All for One and One for All! Disparity Between Overall Crew’s and Individual Rowers’ Pacing Strategies During Rowing

Purpose: This study examined individual contributions to overall pacing strategy during 2- and 5-km rowing trials in a cox-less-4 boat. Methods: A crew of 4 male rowers performed maximal-effort on-water trials over 2 and 5 km, and power output during every individual stroke was measured for each crew member. Mean overall boat and individual rower stroke power were calculated for each 25% epoch (25% of total strokes taken), and power for each individual epoch was calculated as a percentage of mean power maintained over the entire distance. The coefficient of variation was used to determine stroke-to-stroke and epoch-to-epoch variability for individual rowers and the overall boat. Results: In both trials, the overall pacing strategy consisted of a high power output in the initial 25% that decreased in the middle 50% and increased again in the final 25%. However, individual rower data indicate wide variation in individual power profiles that did not always mimic the overall boat profile. Conclusions: This study demonstrates that overall boat power profiles during 2- and 5-km rowing trials are similar to velocity profiles previously reported for individual ergometry and on-water racing events. However, this over-all profile is achieved despite considerable variation in individual rower profiles. Further research is warranted to determine the mechanisms through which individual contributions to overall pacing strategy are regulated and the effectiveness or oth-erwise of seemingly disparate individual strategies on overall performance

How can subnational governments deliver their policy objectives in the age of austerity? Reshaping homelessness policy in Wales

This article explores how a devolved government in a small country, faced with external constraints beyond its immediate control, can deploy policy resources to shape a distinctive approach to public services. We analyse recent homelessness policy in Wales using the NATO (Nodality, Authority, Treasure, Organisation) typology of tools of government proposed by Hood and Margetts, and show how this can be applied usefully to understand the choices that governments must make in conducting relationships with other institutions. We conclude that a combination of Nodality and Authority provide powerful resources for a subnational government which has only limited formal powers and fiscal autonomy

Can meso-governments use metagovernance tools to tackle complex policy problems?

In recent years, a range of countries have devolved significant powers, responsibilities and funding to the regional level. This paper explores how and why the resulting meso-governments may use the tools of metagovernance. A detailed empirical analysis of homelessness policy in Wales found that skilful deployment of metagovernance tools enabled its meso-government to exploit the advantages of geographical and relational proximity to policy communities, while mitigating some of the constraints of its intermediate constitutional status, including limited formal powers and policy capacity. Junior government officials played multiple roles in homelessness networks, shaping and steering them through active network management while also participating in them. This ‘governor-participant’ role blurs the distinction made in the existing literature between ‘hands-on’ and ‘hands-off’ metagovernance tools. It also shows that, in the case of meso-governments at least, it is possible for low-ranking officials to exercise greater agency in policy development than has previously been assumed

Integrated obesity care management system -implementation and research protocol

<p>Abstract</p> <p>Background</p> <p>Nearly 50% of Canadians are overweight and their number is increasing rapidly. The majority of obese subjects are treated by primary care physicians (PCPs) who often feel uncomfortable with the management of obesity. The current research proposal is aimed at the development and implementation of an innovative, integrated, interdisciplinary obesity care management system involving both primary and secondary care professionals.</p> <p>Methods</p> <p>We will use both action and evaluative research in order to achieve the following specific objectives. The first one is to develop and implement a preceptorship-based continuing medical education (CME) program complemented by a web site for physicians and nurses working in Family Medicine Groups (FMGs). This CME will be based on needs assessment and will be validated by one FMG using questionnaires and semi structured interviews. Also, references and teaching tools will be available for participants on the web site. Our second objective is to establish a collaborative intra and inter-regional interdisciplinary network to enable on-going expertise update and networking for FMG teams. This tool consists of a discussion forum and monthly virtual meetings of all participants. Our third objective is to evaluate the implementation of our program for its ability to train 8 FMGs per year, the access and utilization of electronic tools and the participants' satisfaction. This will be measured with questionnaires, web logging tools and group interviews. Our fourth objective is to determine the impact for the participants regarding knowledge and expertise, attitudes and perceptions, self-efficacy for the management of obesity, and changes in FMG organization for obesity management. Questionnaires and interviews will be used for this purpose. Our fifth objective is to deliver transferable knowledge for health professionals and decision-makers. Strategies and pitfalls of setting up this program will also be identified.</p> <p>Conclusion</p> <p>This project is relevant to health system's decision-makers who are confronted with an important increase in the prevalence of obesity. It is therefore critical to develop strategies allowing the management of obesity in the 1^stline setting. Results of this research project could therefore influence health care organization in the field of obesity but also eventually for other chronic diseases.</p

Mobilized Peripheral Blood Stem Cells Versus Unstimulated Bone Marrow As a Graft Source for T-Cell-Replete Haploidentical Donor Transplantation Using Post-Transplant Cyclophosphamide.

Purpose T-cell-replete HLA-haploidentical donor hematopoietic transplantation using post-transplant cyclophosphamide was originally described using bone marrow (BM). With increasing use of mobilized peripheral blood (PB), we compared transplant outcomes after PB and BM transplants. Patients and Methods A total of 681 patients with hematologic malignancy who underwent transplantation in the United States between 2009 and 2014 received BM (n = 481) or PB (n = 190) grafts. Cox regression models were built to examine differences in transplant outcomes by graft type, adjusting for patient, disease, and transplant characteristics. Results Hematopoietic recovery was similar after transplantation of BM and PB (28-day neutrophil recovery, 88% v 93%, P = .07; 100-day platelet recovery, 88% v 85%, P = .33). Risks of grade 2 to 4 acute (hazard ratio [HR], 0.45; P \u3c .001) and chronic (HR, 0.35; P \u3c .001) graft-versus-host disease were lower with transplantation of BM compared with PB. There were no significant differences in overall survival by graft type (HR, 0.99; P = .98), with rates of 54% and 57% at 2 years after transplantation of BM and PB, respectively. There were no differences in nonrelapse mortality risks (HR, 0.92; P = .74) but relapse risks were higher after transplantation of BM (HR, 1.49; P = .009). Additional exploration confirmed that the higher relapse risks after transplantation of BM were limited to patients with leukemia (HR, 1.73; P = .002) and not lymphoma (HR, 0.87; P = .64). Conclusion PB and BM grafts are suitable for haploidentical transplantation with the post-transplant cyclophosphamide approach but with differing patterns of treatment failure. Although, to our knowledge, this is the most comprehensive comparison, these findings must be validated in a randomized prospective comparison with adequate follow-up

BiblioBouts Project Interim Report #5

The University of Michigan’s School of Information and its partner, the Center for History and New Media at George Mason University, have undertaken the 4-year BiblioBouts Project (October 1, 2008 to September 30, 2012) to support the design, development, testing, and evaluation of the web-based BiblioBouts game to teach incoming undergraduate students information literacy skills and concepts. This fifth interim report describes the BiblioBouts Project team’s 12-month progress achieving the project’s 4 objectives: designing, developing, deploying, and evaluating the BiblioBouts game and recommending best practices for future information literacy games. This latest 12-month period was marked by extensive progress in the analysis of evaluation data from the testing of the beta 1.0 version of BiblioBouts and putting to work what was learned from this analysis in the design and development of the beta 2.0 version of BiblioBouts. Major tasks that will occupy the team for the next 12 months are demonstrating BiblioBouts’ learning goals, recruiting more instructors to incorporate BiblioBouts in their classes, seeking additional funding, and finding a future home for BiblioBouts. For additional information about game design, pedagogical goals, scoring, game play, project participants, and playing BiblioBouts in your course, consult the BiblioBouts Project web site (http://bibliobouts.si.umich.edu).Institute of Museum and Library Studieshttp://deepblue.lib.umich.edu/bitstream/2027.42/87186/1/bbInterimReportToIMLS05.pd

Two Earth-sized planets orbiting Kepler-20

Since the discovery of the first extrasolar giant planets around Sun-like stars, evolving observational capabilities have brought us closer to the detection of true Earth analogues. The size of an exoplanet can be determined when it periodically passes in front of (transits) its parent star, causing a decrease in starlight proportional to its radius. The smallest exoplanet hitherto discovered has a radius 1.42 times that of the Earth's radius (R Earth), and hence has 2.9 times its volume. Here we report the discovery of two planets, one Earth-sized (1.03R Earth) and the other smaller than the Earth (0.87R Earth), orbiting the star Kepler-20, which is already known to host three other, larger, transiting planets. The gravitational pull of the new planets on the parent star is too small to measure with current instrumentation. We apply a statistical method to show that the likelihood of the planetary interpretation of the transit signals is more than three orders of magnitude larger than that of the alternative hypothesis that the signals result from an eclipsing binary star. Theoretical considerations imply that these planets are rocky, with a composition of iron and silicate. The outer planet could have developed a thick water vapour atmosphere.Comment: Letter to Nature; Received 8 November; accepted 13 December 2011; Published online 20 December 201

Appendectomy versus non-operative treatment for acute uncomplicated appendicitis in children: Study protocol for a multicentre, open-label, non-inferiority, randomised controlled trial

Background Appendectomy is considered the gold standard treatment for acute appendicitis. Recently the need for surgery has been challenged in both adults and children. In children there is growing clinician, patient and parental interest in non-operative treatment of acute appendicitis with antibiotics as opposed to surgery. To date no multicentre randomised controlled trials that are appropriately powered to determine efficacy of nonoperative treatment (antibiotics) for acute appendicitis in children compared with surgery (appendectomy) have been performed. Methods Multicentre, international, randomised controlled trial with a non-inferiority design. Children (age 5–16 years) with a clinical and/or radiological diagnosis of acute uncomplicated appendicitis will be randomised (1:1 ratio) to receive either laparoscopic appendectomy or treatment with intravenous (minimum 12 hours) followed by oral antibiotics (total course 10 days). Allocation to groups will be stratified by gender, duration of symptoms (≫ or \u3c48 hours) and centre. Children in both treatment groups will follow a standardised treatment pathway. Primary outcome is treatment failure defined as additional intervention related to appendicitis requiring general anaesthesia within 1 year of randomisation (including recurrent appendicitis) or negative appendectomy. Important secondary outcomes will be reported and a cost-effectiveness analysis will be performed. The primary outcome will be analysed on a non-inferiority basis using a 20% non-inferiority margin. Planned sample size is 978 children. Discussion The APPY trial will be the first multicentre randomised trial comparing non-operative treatment with appendectomy for acute uncomplicated appendicitis in children. The results of this trial have the potential to revolutionise the treatment of this common gastrointestinal emergency. The randomised design will limit the effect of bias on outcomes seen in other studies. Trial registration number clinicaltrials.gov:NCT02687464. Registered on Jan 13th 2016