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To investigate the relationship between physical function and knee-related symptoms and 8-month physical activity (PA) level in older adults undergone total knee replacement (TKR). The 8-month follow-up after the randomized controlled trial (RCT) comparing exergaming with standard post-TKR exercise (NCT03717727). N/A. Originally 52 random sample of individuals undergoing TKR surgery participated in a 4-month post-operative exergaming trial (RCT), after which 40 (mean age 67 years) completed the 8-month follow-up. Nonexercised, post-intervention follow-up. Self-reported PA including a leisure time PA and PA related to daily errands and commuting was collected during the follow-up period using structured diaries from which metabolic equivalent of task hours (METh) per month were calculated. For analysis, participants were divided into METh tertiles: I, < 13.0 (n=13), II, 13.0-20.9 (n=13), and III, > 21.0 (n=14). Physical function and knee related symptoms were measured after RCT's intervention period using the Oxford Knee Score questionnaire, Timed Up and Go test, visual analog scale, 10-meter walking test, Short Physical Performance Battery, isometric knee extension and flexion force test, and Knee injury and Osteoarthritis Outcome Score questionnaire. There was a significant linear relationship between higher post-intervention knee flexion muscle force of the operated lower-limb and higher PA level during 8-month follow-up (P for linearity = 0.002). There was no linear relationship between other variables measuring physical function or knee-related symptoms and PA level. Results suggest that a higher knee flexion muscle force of operated lower limb after rehabilitative intervention period has positive impact on the long-term PA during leisure time, daily errands and commuting in the older adults recovering from TKR surgery. The authors have no conflicts of interest to disclose. [ABSTRACT FROM AUTHOR]

Abstract Background The adaptive significance of female polyandry is currently under considerable debate. In non-resource based mating systems, indirect, i.e. genetic benefits have been proposed to be responsible for the fitness gain from polyandry. We studied the benefits of polyandry in the Arctic charr (Salvelinus alpinus) using an experimental design in which the material investments by the sires and maternal environmental effects were controlled. Results Embryonic mortality showed a strong paternal genetic component, and it was lower in polyandrously fertilized offspring (sperm competition of two males) than in monandrous fertilizations. We also found that high sperm velocity was associated with low offspring mortality, but not with the size of the offspring or their yolk volume. Although no male effect was found on the size of the offspring yolk reserves, yolk volume was higher in offspring from polyandrous matings than offspring of the either of the two males when mated monandrously. Conclusions In support of the "good sperm hypothesis, we found that sperm velocity was positively associated with offspring fitness. In addition, our results suggest that polyandrous females gain genetic advantage (higher offspring survival) from this behavior, but that some benefits of polyandry (larger yolk volume) may not be explained solely by the additive genetic effects. This suggests that sperm competition environment may intensify the selection on genetically superior sperm which in turn may produce offspring that have superior yolk reserves. However, as high sperm velocity was not associated with larger yolk volume, it is possible that also some other non-genetic effects may contribute to offspring fitness. The potential role of polyandrous mating in inbreeding avoidance is discussed.

The concept of co-creation has been extensively discussed in tourism and hospitality research. Most studies focus mainly on exploring the involvement of customers in experience creation and the development of tourism services and innovations. Although this way of thinking can be valuable for creating competitive tourism services, it neglects other aspects of co-creation that may play an important role in tourism. Considering this gap, we work towards a more comprehensive understanding of value co-creation processes in small tourism firms by drawing upon cultural marketing and organisational improvisation. To illustrate this process, we present two company cases from northern Sweden, Treehotel and Icehotel. The empirical material used in this study consists of qualitative data collected via semi-structured interviews, participant and non-participant observation, and documentary materials. The study contributes to the co-creation discussion in tourism and hospitality by unpacking the role of human and non-human stakeholders, material resources, and unexpected events in the value co-creation processes within a small tourism firm context. [ABSTRACT FROM AUTHOR]

Launching orbital and suborbital rockets from a high altitude is beneficial because of e.g. nozzle optimisation and reduced drag. Aircraft and gas balloons have been used for the purpose. Here we present a concept where a balloon is filled with pure water vapour on ground so that it rises to the launch altitude. The system resembles a gas balloon because no onboard energy source is carried, and no hard objects fall down. We simulate the ascent behaviour of the balloon. In the baseline simulation, we consider a 10 tonne rocket lifted to an altitude of 18 km.We model the trajectory of the balloon by taking into account steam adiabatic cooling, surface cooling, water condensation and balloon aerodynamic drag. The required steam mass proves to be only 1.4 times the mass of the rocket stage, and the ascent time is around 10 minutes. For small payloads, surface cooling increases the relative amount of steam needed, unless insulation is applied to the balloon skin. The ground-filled steam balloon seems to be an attractive and sustainable method of lifting payloads such as rockets into high altitude. [ABSTRACT FROM AUTHOR]

Background: Pediatric patients comprise a large user group for emergency services. However, few studies have concerned the views of children and parents on emergency care. Purpose: To describe and compare assessments of the quality of pediatric emergency care by children and their parents. Methods: Ninety-eight children and their parents from 4 emergency departments participated in the survey. Data were analyzed using descriptive methods and logistic regression analysis. Results: Participants considered emergency care of high quality. Although children and parents gave similar assessments, children gave lower scores than parents on children's ability to participate in care and private discussions with emergency staff. The predicting factors for children's and their parents' satisfaction with emergency department care were the parents' vocational degree and fewer visits of the child to the emergency department within the current year. Conclusions: Pediatric emergency care should focus on innovative ways of improving children's involvement in their care. [ABSTRACT FROM AUTHOR]

Background: Prehospital stroke triage is challenged by endovascular treatment for large vessel occlusion (LVO) being available only in major stroke centers. Conjugate eye deviation (CED) is closely related to LVO, whereas common stroke signs (face-arm-leg-speech-visual) screen stroke. We hypothesized that combining CED with common stroke signs would yield a prehospital stroke scale for identifying both LVO and stroke in general.Methods and Results: We retrospectively analyzed consecutive patients (n = 856) with prehospital Code Stroke (recanalization candidate). The National Institutes of Health Stroke Scale (NIHSS) and computed tomography were administered to patients on arrival. Computed tomography angiography was performed on patients with NIHSS score of 8 or greater and considered to benefit from endovascular treatment. With random forest analysis and deviance analysis of the general linear model we confirmed the superiority of the NIHSS "Best Gaze" over other NIHSS items in detecting LVO. Based on this and commonly used stroke signs we presented the Finnish Prehospital Stroke Scale (FPSS) including dichotomized face drooping, extremity weakness, speech difficulty, visual disturbance, and CED. FPSS detected LVO with a sensitivity of 54%, specificity of 91%, positive predictive value of 48%, negative predictive value of 93%, and likelihood ratio of 6.2.Conclusions: Based on CED and universally used stroke signs, FPSS recognizes stroke in general and additionally, LVO as a stroke subtype comparably to other scales intended to detect LVO only. As the FPSS items are dichotomized, it is likely to be easy for emergency medical services to implement. [ABSTRACT FROM AUTHOR]

The current bifurcation of the acute stroke care pathway requires prehospital separation of strokes caused by large vessel occlusion. The first four binary items of the Finnish Prehospital Stroke Scale (FPSS) identify stroke in general, while the fifth binary item alone identifies stroke due to large vessel occlusion. The straightforward design is both easy for paramedics and statistically beneficial. We implemented FPSS based Western Finland Stroke Triage Plan, including medical districts of a comprehensive stroke center and four primary stroke centers. The prospective study population was consecutive recanalization candidates transported to the comprehensive stroke center within the first six months of implementing the stroke triage plan. Cohort 1 consisted of n=302 thrombolysis- or endovascular treatment candidates transported from the comprehensive stroke center hospital district. Cohort 2 comprised ten endovascular treatment candidates transferred directly to the comprehensive stroke center from the medical districts of four primary stroke centers. In Cohort 1, FPSS sensitivity for large vessel occlusion was 0.66, specificity 0.94, positive predictive value 0.70, and negative predictive value 0.93. Of the ten Cohort 2 patients, nine had large vessel occlusion, and one had an intracerebral hemorrhage. FPSS is straightforward enough to be implemented in primary care services to identify candidates for endovascular treatment and thrombolysis. When used by paramedics, it predicted two-thirds of large vessel occlusions with the highest specificity and positive predictive value reported to date. [ABSTRACT FROM AUTHOR]