A randomized trial of long-term remote monitoring of pacemaker recipients (The COMPAS trial)

International audienceAIMS: Professional practice guidelines recommend that pacemaker recipients be followed regularly. However, the majority of scheduled ambulatory visits is unproductive and imposes a heavy burden on the health-care system. METHODS AND RESULTS: The COMPAS randomized, multicentre, non-inferiority trial examined the safety of long-term remote monitoring of pacemakers. Between December 2005 and January 2008, 538 patients were randomly assigned to remote monitoring follow-up (active group) vs. standard care (control group). The primary objective was to confirm that the proportion of patients who experienced at least one major adverse event (MAE), including all-cause death and hospitalizations for device-related or cardiovascular adverse events, was not >7% higher in the active than in the control group. MAE-free survivals and quality of life were compared in both groups. The characteristics of the study groups were similar. Over a follow-up of 18.3 months, 17.3% of patients in the active and 19.1% in the control group experienced at least one MAE (P < 0.01 for non-inferiority). Hospitalizations for atrial arrhythmias (6 vs. 18) and strokes (2 vs. 8) were fewer (P < 0.05), and the number of interim ambulatory visits was 56% lower (P < 0.001) in the active than the control group. Changes in pacemaker programming or drug regimens were made in 62% of visits in the active vs. 29% in the control group (P < 0.001). Quality of life remained unchanged in both groups. CONCLUSION: Remote monitoring was a safe alternative to conventional care and significantly lowered the number of ambulatory visits during long-term follow-up of permanently paced patients. ClinicalTrials.gov identifier: NCT00989326

Primary physical education:Shifting perspectives to move forwards

Physical Education is widespread across the world yet despite its cultural variation it remains remarkably similar. The ability of the subject to replicate its practices makes it a potential site for exploration from a memetic perspective. The purpose of this paper is to examine documentary evidence such as research papers, policy documents and inspection reports and offer for consideration potential memes that are at work within the memeplex of UK primary school Physical Education. Four proposals are offered as potential memes; ‘sport as techniques’, ‘anyone can teach it’, ‘busy, happy and good’ and ‘nowhere important’. It is concluded that the current environment in primary schooling within the UK serves to strengthen the proposed four primary Physical Education memes by reaffirming current practices. Moving beyond these memes requires significant rethinking about what constitutes primary Physical Education

Malandragem and Ginga: Socio-cultural constraints on the development of expertise and skills in Brazilian football

In an ecological dynamics rationale, the development of expertise in sports is shaped by interactions of personal, task and environmental constraints. A notable outcome of this process is the distinctive performance styles of athletes shaped by socio-cultural-historical constraints. To understand this process, we examined the role of socio-cultural constraints shaping the development of skill in Brazilian football players at the macrosystem level. A range of data sources were inductively generated and analysed through the qualitative interpretative paradigm, including historical contextual analysis, participant observation, and unstructured interviews. Malandragem (i.e., cunning) emerged as a major focus and our findings suggested that behavioural characteristics, such as mischief and deception, are common attributes valued by many elite Brazilian footballers. Our analysis suggests how the value system of Malandragem is a product of the socio-cultural constraints primarily influenced by the Mulattos’ cultural traditions, historically interacting with particular socio-economic conditions. In Brazil, Malandragem can manifest itself through the Ginga (i.e., body sway) playing style in which footballers move deceptively to gain competitive advantages over opponents. Whilst the theatrical antics of contemporary Malandros (i.e., tricksters and/or streetwise persons), such as Neymar Junior, are frowned upon by many football critics, we argue that some aspects of being Malandro may be contributing to the development of a high level of perceptual-motor and cognitive functioning that has underpinned the Ginga playing style in Brazilian football for many decades