Bone disease and fractures are common in men and women with chronic kidney disease (CKD). The etiology of fractures in CKD is multi-factorial; identifying risk factors for fracture is important in CKD, so that patients who are at high risk can be treated before they fracture. The majority of studies have focused on risk factors associated with fracture in patients with stage 5 CKD on dialysis–there is a need for studies in pre-dialysis CKD. Three novel, non-radiological factors were assessed in 211 men and women with stage 3-5 CKD: cytokines osteoprotegerin (OPG) and receptor activator of nuclear factor kappa beta ligand (RANKL); tests of neuromuscular function including the timed up and go (TUG), 6 minute walk (6MW), and grip strength; and daily activity levels by accelerometry. Fractures were defined as self-reported low-trauma fractures since the age of 40 and/or prevalent vertebral fractures identified by morphometry. Logistic regression and receiver operating characteristic curves (ROC) were performed using STATA version 11.0. Those with fractures had elevated OPG compared to those without fractures (9.37±4.23 vs. 8.13±3.04 pmol/L, p=0.03), however, after adjusting for age OPG did not differ by fracture status. After adjusting for age, weight, and sex, impairments in both the TUG and 6MW tests were associated with fractures (TUG odds ratio (OR): 1.68, 95% confidence interval (CI): 1.40-2.02; 6MW OR: 0.53, 95% CI: 0.52-0.54). The diagnostic tests characteristics of the TUG and 6MW tests were excellent; both could discriminate fracture status (TUG AUROC: 0.90, 95% CI: 0.84-0.95; 6MW AUROC: 0.87, 95% CI: 0.84-0.95). Overall, subjects were primarily sedentary. After adjusting for stage of CKD, increased sedentary activity and decreased light intensity activity could discriminate fracture status (sedentary AUROC: 0.72, 95% CI: 0.56 to 0.87; light activity AUROC: 0.71, 95% CI: 0.55 to 0.87). In conclusion, non-radiological, novel factors including the TUG, the 6MW, and daily activity, but not OPG or RANKL were able to discriminate fracture status in men and women with stage 3-5 CKD.

The purpose of this study was to determine the relationship of spinal deformity with physical function and self-perception in children with spina bifida. Ninety-eight eligible children with scoliosis and spina bifida were identified; 80 of them (82%) consented to participate. Spinal deformity was measured in many ways, including scoliosis, coronal balance, and pelvic obliquity. Measures of physical function included the Sitting Balance Scale, Jebsen Hand Scale, Hoffer Ambulation Scale, the Spine Bifida Spine Questionnaire, and the Activities Scale for Kids (ASK). Self-perception was determined with Harter's Self-Perception Profile. No relationship was found between spinal deformity and overall physical function (ASK). Of all aspects of spinal deformity, only coronal imbalance was significantly related to only one aspect of physical function (ie, sitting imbalance). No aspect of spinal deformity was related to self-perception. In conclusion, surgeons should be clear in their indications for surgery and recognize that in the short term the potential benefit of surgery may be, at best, to improve only sitting balance.

Despite a large prevalence of rotator cuff impingements or tears in the elderly population, little research has focused on understanding how this population adapts to perform tasks of daily living. Past research has focused on the analysis of upper limb kinematics of young healthy individuals while performing these essential tasks (Magermans, 2004, Murray and Johnson., 2004). The purpose of this thesis was to identify kinematic and shoulder loading differences between elderly mobile individuals and elderly individuals with rotator cuff impingements during specific activities of daily living. Motion capture techniques were used in combination with the Shoulder Loading Analysis Modules (Dickerson, 2005, Dickerson et al., 2007) to estimate thoracohumeral kinematics and calculate external joint moments. Two-tailed t-tests with injury status as the factor determined that differences in active range of motion in flexion/extension and humeral rotations existed between the two populations. Results of the ADL analysis showed that the impinged population tended to have decreased plane of elevation and humeral rotations during ADLs. Task was also a main factor for most variables examined. Perineal care, hair-combing and reaching tasks were the most demanding in terms of range of motion necessary to complete the task. The reaching tasks resulted in the highest shoulder moment. K-means clustering techniques proved to be unsuccessful in identifying different motion strategies between the two study groups. This investigation showed that developing adaptations for perineal care, hair-combing and reaching tasks should be considered a priority when working with patients with rotator cuff impingements, as these tasks demanded the largest ranges of motion as well as high shoulder moments.

Despite a large prevalence of rotator cuff impingements or tears in the elderly population, little research has focused on understanding how this population adapts to perform tasks of daily living. Past research has focused on the analysis of upper limb kinematics of young healthy individuals while performing these essential tasks (Magermans, 2004, Murray and Johnson., 2004). The purpose of this thesis was to identify kinematic and shoulder loading differences between elderly mobile individuals and elderly individuals with rotator cuff impingements during specific activities of daily living. Motion capture techniques were used in combination with the Shoulder Loading Analysis Modules (Dickerson, 2005, Dickerson et al., 2007) to estimate thoracohumeral kinematics and calculate external joint moments. Two-tailed t-tests with injury status as the factor determined that differences in active range of motion in flexion/extension and humeral rotations existed between the two populations. Results of the ADL analysis showed that the impinged population tended to have decreased plane of elevation and humeral rotations during ADLs. Task was also a main factor for most variables examined. Perineal care, hair-combing and reaching tasks were the most demanding in terms of range of motion necessary to complete the task. The reaching tasks resulted in the highest shoulder moment. K-means clustering techniques proved to be unsuccessful in identifying different motion strategies between the two study groups. This investigation showed that developing adaptations for perineal care, hair-combing and reaching tasks should be considered a priority when working with patients with rotator cuff impingements, as these tasks demanded the largest ranges of motion as well as high shoulder moments.

Groupon is a popular group-buying website where they act as an intermediary between buyers and sellers. The company has grown rapidly and was established in Sweden in the year of 2010. The aim of this study is to investigate if businesses that have been marketed in Stockholm and that have been co-operating with Groupon have been affected in terms of customer loyalty and profitability. Furthermore the study also examines consumer’s opinions, purchase behavior and loyalty against Groupons business partners. The results showed that salon/spa in comparison with other industries received very high added sales (67 %) and had a large number of loyal customers (42 %). For the retail industry, 33 % did not receive additional sales and 67 % have not received customer loyalty. Tourism/travel and other industries believe the campaigns to be very successful and they have received good customer loyalty and sales. The companies who did not consider their campaigns successful had problems with the communication between themselves and Groupon. Finally, 49 % of the consumers turned out to be loyal to the businesses of which they had used daily deals.

Purpose: From an activity-perspective examine the meaning of housing accessibility and older persons´ perception of participation. Method: Systematic literature review of articles searched in the databases, Medline, Pubmed, Ahmed, Cinahl, Scopus and Google Scholar. Search on individual keywords, and in various combinations of the words home environment, home modification, occupational therapy, aging, accessibility and participation. Nine scientific articles were examined. Results: The articles were published between 2005 and 2009. Housing accessibility is important for a better well-being and independence in daily activities of elderly persons. Older persons´ participation and perceived satisfaction with participation, become lower with reduced ability to perform daily activities. Conclusion: Interventions designed to increase accessibility in the home environment may be important for older persons´ well-being. Interventions should be preceded by careful assessment of what is important for the individual as older persons´ perception of participation are individual and change over time.Further knowledge on this subject is needed, particularly studies with participants in very old age and poor health.

Bakgrund: Hjärtsvikt är en kronisk sjukdom som blir allt vanligare i västvärlden, underliggande hjärt- och kärlsjukdomar är ofta bidragande orsaker till att hjärtsvikt uppstår. Sjukdomen har en allvarlig påverkan på kroppen och gör att personers hälsa sätts ur balans. Syfte: Syftet var att belysa upplevelser av att leva med diagnostiserad hjärtsvikt med minst NYHA II. Metod: En litteraturstudie har gjorts och baserats på 13 vetenskapliga artiklar. Resultat: Personer med hjärtsvikt upplever fysisk, social och psykisk påverkan på livet på grund av sjukdomen. Det väcker känslor av ilska, frustration och ångest. Personerna har ofta behov av att göra livstilsförändringar som påverkar deras sociala nätverk negativt och skapar känslor av ensamhet och sorg. Många funderar mycket på framtiden och hur familjesituationen kan komma att förändras. Diskussion: Fynden som diskuteras är den fysiska påverkan, osäkerheten inför framtiden och hur familj- och närståenderelationerna kan förändras. Slutord: Som sjuksköterska och andra yrkesgrupper inom vården  är det viktigt att  ha förståelse för vilka känslor som personer med hjärtsvikt har och upplever. Genom att förstå vilka fysiska begränsningar personerna har och vilka upplevelser det skapar, kan omvårdnadsarbetet underlättas. / Background: Heart failure is a chronic disease that is becoming increasingly more common in the Western civilization, where the underlying cardiovascular diseases often are contributing factors to the occurrence of heart failure. The disease has a serious impact on the body and makes health out of balance. Aim: The aim was to highlight experiences of living with diagnosed heart failure graded at least as NYHA II. Methods: A literature review has been made based on 13 scientific articles. Results: People’s experiences of living with heart failure are physical, social and psychological impact on life due to the disease. It arouses feelings of anger, frustration and anxiety. People often need to make lifestyle changes that affect their social networks negatively and this creates feelings of loneliness and sadness. Many think a lot about the future and how the family situation may change. Discussion: The findings which have been discussed are the physical impact, uncertainty about the future and how family and close relationships can change.Conclusion: As a nurse and other professionals in health care it´s important to understand the feelings that people with heart failure have. By understanding the physical limitations and the experiences it creates, nursing work might become easier.

A massive amount has been written about forecasting but few articles are written about the development of time series models of call volumes for emergency services. In this study, we use different techniques for forecasting and make the comparison of the techniques for the call volume of the emergency service Rescue 1122 Lahore, Pakistan. For the purpose of this study data is taken from emergency calls of Rescue 1122 from 1st January 2008 to 31 December 2009 and 731 observations are used. Our goal is to develop a simple model that could be used for forecasting the daily call volume. Two different approaches are used for forecasting the daily call volume Box and Jenkins (ARIMA) methodology and Smoothing methodology. We generate the models for forecasting of call volume and present a comparison of the two different techniques.

¡@Bony flyingfish (Hirundichthys oxycephalus) is the primary component of flyingfish-egg fishery captures in the northeastern waters of Taiwan, and is also one of the dominant species of flyingfish in eastern waters of Taiwan. In recent years, people are conscious of overfishing in negarding to the continuously decreasing flyingfish resources. For rational management and sustainability of the fishery, there is an urgent need to study age and growth of the fish. Based on the laboratory-reared fish from the fertilized eggs collected in the wild, the daily periodicity of growth increments in three pairs of otoliths (lapillus, sagitta and asteriscus) was validated. First growth increment formed in the first day after hatching for sagitta and lupillus, and was in the eleven day after hatching for Asteriscus. ¡@¡@Ages of the wild flyingfish sample of 5.4~229.1 mm FL collected by drifted gillnets in Hualian, Taitung, Lyudao and Lanyu waters during April 2009 to March 2010, were determined by daily growth increment (DGI) counting in asteriscus, as adjusted by an addition of 11 DGIs. The von Bertalanffy growth parameters of the fish were estimated to be 253.9 mm in asymptotic length and 0.00753 mm d-1 in growth coefficient. Use DGIs estimation hatch date from otolith ringing, and estimated spawning date by deduct from 3 day hatch requisition. we found 2 recruitment group in eastern Taiwan within a year, most fish hatched either in summer or winter. In this study showing that bony flyingfish was an grew fast and had long longevity sp., therefore, on fishery management, we should decrease the fishing pressure and give them enough surplus biomass, so the biomass could recover rapidly. And we found two recruitment group, one could behalf of stock from east taiwan, and maybe it could behalf of two stocks ,on the other hand the method of fishery management should be a quite different .We suggest to confirm by the further reproductive biology research.

Several research studies have been conducted on the effectiveness of check-in/ check-out (CICO) procedures in behavior education programs (BEPs). However, little research has been conducted on implementing CICO procedures specifically for special education students. This study examined the effects of CICO procedures on six junior high students receiving special education services. Baseline data of targeted behaviors were collected during the first two weeks of the third six weeks grading period. The participants were receiving special education services due to a previous Admission, Review, and Dismissal (ARD) committee decision. CICO procedures are part of a secondary level behavior support system typically found in the BEP. The CICO procedures include a morning check-in, teacher feedback on a daily behavior report card (DBRC), an afternoon check-out, and weekly parent notification of student performance. A token economy system and behavior team meetings are two components also involved in implementing the CICO procedures. Intervention data were collected during implementation of the CICO procedures during the remaining three weeks of the third six weeks grading period. The intervention was not implemented the last week of the grading period due to final exams. The CICO procedures had high social validity ratings. Reliability, limitations and implications for future research on the current study are discussed.