Do pedometers motivate people to walk more?

Physical activity confers many important health benefits. The 'active living message' recommends that adults should accumulate 30 ruin of moderate-intensity physical activity (e.g. brisk walking) on most--preferably all--days of the week, but the populations of most developed countries are not meeting this target. Walking is one mode of activity that most people can do without skills, equipment, facilities or extra expense and walking has less bias in terms of age, sex and social class than facility-based exercise. Thus we need to investigate interventions that promote walking

Degenerating families of dendrograms

Dendrograms used in data analysis are ultrametric spaces, hence objects of nonarchimedean geometry. It is known that there exist $p$-adic representation of dendrograms. Completed by a point at infinity, they can be viewed as subtrees of the Bruhat-Tits tree associated to the $p$-adic projective line. The implications are that certain moduli spaces known in algebraic geometry are $p$-adic parameter spaces of (families of) dendrograms, and stochastic classification can also be handled within this framework. At the end, we calculate the topology of the hidden part of a dendrogram.Comment: 13 pages, 8 figure

Maximising the acquisition of core communication skills at the start of medical training

Background Clinical communication teaching for medical undergraduates may involve real patient contact alongside simulated patient contact. However, there is still comparatively little known about the experience of learning with real patients and how that may impact on the simulated patient encounter. Aim To explore the impact of real patient contact on the experience of communication skills training and simulated patient contact for first year medical undergraduate students. Methods As part of the six-year MBBS undergraduate medical degree at Imperial College London, students are obliged to undertake communication skills training, which involves teaching with simulated and real patients. In 2017 (toward the end of formal teaching), a small sample of Year 1 medical students, who had taken part in extra-curricular teaching with real patients were recruited for the study to compare their performance with a control group in a simulated patient encounter. The performance of both groups was analysed alongside follow up focus group data from a sample of the study group. Results Quantitative analysis revealed there was no significant difference in communication skills during a scored simulated patient interview between students with real patient contact and those without. Focus group data, however, revealed valuable insights into the experience of learning with real patients. Students reported a marked increase in their confidence and ability to naturalise their communication skills as a result of real patient contact. Students also reported that skills gained through real patient contact may not always transfer easily to the simulated patient setting. Conclusion Real patient contact is an invaluable component of communication training for undergraduate medical students. For successful implementation there needs to be a clear curricular purpose at pedagogical, practical and organisational levels. Students’ experience of real patient contact can provide an informed foundation upon which to implement other modes of teaching. Keywords: Real patient contact, Communication skills training, Early years curriculu

Futureproofing Complex Infrastructure Projects Using Real Options

Existing project performance measures in the infrastructure sector focus on construction performance (time, cost, quality) and pay less attention to lifecycle performance. The consequence of this shortsighted perspective is that decisions taken early lead to poorer solutions. Infrastructure that should last centuries quickly becomes inadequate, leading to costly reconfigurations. Real options reasoning can help managers to overcome this issue by unlocking lifecycle performance thinking in complex infrastructure projects. Real options reasoning enables managers to explore the value of flexibility by employing futureproofing strategies during the development process. From analysis of interviews with experts in healthcare infrastructure, we observed that projects that led to obsolescence were developed using tight design briefs and were focused on capital targets, and decision-makers were less invested in the concept of futureproofing. On the other hand, projects that were futureproofed followed a loosely-defined design brief and shifted focus towards whole-life targets. We make five recommendations for futureproofed infrastructure

Talking about Futureproofing: Real Options Reasoning in Complex Infrastructure Projects

Complex infrastructure projects often attract criticism regarding their short- and long-term performance. An effective development process requires thinking about both present and future requirements. We employed the lens of real options reasoning to investigate the power of verbal theorizing, without the aid of analytical modeling, to add flexibility in the development process. Drawing on 32 semi-structured interviews with decision-makers involved in health estate projects, we examined if and how informal talks in the development process can lead to futureproof outcomes. Our findings synthesize and conceptualize relevant insights on iterative design thinking, affordability, bounded rationality, and motivational gaps as causal mechanisms for futureproofing talks and thus real options reasoning. This article contributes to the planning and project studies literature dealing with futureproofing complex infrastructure projects

Concentrated Differential Privacy: Simplifications, Extensions, and Lower Bounds

"Concentrated differential privacy" was recently introduced by Dwork and Rothblum as a relaxation of differential privacy, which permits sharper analyses of many privacy-preserving computations. We present an alternative formulation of the concept of concentrated differential privacy in terms of the Renyi divergence between the distributions obtained by running an algorithm on neighboring inputs. With this reformulation in hand, we prove sharper quantitative results, establish lower bounds, and raise a few new questions. We also unify this approach with approximate differential privacy by giving an appropriate definition of "approximate concentrated differential privacy.

Modelling and Simulation of the Power Take-Off System for a Hinge-Barge Wave-Energy Converter

The McCabe Wave Pump (MWP) has possibilities for the conversion of wave energy into electrical energy and the production of potable water. However, in order to optimise the dynamics and operation of this device in the face of a wide variety of sea conditions, a number of important control issues must be addressed. The first step, which is addressed in this paper, is the production of a dynamical model of the MWP, which can provide a basis for both control design and simulation. Since the power take-off (PTO) system provides the main damping in the system, the paper places particular emphasis on the PTO model and how it couples to the main rig dynamics. The control problem formulation is also briefly addressed

Modelling and Simulation of the Power Take-Off System for a Hinge-Barge Wave-Energy Converter

The McCabe Wave Pump (MWP) has possibilities for the conversion of wave energy into electrical energy and the production of potable water. However, in order to optimise the dynamics and operation of this device in the face of a wide variety of sea conditions, a number of important control issues must be addressed. The first step, which is addressed in this paper, is the production of a dynamical model of the MWP, which can provide a basis for both control design and simulation. Since the power take-off (PTO) system provides the main damping in the system, the paper places particular emphasis on the PTO model and how it couples to the main rig dynamics. The control problem formulation is also briefly addressed

Analysis of communication styles underpinning clinical decision-making in cancer multidisciplinary team meetings

INTRODUCTION: In cancer care, multidisciplinary team (MDT) meetings are the gold standard. While they are trying to maximize productivity on the back of the steadily increasing workload, growing cancer incidence, financial constraints, and staff shortages, concerns have been raised with regards to the quality of team output, as reported by Cancer Research UK in 2017: "Sometimes we discuss up to 70 patients. This is after a whole day of clinics, and we do not finish until after 19.00. Would you want to be number 70?". This study aimed to explore systematically some of the dynamics of group interaction and teamwork in MDT meetings. MATERIALS AND METHODS: This was a prospective observational study conducted across three MDTs/university hospitals in the United Kingdom. We video-recorded 30 weekly meetings where 822 patient cases were reviewed. A cross-section of the recordings was transcribed using the Jefferson notation system and analyzed using frequency counts (quantitative) and some principles of conversation analysis (qualitative). RESULTS: We found that, across teams, surgeons were the most frequent initiators and responders of interactional sequences, speaking on average 47% of the time during case discussions. Cancer nurse specialists and coordinators were the least frequent initiators, with the former speaking 4% of the time and the latter speaking 1% of the time. We also found that the meetings had high levels of interactivity, with an initiator-responder ratio of 1:1.63, meaning that for every sequence of interactions initiated, the initiator received more than a single response. Lastly, we found that verbal dysfluencies (laughter, interruptions, and incomplete sentences) were more common in the second half of meetings, where a 45% increase in their frequency was observed. DISCUSSION: Our findings highlight the importance of teamwork in planning MDT meetings, particularly with regard to Cancer Research UK in 2017 cognitive load/fatigue and decision-making, the hierarchy of clinical expertise, and the increased integration of patients' psychosocial information into MDT discussion and their perspectives. Utilizing a micro-level methodology, we highlight identifiable patterns of interaction among participants in MDT meetings and how these can be used to inform the optimization of teamwork