Search

Nutrition is a significant factor in a power athlete's ability to achieve hypertrophy, strength, lean body mass, and overall performance goals. Optimizing an athlete's macronutrient balance, timing of intake, and hydration is essential for advancing performance and should be fluid as the athlete transitions between cycles of training, matching nutrient requirements to intensity of training throughout periodization. Supplement use can help athletes meet their performance and nutrition goals when used as an adjunct to a well-chosen diet, both by direct ergogenic effect and by reducing risk of illness or injury. Educating athletes and coaches on an optimal nutrition plan to support training, performance, and health is critical to prevent the negative effects that may come from poor diet, dangerous weight cutting practices, and relative energy deficiency in sport.

To assess the proportion of missed/misinterpreted imaging examinations of pancreatic ductal adenocarcinoma (PDAC), and their association with the diagnostic interval and survival. Two hundred fifty-seven patients (mean age, 71.8 years) diagnosed with PDAC in 2014–2015 were identified from the Nova Scotia Cancer Registry. Demographics, stage, tumor location, and dates of initial presentation, diagnosis, and, if applicable, surgery and death were recorded. US, CT, and MRI examinations during the diagnostic interval were independently graded by two radiologists using the RADPEER system; discordance was resolved in consensus. Mean diagnostic interval and survival were compared amongst RADPEER groups (one-way ANOVA). Kaplan-Meier analysis was performed for age (

Background Over the past decade, mammography has transitioned from film to digital media with promises of increased productivity and time savings. Between 2007 and 2010 in Nova Scotia, 10 mammography sites transitioned from analog to digital, providing a natural experiment to evaluate the transition (full-field digital mammography) on mammography with respect to changes in throughput volumes in a “real-world” setting. Methods Study data consisted of aggregate, monthly, site-specific counts of screening and diagnostic mammograms for the period 2006 to 2014, which were obtained from an information system that supports central booking, clinical reporting, and patient management for all breast imaging in Nova Scotia. A multigroup interrupted time series design using segmented regression with site-month data assessed pre-to post-transition changes in screening throughput volumes and the proportion of diagnostic mammograms performed. Results The overall mean monthly number of mammograms per machine per full-time equivalent increased by 17% from 192.9 (95% confidence interval: 182.7–203.1) to 225.7 (95% CI 218.3–233.0); however, there was marked heterogeneity across these sites. A pooled analysis for all sites revealed that there was no statistically significantly change in the proportion of diagnostic mammograms performed after transition. Conclusions Increases in throughput volumes were observed only in some sites, suggesting unmeasured site-specific factors may have limited the potential for improvement. Interrupted time series methods are an appropriate and meaningful approach for evaluating technology and procedure changes in diagnostic imaging.

To develop a breast cancer risk model to identify women at mammographic screening who are at higher risk of breast cancer within the general screening population. This retrospective nested case-control study used data from a population-based breast screening program (2009–2015). All women aged 40–75 diagnosed with screen-detected or interval breast cancer (n = 1882) were frequency-matched 3:1 on age and screen-year with women without screen-detected breast cancer (n = 5888). Image-derived risk factors from the screening mammogram (percent mammographic density [PMD], breast volume, age) were combined with core biopsy history, first-degree family history, and other clinical risk factors in risk models. Model performance was assessed using the area under the receiver operating characteristic curve (AUC). Classifiers assigning women to low- versus high-risk deciles were derived from risk models. Agreement between classifiers was assessed using a weighted kappa. The AUC was 0.597 for a risk model including only image-derived risk factors. The successive addition of core biopsy and family history significantly improved performance (AUC = 0.660, p

Schemes of arrangement are an important and flexible mechanism, which can be used to reorganise a company's capital. Schemes have undergone a renaissance over the last twenty years, particularly as a debt restructuring device in the aftermath of the 2008 financial crisis when companies and their advisors have needed to develop effective tools for dealing with financial distress. The COVID-19 pandemic has provided a further incentive for jurisdictions to ensure that they have an effective debt restructuring mechanism in place. Schemes have also become the mechanism of choice for recommended takeovers. This book performs a critical, contextual and comparative analysis of schemes and their uses, examines recent developments in this area, including the Corporate Insolvency and Governance Act 2020, and considers whether further reform is needed to ensure that schemes continue to develop as an indispensable tool for companies for the future.

It is common for contracts to include a clause that provides that on an event of default the counterparty has an unconditional right to terminate the contract or accelerate payment (an ipso facto clause). The regulation of ipso facto clauses has become a topic of debate in recent years with a number of jurisdictions introducing constraints on such clauses as part of broader restructuring reform packages. These jurisdictions include Germany in 2021 (as part of its implementation of the EU Restructuring Directive) and the United Kingdom in 2020. For jurisdictions introducing such constraints for the first time, there is much to learn from those, such as Canada, that have had constraints on ipso facto clauses in place for much longer. This article examines the experience in Canada alongside the constraints introduced in the United Kingdom, the EU Restructuring Directive and Germany, and identifies a series of steps that policymakers should follow when revising a regime on ipso facto clauses. Although there are a number of common themes that emerge, it is clear that different jurisdictions often make quite distinct policy choices regarding the rationale for any constraints on ipso facto clauses as well as on the specific nature and scope of the provisions. Different jurisdictions find different points of balance between the interests of individual creditors in upholding their freedom of contract and the rights of the debtor and creditors as a whole in preserving the business as a going concern. The range of choices is not per se problematic as long as they are implemented with clarity and transparency, so that debtors and creditors can bargain ex ante in the light of any legislative provisions.

Pleckstrin homology (PH) domains are common modules of ∼120 amino acids found in proteins involved in signalling, cytoskeletal organization, membrane transport, and modification of phospholipids. Previous live cell studies have involved the use of the green-fluorescent protein (GFP) labelling of PH-domain of phospholipase C δ1 (PLC δ1) to study the interactions of molecules at the membrane interface.For this study, the aim was to construct and express the GFP-PH domain of PLC δ1 in the Saccharomyces cerevisiae BY4741. The transformants expressing GFP-PH domain of PLC δ1 displayed localised fluorescence to the cell periphery (plasma membrane) while the negative control expressed GFP within the cytoplasm only. No GFP was observed in the non-transformed yeast cells.Thus, this technique could be useful in future molecular interactions studies targeted specifically at the yeast cell membrane interface in live yeast cells.

Objective: We examined nonsystematic adverse events (AEs) in Part 2 (of 2) of a study describing the assessment and reporting AEs in clinical trials. Study Design and Setting: We examined 21 trials of gabapentin for neuropathic pain (52 sources) and seven trials of quetiapine for bipolar depression (80 sources) using data from the Multiple Data Sources study. We extracted and compared information about nonsystematic AEs (i.e., AEs that were not assessed for every participant), including AEs categorized as “serious.” We recorded whether AEs were grouped by anatomic or physiological system. Results: Trials of the same drug reported information about different AEs. Information in public sources was inadequate for decision-making. No public source reported all AEs, or all serious AEs, identified in nonpublic sources about the same trial. Of trials with only public sources, 2/15 (13%) gabapentin and 0/3 (0%) quetiapine trials grouped AEs by anatomic or physiological system. Conclusion: Public sources contained little information about nonsystematic AEs, including serious AEs. Grouping might make nonsystematic AEs easier to detect; however, most public sources did not report grouped AEs. Standards are needed to improve the collection and reporting of nonsystematic AEs so that stakeholders can use trials to assess the balance of potential benefits and harms.

Many jurisdictions have recently introduced reforms to their debt restructuring regimes in order to ensure that financially distressed but viable companies have effective tools to facilitate their rescue. The COVID-19 pandemic has intensified the need for such tools. The inclusion of a statutory stay is a consistent feature in these reforms. This article examines the introduction of a restructuring moratorium in the UK as part of its recent debt restructuring reforms, introduced by the Corporate Insolvency and Governance Act 2020. While moratoria can be potentially very valuable in promoting the rescue of a company or business, a balance is required between the benefits to the company and the creditors as a whole on the one hand and the rights of the individual creditors on the other. The success of the UK’s restructuring moratorium in achieving a successful balance is assessed. Ultimately it is argued that the necessary balance does not seem to have been achieved and that the constraints and limitations placed on the moratorium, for creditor protection and other reasons, limit the potential value of this mechanism to a significant extent. Many companies will therefore have to continue to look elsewhere for protection from creditors seeking to disrupt their restructurings.

Highlights • Epidemiologists play a large role in the public health response to COVID-19. • This role includes research into questions of health policy and practice. • Epidemiologists are trained to promote methodological rigor in research. • This training can help reduce research waste and counter misinformation.

Background: Mood and physical symptoms related to the menstrual cycle greatly affect women’s productivity at work and often lead to absenteeism. However, employer-led initiatives to tackle these issues are lacking. Digital health interventions focused on women’s health (such as the Flo mobile phone app) could help fill this gap given their anonymity, scalability and accessibility. Objective: We aimed to 1) measure the impact of disturbances related to the menstrual cycle on work-related productivity in users of the Flo app; 2) characterize levels of support and benefits women receive in the workplace and 3) explore whether the Flo app could help mitigate the impact of issues related to the menstrual cycle on productivity and absenteeism. Methods: 1867 users of the Flo app participated in a survey exploring 1) the extent to which their menstrual cycle negatively impacts their workplace productivity, including whether menstrual cycle-related symptoms led to absence from work in the previous 12 months; 2) whether Flo users feel supported by their manager and whether they receive specific benefits regarding issues related to their cycle and 3) the role of Flo in the management of menstrual cycle symptoms, preparedness, bodily awareness, openness with others, perceived support and mood.Results: The majority of Flo users reported a moderate to severe impact of their cycle on workplace productivity. 45.2% of the respondents reported absenteeism, with an average of 5.8 days of work missed due to their cycle. 48.4% reported not receiving any support from their manager and 94.6% said they were not provided with any specific benefit for issues related to their menstrual cycle. 75.6% declared they want such benefits. Users stated that the Flo app helped them with the management of menstrual cycle symptoms (68.7%), preparedness and bodily awareness (88.7%), openness with others (52.5%) and feeling supported (77.6%). Furthermore, users who reported the most positive impact of the Flo app were 18-25% less likely to report an impact of their menstrual cycle on their productivity and 12-18% less likely to take days off work for issues related to their cycle.Conclusions: The menstrual cycle can have a significant effect on workplace productivity and absenteeism, and resources available to employees are scarce. Digital health apps, such as the Flo app, could equip individuals with tools to better cope with issues related to their menstrual cycle and facilitate discussions around menstrual health in the workplace.

Since the inception of the European project, the creation of a single financial market has been a core policy goal. The ambition of the project subsequently expanded to include both economic and monetary union (EMU), a plan which came to fruition with the establishment of a single currency for euro area countries at the turn of the century. EMU has been said to be a ‘cornerstone of the European Union’, and may be regarded as a political as much as an economic endeavour.

The Diabetes Care Program of Nova Scotia (DCPNS)‘s mission is “to improve, through leadership and partnerships, the health of Nova Scotians living with, affected by, or at risk of developing diabetes.” Working together with local, provincial and national partners, the DCPNS has improved and standardized diabetes care in Nova Scotia over the past 25 years by developing and deploying a resourceful and collaborative program model. This article describes the model and highlights its key achievements. With balanced representation from frontline providers through to senior decision makers in health care, the DCPNS works across the age continuum, supporting the implementation of national clinical practice guidelines and, when necessary, developing provincial guidelines to meet local needs. The development and implementation of standardized documentation and data collection tools in all diabetes centres created a robust opportunity for the development and expansion of the DCPNS registry. This registry provides useful clinical and statistical information to staff, providers within the circle of care, management and senior leadership. Data are used to support individual care, program planning, quality improvement and business planning at both the local and the provincial levels. The DCPNS supports the sharing of new knowledge and advances through continuous education for providers. The DCPNS's ability to engage diabetes educators and key physician champions has ensured balanced perspectives in the creation of tools and resources that can be effective in real-world practice. The DCPNS has evolved to become an illustrative example of the chronic care model in action.

The European Commission published a draft Directive in November 2016, with the aim of ensuring that all Member States have in place an effective mechanism for dealing with viable, but financially distressed, businesses. The draft Directive includes provisions designed to encourage financing for the debtor company, both interim financing to “keep the lights on” for a brief period while the debtor negotiates with its creditors for a resolution to its financial distress, and where possible, to finance implementation of a restructuring plan, called “new financing” in the draft Directive. Creating such a financing regime is a complex and difficult issue, as the law’s intervention in this area often involves constraints on the rights of existing creditors, requiring that a careful balance is maintained between existing creditors’ rights and the rights of the interim financier. This paper examines the underlying policy rationale and benefits of having new and interim financing available to financially distressed debtor companies, and discusses the risks involved. It examines the EU Commission’s proposals in light of the experience of jurisdictions that have already tackled these issues, notably the United States and Canada, or have developed a market-based solution to this problem, such as the UK. While the European Commission’s wish to include such measures in its restructuring proposals is laudable, the measures as drafted raise concerns, particularly regarding risks associated with priority for the grantors of such finance. The authors suggest that there are four fundamental aspects of such financing on which the Directive could give guidance to Member States, namely, effective notice to pre-filing creditors, thresholds for the debtor to qualify, a menu of relevant criteria to balance benefit and prejudice, and a role for the court in resolving disputes, ensuring fairness to stakeholders, and serving as an accountability check on interim financing arrangements, all aimed at maintaining the integrity of the insolvency process.

Stroke is a complex disorder that challenges healthcare systems. An audit of in-hospital stroke care in the province of Nova Scotia, Canada, in 2004–2005 indicated that many aspects of care delivery fell short of national best practice recommendations. Stroke care in Nova Scotia was reorganised using a combination of interventions to facilitate systems change and quality improvement. The focus was mainly on implementing evidence-based stroke unit care, augmenting thrombolytic therapy and enhancing dysphagia assessment. Key were the development of a provincial network to facilitate ongoing collaboration and structured information exchange, the creation of the stroke coordinator and stroke physician champion roles, and the implementation of a registry to capture information about adults hospitalised because of stroke or transient ischaemic attack. To evaluate the interventions, a longitudinal analysis compared the audit results with registry data for 2012, 2015 and 2019. The proportion of patients receiving multidisciplinary stroke unit care rose from 22.4% in 2005 to 74.0% in 2019. The proportion of patients who received alteplase increased steadily from 3.2% to 18.5%, and the median delay between hospital arrival and alteplase administration decreased from 102 min to 56 min, without an increase in intracranial haemorrhage. Dysphagia screening increased from 41.4% to 77.4%. More patients were transferred from acute care to a dedicated in-patient rehabilitation unit, and fewer were discharged to residential or long-term care. These enhancements did not prolong length-of-stay in acute care. The network was a critical success factor; competing priorities in the healthcare system were the main challenge to implementing change. A multidimensional, multiyear, improvement intervention yielded substantial and sustained improvements in the process and structure of stroke care in Nova Scotia.

Shareholders’ duties can arise in a number of ways: by agreement between the shareholders contractually; by agreement via the company’s constitution, and by imposition of law, whether that is by way of legislation or a judicial decision. Effective remedies are needed if these duties are not fulfilled, in order to deter non-compliance, and to provide compensation where relevant. This chapter will discuss the benefits of financial sanctions as a remedy for breach of shareholders’ duties and explore the availability and likelihood of financial sanctions where such duties are breached. Actions by other shareholders for breach of duty (whether via contractual claims or otherwise) will be compared and contrasted with potential actions by regulators. It will be argued that financial sanctions can be a useful weapon in the armoury of those faced with the possibility of a breach of shareholders’ duties.

In their report of 10 December 2018, the Canadian Task Force on Preventive Health Care gave a lukewarm endorsement of screening mammography.[...]

BACKGROUND: Guidelines aimed at improving care for lung cancer, the leading cause of cancer-related death in Canada and worldwide, require accurate knowledge of the diagnostic setting or pathway. We sought to determine how often lung cancer is initially diagnosed through the emergency department. METHODS: We performed a descriptive study that included all cases of primary lung cancer diagnosed in residents of Nova Scotia in 2014. Cancer registry data included diagnostic data and date of death to Aug. 31, 2016. We reviewed linked hospital records, including laboratory and imaging results, to identify the first positive diagnostic study and the route of presentation (emergency department v. other). We evaluated time from diagnosis to death as a function of presentation route using Kaplan–Meier curves and Cox regression (hazard rate ratios [HRRs]). RESULTS: Sufficient data were available for 946 of 951 cases identified, of which 336 (35.5%) were diagnosed through the emergency department. Cases diagnosed via the emergency department were more likely to be at an advanced stage (stage IV, 59.5% v. 43.4%), with patients experiencing shorter survival (1-yr survival, 28.4% v. 49.5%), including stage-specific survival. Mortality for cases diagnosed in the emergency department was 54% higher than for the non–emergency department group after adjusting for age and stage (HRR 1.54, 95% confidence interval 1.32–1.81). Few patients (7.1%, n = 24) who presented to the emergency department reported having no family physician. INTERPRETATION: The emergency department is a common route of presentation for lung cancer and is associated with advanced stage at diagnosis and reduced survival time. Strategies are needed to encourage pre-emergent diagnosis and to ensure that emergency providers are supported in the initial care of patients with lung cancer.