics confirmed that it was very unlikely (p = 0.0001) that the expert-led group was 20% better than the peer-led group. There were no safety incidents, and High Pass grades were achieved by 64 (49%) of students: 33/58 (57%) from the expert-led group, 31/74 (42%) from the peer-led group. Exact statistics showed that the difference of 15% meant that it was possible that the expert-led teaching was 20% better at generating students with High Passes. Conclusions The key elements of advanced cardiac resuscitation can be safely and effectively taught to medical students in small groups by peer-instructors who have undergone basic medical education training.

Older drivers appear to be over-involved in collisions with other vehicles while turning. A simulation experiment examined the ability of older driver to make turn decisions. Active drivers aged between 24–37 and above 70 years made judgments on whether they would turn between oncoming traffic. Gap times between vehicles and the oncoming traffic speed were manipulated on computer generated graphic projections. Older drivers were far more conservative in their decisions to turn and in some conditions the decision to turn was delayed. They also appeared to rely more heavily than younger drivers on gap distance to determine whether to turn. This evidence suggests that some older drivers may use a different model for turn decisions based on motion perception abilities and information processing speed.