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This thesis presents an analysis of organizational factors influencing Consequence Management of Dysfunctional Behavior and develops a framework for use by organizations regarding how they can more effectively reduce the incidences and manage the consequences of Dysfunctional Behavior.\ud \ud Twenty-five (25) Christian Evangelical Mission Organizations (CEMOs), located in the United States of America, provided substantive resources for this study including: fifteen that provided responses to surveys, four that provided organizational documents for analysis, and forty-four persons from twenty-one organizations were interviewed for the purpose of defining Dysfunctional Behavior, identifying the consequences stemming from that Dysfunctional Behavior, and establishing the extent of strategies for managing the consequences of Dysfunctional Behavior.\ud \ud A Strategic Model Template (SMT) is presented for organizations to use as a means of identifying Dysfunctional Behavior and effectively conducting Consequence Management. To this end, several typologies (Dysfunctional Behavior, Consequences, Sources of Information, Severity of Dysfunctional Behavior, Severity of Consequences, and Rationale for Consequence Management) are presented together with a Consequence Management Matrix as necessary both to the development of the SMT and its implementation with Strategic Integrity.\ud \ud The discovery of The Constraining Triangle identifies the forces unique to CEMOs that work to prevent the effective application of Consequence Management. These forces are a result of CEMO history and traditions and CEMO theology and the theology of CEMO members.

Aims: Cardiovascular disease (CVD) is the leading cause of mortality in patients with end‐stage renal disease (ESRD) receiving maintenance hemodialysis treatment. This study investigated the effect of a 12‐week intradialytic progressive resistance training (PRT) intervention on pulse wave velocity (PWV) and associated hemodynamic, anthropometric, and hematologic outcomes in patients with ESRD. Method: Twenty‐two patients with ESRD (59% men, 71.3 ± 11.0 years) were recruited. Supervised PRT (3 sets of 11 exercises) was prescribed three times per week during routine dialysis. The primary outcome was brachial‐ankle PWV via applanation tonometry. Secondary outcomes included augmentation index, brachial and aortic blood pressures, endothelial progenitor cells, C‐reactive protein, blood lipids and anthropometrics. Results: The intradialytic PRT regimen resulted in no significant change in PWV between control and intervention periods [mean difference = 0 (95% CI = ‐0.1 to 0.1); P=0.58]. Similarly, no significant change was noted in any secondary outcome measures between the control and intervention periods. Post‐hoc analyses limited to high adherers (≥75% attendance; n=11) did not differ from the primary analysis, indicating no dose‐response effect of our intervention Conclusion: Our 12‐week PRT intervention did not change PWV or any secondary outcomes. Future studies should determine if higher dosages of intradialytic PRT (i.e. longer duration and/or higher intensity) can be applied as a method improve arterial stiffness to potentially reduce cardiovascular disease and associated mortality this cohort Refereed/Peer-reviewed

usc This article reviews the literature addressing exercise programs for dialysis patients to identify elements necessary for sustaining exercise programs in this population. Literature searches for publications (January 1980–February 2009) in Medline (OVID), PubMed, CINAHL (EBSCO), EBSCOhost EJS, ProQuest Central, Web of Science, Cochrane Library, Google Scholar, ScienceDirect, SpringerLink (Kluwer), and Wiley Interscience (Blackwell) were performed. Reference lists from relevant articles were hand‐searched for further publications. Criteria for inclusion included full‐text primary research and review articles focused on exercise for adult hemodialysis patients. One hundred and seventy one publications were found with a primary focus on exercise in hemodialysis. Of these, 28 primary research and 14 review articles addressed one or more aspects of sustainability of hemodialysis exercise programs. Factors contributing to sustainable exercise programs included: dedicated exercise professionals; encouragement to exercise intradialytically; dialysis and medical staff commitment; adequate physical requirements of equipment and space; interesting and stimulating; cost implications need to be addressed; exercise is not for everyone; requires individual prescription; and there is no age barrier to exercise on hemodialysis.

Background: Intradialytic exercise programmes are important because of the deterioration in physical function that occurs in people receiving haemodialysis. Unfortunately, exercise programmes are rarely sustained in haemodialysis clinics. The aim of this study was to determine the efficacy of a sustainable resistance exercise programme on the physical function of people receiving haemodialysis. Methods: A total of 171 participants from 15 community satellite haemodialysis clinics performed progressive resistance training using resistance elastic bands in a seated position during the first hour of haemodialysis treatment. We used a stepped-wedge design of three groups, each containing five randomly allocated cluster units allocated to an intervention of 12, 24 or 36 weeks. The primary outcome measure was objective physical function measured by the 30-s sit-to-stand (STS) test, the 8-foot timed up and go (TUG) test and the four-square step test. Secondary outcome measures included quality of life, involvement in community activity, blood pressure and self-reported falls. Results: Exercise training led to significant improvements in physical function as measured by STS and TUG. There was a significant average downward change (β = -1.59, P < 0.01) before the intervention and a significant upward change after the intervention (β = 0.38, P < 0.01) for the 30-s STS with a similar pattern noted for the TUG. Conclusion: Intradialytic resistance training can improve the physical function of people receiving dialysis. Refereed/Peer-reviewed