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Objectives: Chronic back pain (CBP) can lead to disability and burden. In addition to its medical causes, its development is influenced by psychosocial risk factors, the so-called flag factors, which are categorized and integrated into many treatment guidelines. Currently, most studies investigate single flag factors, which limit the estimation of individual factor significance in the development of chronic pain. Furthermore, factors concerning patients’ lifestyle, biography and treatment history are often neglected. Therefore, the objectives of the present study are to identify commonly neglected factors of CBP and integrate them into an analysis model comparing their significance with established flag factors.
Methods: A total of 24 patients and therapists were cross-sectionally interviewed to identify commonly neglected factors of CBP. Subsequently, the impact of these factors was surveyed in a longitudinal study. In two rehabilitation clinics, CBP patients (n = 145) were examined before and 6 months after a 3-week inpatient rehabilitation. Outcome variables, chronification factor pain experience (CF-PE) and chronification factor disability (CF-D), were ascertained with confirmatory factor analysis (CFA) of standardized questionnaires. Predictors were evaluated using stepwise calculations of simple and multiple regression models.
Results: Through interviews, medical history, iatrogenic factors, poor compliance, critical life events (LEs), social support (SS) type and effort–reward were identified as commonly neglected factors. However, only the final three held significance in comparison to established factors such as depression and pain-related cognitions. Longitudinally, lifestyle factors found to influence future pain were initial pain, physically demanding work, nicotine consumption, gender and rehabilitation clinic. LEs were unexpectedly found to be a strong predictor of future pain, as were the protective factors, reward at work and perceived SS.
Discussion: These findings shed insight regarding often overlooked factors in the development of CBP, suggesting that more detailed operationalization and superordinate frameworks would be beneficial to further research.
Conclusion: In particular, LEs should be taken into account in future research. Protective factors should be integrated in therapeutic settings.
Reward expectation and affective responses across psychiatric disorders - A dimensional approach
(2014)
Processing of reward is the basis of adaptive behavior of the human being. Neural correlates of reward processing seem to be influenced by developmental changes from adolescence to late adulthood. The aim of this study is to uncover these neural correlates during a slot machine gambling task across the lifespan. Therefore, we used functional magnetic resonance imaging to investigate 102 volunteers in three different age groups: 34 adolescents, 34 younger adults, and 34 older adults. We focused on the core reward areas ventral striatum (VS) and ventromedial prefrontal cortex (VMPFC), the valence processing associated areas, anterior cingulate cortex (ACC) and insula, as well as information integration associated areas, dorsolateral prefrontal cortex (DLPFC), and inferior parietal lobule (IPL). Results showed that VS and VMPFC were characterized by a hyperactivation in adolescents compared with younger adults. Furthermore, the ACC and insula were characterized by a U-shape pattern (hypoactivation in younger adults compared with adolescents and older adults), whereas the DLPFC and IPL were characterized by a J-shaped form (hyperactivation in older adults compared with younger groups). Furthermore, a functional connectivity analysis revealed an elevated negative functional coupling between the inhibition-related area rIFG and VS in younger adults compared with adolescents. Results indicate that lifespan-related changes during reward anticipation are characterized by different trajectories in different reward network modules and support the hypothesis of an imbalance in maturation of striatal and prefrontal cortex in adolescents. Furthermore, these results suggest compensatory age-specific effects in fronto-parietal regions. Hum Brain Mapp 35:5153-5165, 2014. (c) 2014 Wiley Periodicals, Inc.
Midbrain dopamine neurons invigorate responses by signaling opportunity costs (tonic dopamine) and promote associative learning by encoding a reward prediction error signal (phasic dopamine). Recent studies on Bayesian sensorimotor control have implicated midbrain dopamine concentration in the integration of prior knowledge and current sensory information. The present behavioral study addressed the contributions of tonic and phasic dopamine in a Bayesian decision-making task by alternating reward magnitude and inferring reward prediction errors. Twenty-four participants were asked to indicate the position of a hidden target stimulus under varying prior and likelihood uncertainty. Trial-by-trial rewards were allocated based on performance and two different reward maxima. Overall, participants’ behavior agreed with Bayesian decision theory, but indicated excessive reliance on likelihood information. These results thus
oppose accounts of statistically optimal integration in sensorimotor control, and suggest that the sensorimotor system is subject to additional decision heuristics. Moreover, higher reward magnitude was not observed to induce enhanced response vigor, and was associated with less Bayes-like integration. In addition, the weighting of prior knowledge and current sensory information proceeded independently of reward prediction errors.
Taken together, these findings suggest that the process of combining prior and likelihood uncertainties in sensorimotor control is largely robust to variations in reward.
Background
Millions of people in Germany suffer from chronic pain, in which course and intensity are multifactorial. Besides physical injuries, certain psychosocial risk factors are involved in the disease process. The national health care guidelines for the diagnosis and treatment of non-specific low back pain recommend the screening of psychosocial risk factors as early as possible, to be able to adapt the therapy to patient needs (e.g., unimodal or multimodal). However, such a procedure has been difficult to implement in practice and has not yet been integrated into the rehabilitation care structures across the country.
Methods
The aim of this study is to implement an individualized therapy and aftercare program within the rehabilitation offer of the German Pension Insurance in the area of orthopedics and to examine its success and sustainability in comparison to the previous standard aftercare program.
The study is a multicenter randomized controlled trial including 1204 patients from six orthopedic rehabilitation clinics. A 2:1 allocation ratio to intervention (individualized and home-based rehabilitation aftercare) versus the control group (regular outpatient rehabilitation aftercare) is set. Upon admission to the rehabilitation clinic, participants in the intervention group will be screened according to their psychosocial risk profile. They could then receive either unimodal or multimodal, together with an individualized training program. The program is instructed in the clinic (approximately 3 weeks) and will continue independently at home afterwards for 3 months. The success of the program is examined by means of a total of four surveys. The co-primary outcomes are the Characteristic Pain Intensity and Disability Score assessed by the German version of the Chronic Pain Grade questionnaire (CPG).
Discussion
An improvement in terms of pain, work ability, patient compliance, and acceptance in our intervention program compared to the standard aftercare is expected. The study contributes to provide individualized care also to patients living far away from clinical centers.
Trial registration
DRKS, DRKS00020373. Registered on 15 April 2020
Background
Millions of people in Germany suffer from chronic pain, in which course and intensity are multifactorial. Besides physical injuries, certain psychosocial risk factors are involved in the disease process. The national health care guidelines for the diagnosis and treatment of non-specific low back pain recommend the screening of psychosocial risk factors as early as possible, to be able to adapt the therapy to patient needs (e.g., unimodal or multimodal). However, such a procedure has been difficult to implement in practice and has not yet been integrated into the rehabilitation care structures across the country.
Methods
The aim of this study is to implement an individualized therapy and aftercare program within the rehabilitation offer of the German Pension Insurance in the area of orthopedics and to examine its success and sustainability in comparison to the previous standard aftercare program.
The study is a multicenter randomized controlled trial including 1204 patients from six orthopedic rehabilitation clinics. A 2:1 allocation ratio to intervention (individualized and home-based rehabilitation aftercare) versus the control group (regular outpatient rehabilitation aftercare) is set. Upon admission to the rehabilitation clinic, participants in the intervention group will be screened according to their psychosocial risk profile. They could then receive either unimodal or multimodal, together with an individualized training program. The program is instructed in the clinic (approximately 3 weeks) and will continue independently at home afterwards for 3 months. The success of the program is examined by means of a total of four surveys. The co-primary outcomes are the Characteristic Pain Intensity and Disability Score assessed by the German version of the Chronic Pain Grade questionnaire (CPG).
Discussion
An improvement in terms of pain, work ability, patient compliance, and acceptance in our intervention program compared to the standard aftercare is expected. The study contributes to provide individualized care also to patients living far away from clinical centers.
Trial registration
DRKS, DRKS00020373. Registered on 15 April 2020
The purpose of this study was to examine the test-retest reliability, and convergent and discriminative validity of a new taekwondo-specific change-of-direction (COD) speed test with striking techniques (TST) in elite taekwondo athletes. Twenty (10 males and 10 females) elite (athletes who compete at national level) and top-elite (athletes who compete at national and international level) taekwondo athletes with an average training background of 8.9 ± 1.3 years of systematic taekwondo training participated in this study. During the two-week test-retest period, various generic performance tests measuring COD speed, balance, speed, and jump performance were carried out during the first week and as a retest during the second week. Three TST trials were conducted with each athlete and the best trial was used for further analyses. The relevant performance measure derived from the TST was the time with striking penalty (TST-TSP). TST-TSP performances amounted to 10.57 ± 1.08 s for males and 11.74 ± 1.34 s for females. The reliability analysis of the TST performance was conducted after logarithmic transformation, in order to address the problem of heteroscedasticity. In both groups, the TST demonstrated a high relative test-retest reliability (intraclass correlation coefficients and 90% compatibility limits were 0.80 and 0.47 to 0.93, respectively). For absolute reliability, the TST’s typical error of measurement (TEM), 90% compatibility limits, and magnitudes were 4.6%, 3.4 to 7.7, for males, and 5.4%, 3.9 to 9.0, for females. The homogeneous sample of taekwondo athletes meant that the TST’s TEM exceeded the usual smallest important change (SIC) with 0.2 effect size in the two groups. The new test showed mostly very large correlations with linear sprint speed (r = 0.71 to 0.85) and dynamic balance (r = −0.71 and −0.74), large correlations with COD speed (r = 0.57 to 0.60) and vertical jump performance (r = −0.50 to −0.65), and moderate correlations with horizontal jump performance (r = −0.34 to −0.45) and static balance (r = −0.39 to −0.44). Top-elite athletes showed better TST performances than elite counterparts. Receiver operating characteristic analysis indicated that the TST effectively discriminated between top-elite and elite taekwondo athletes. In conclusion, the TST is a valid, and sensitive test to evaluate the COD speed with taekwondo specific skills, and reliable when considering ICC and TEM. Although the usefulness of the TST is questioned to detect small performance changes in the present population, the TST can detect moderate changes in taekwondo-specific COD speed.
The purpose of this study was to examine the test-retest reliability, and convergent and discriminative validity of a new taekwondo-specific change-of-direction (COD) speed test with striking techniques (TST) in elite taekwondo athletes. Twenty (10 males and 10 females) elite (athletes who compete at national level) and top-elite (athletes who compete at national and international level) taekwondo athletes with an average training background of 8.9 ± 1.3 years of systematic taekwondo training participated in this study. During the two-week test-retest period, various generic performance tests measuring COD speed, balance, speed, and jump performance were carried out during the first week and as a retest during the second week. Three TST trials were conducted with each athlete and the best trial was used for further analyses. The relevant performance measure derived from the TST was the time with striking penalty (TST-TSP). TST-TSP performances amounted to 10.57 ± 1.08 s for males and 11.74 ± 1.34 s for females. The reliability analysis of the TST performance was conducted after logarithmic transformation, in order to address the problem of heteroscedasticity. In both groups, the TST demonstrated a high relative test-retest reliability (intraclass correlation coefficients and 90% compatibility limits were 0.80 and 0.47 to 0.93, respectively). For absolute reliability, the TST’s typical error of measurement (TEM), 90% compatibility limits, and magnitudes were 4.6%, 3.4 to 7.7, for males, and 5.4%, 3.9 to 9.0, for females. The homogeneous sample of taekwondo athletes meant that the TST’s TEM exceeded the usual smallest important change (SIC) with 0.2 effect size in the two groups. The new test showed mostly very large correlations with linear sprint speed (r = 0.71 to 0.85) and dynamic balance (r = −0.71 and −0.74), large correlations with COD speed (r = 0.57 to 0.60) and vertical jump performance (r = −0.50 to −0.65), and moderate correlations with horizontal jump performance (r = −0.34 to −0.45) and static balance (r = −0.39 to −0.44). Top-elite athletes showed better TST performances than elite counterparts. Receiver operating characteristic analysis indicated that the TST effectively discriminated between top-elite and elite taekwondo athletes. In conclusion, the TST is a valid, and sensitive test to evaluate the COD speed with taekwondo specific skills, and reliable when considering ICC and TEM. Although the usefulness of the TST is questioned to detect small performance changes in the present population, the TST can detect moderate changes in taekwondo-specific COD speed.
This study investigated associations between variables of trunk muscle strength (TMS), spinal mobility, and balance in seniors. Thirty-four seniors (sex: 18 female, 16 male; age: 70 +/- 4 years; activity level: 13 +/- 7 hr/week) were tested for maximal isometric strength (MIS) of the trunk extensors, flexors, lateral flexors, rotators, spinal mobility, and steady-state, reactive, and proactive balance. Significant correlations were detected between all measures of TMS and static steady-state balance (r = .43.57, p < .05). Significant correlations were observed between specific measures of TMS and dynamic steady-state balance (r = .42.55, p < .05). No significant correlations were found between all variables of TMS and reactive/proactive balance and between all variables of spinal mobility and balance. Regression analyses revealed that TMS explains between 1-33% of total variance of the respective balance parameters. Findings indicate that TMS is related to measures of steady-state balance which may imply that TMS promoting exercises should be integrated in strength training for seniors.
Finger-based numerical representations have gained increasing research interest. However, their description and assessment often refer to different numerical principles of ordinality, cardinality and 1-to-1 correspondence. Our aim was to investigate similarities and differences between these principles in finger-based numerical representations. Sixty-eight healthy adults performed ordinal finger counting, cardinal finger montring (showing the number of gestures) and finger-to-number mapping with twisted arms and fingers. We found that counting gestures and montring postures were identical for Number 10 but differed to varying degrees for other numbers. Interestingly, there was no systematic relation between finger-to-number mapping and ordinal finger counting habits. These data question the assumption of a unitary embodied finger-based numerical representation, but suggest that different finger-based representations co-exist and can be recruited flexibly depending on the numerical aspects to be conveyed.
Referential Coding Does Not Rely on Location Features: Evidence for a Nonspatial Joint Simon Effect
(2015)
The joint Simon effect (JSE) shows that the presence of another agent can change one's representation of one's task and/or action. According to the spatial response coding approach, this is because another person in one's peri-personal space automatically induces the spatial coding of one's own action, which in turn invites spatial stimulus-response priming. According to the referential coding approach, the presence of another person or event creates response conflict, which the actor is assumed to solve by emphasizing response features that discriminate between one's own response and that of the other. The 2 approaches often make the same predictions, but the spatial response coding approach considers spatial location as the only dimension that can drive response coding, whereas the referential coding approach allows for other dimensions as well. To compare these approaches, the authors ran 2 experiments to see whether a nonspatial JSE can be demonstrated. Participants responded to the geometrical shape of a central colored stimulus by pressing a left or right button, while wearing gloves of the same or different color as the stimuli. Participants performed the task individually, either by responding to either stimulus shapes (Experiment 1) or by responding to only 1 of the 2 shapes (Experiment 2), and in the presence of a coactor. Congruence between stimulus and glove color affected performance in the 2-choice and the joint tasks but not in the individual go/no-go task. This demonstration of a nonspatial JSE is inconsistent with the spatial response coding approach but supports the referential coding approach.
Understanding the development of spoken language in young children has become increasingly important for advancing basic theories of language acquisition and for clinical practice. However, such a goal requires refined measurements of speech articulation (e.g., from the tongue), which are difficult to obtain from young children. In recent years though, technological advances have allowed developmental researchers to make significant steps in that direction. For instance, movements of the tongue, an articulator that is essential for spoken language, can now be tracked and recorded in children with ultrasound imaging. This technique has opened novel research avenues in (a)typical language acquisition, enabling researchers to reliably capture what has long remained invisible in the speech of young children. Within this context, we have designed an experimental platform for the recording and the processing of kinematic data: SOLLAR (Sonographic and Optical Linguo-Labial Articulatory Recording system). The method has been tailored for children, but it is suitable for adults. In the present article, we introduce the recording environment developed to record over 100 children and 30 adults within SOLLAR. We then describe SOLLAR’s data processing framework, providing examples of data visualization and a summary of strengths and limitations.
Understanding the development of spoken language in young children has become increasingly important for advancing basic theories of language acquisition and for clinical practice. However, such a goal requires refined measurements of speech articulation (e.g., from the tongue), which are difficult to obtain from young children. In recent years though, technological advances have allowed developmental researchers to make significant steps in that direction. For instance, movements of the tongue, an articulator that is essential for spoken language, can now be tracked and recorded in children with ultrasound imaging. This technique has opened novel research avenues in (a)typical language acquisition, enabling researchers to reliably capture what has long remained invisible in the speech of young children. Within this context, we have designed an experimental platform for the recording and the processing of kinematic data: SOLLAR (Sonographic and Optical Linguo-Labial Articulatory Recording system). The method has been tailored for children, but it is suitable for adults. In the present article, we introduce the recording environment developed to record over 100 children and 30 adults within SOLLAR. We then describe SOLLAR’s data processing framework, providing examples of data visualization and a summary of strengths and limitations.
Die nun begonnene Reihe „studieren++“ resultiert aus einer von der Universität Potsdam angebotenen Vorlesungsreihe. Das Besondere an dieser Vorlesungsreihe ist der multidisziplinäre Anspruch und die konsequent umgesetzte Zusammenarbeit über Disziplingrenzen hinweg. Die nicht nur über Instituts-, sondern über Fakultätsgrenzen praktizierte Interdisziplinarität erlaubt die Betrachtung eines Problems oder Sachverhalts aus unterschiedlichen Blickwinkeln. Wissenschaftliche Fragestellungen sind komplex und nicht immer auf eine Disziplin beschränkt. Sie in ihrer Gänze erfassen und nachhaltige Lösungsstrategien oder Konzepte entwickeln zu können gelingt oft nur durch eine multidisziplinäre Kooperation. Eine Lehrveranstaltung wie die vorliegende ist nicht nur für die Studierenden einer Universität eine hervorragende Möglichkeit, um über die Grenzen der eigenen Disziplin hinaus zu blicken und die Zusammenarbeit mit Wissenschaftlerinnen und Wissenschaftlern aus anderen Bereichen zu pflegen. So lernt man, sich in andere Sichtweisen hineinzuversetzen und sich zwischen den Disziplinen zu bewegen – eine Kompetenz, die in der hochkomplexen Arbeitswelt von heute von hohem Nutzen ist.
Der vorliegende erste Band der Reihe hat „Raum und Zahl“ zum Thema und ist aus einer Ringvorlesung aus dem Wintersemester 2013/2014 entstanden. Drei der fünf Fakultäten, insgesamt neun Institute der Universität Potsdam, haben sich an der Vorlesung beteiligt und sich dieses spannenden Themas angenommen. Als jemand, der sich jahrelang wissenschaftlich mit algorithmischer Geometrie sowie mit raumbezogenen Datenbanken und Navigationssystemen beschäftigt hat, kann ich nur bekräftigen, dass die Bezüge zwischen Raum und Zahl, zwischen Räumen und Zahlen, noch viel stärker im öffentlichen Bewusstsein verankert gehören. Räume auch quantitativ zu erfassen und zu verstehen ist eine Kulturtechnik, die an Wichtigkeit eher noch zunimmt, vor allem vor dem Hintergrund, dass wir genetisch nicht allzu gut auf derartige Herausforderungen vorbereitet sind. Denn viele unserer einschlägigen Gene entstammen noch aus der Zeit der Savanne, einer Zeit, zu der das Raumkonzept sich fast ausschließlich auf die unmittelbare räumliche Umgebung bezog und Zahlen jenseits von 10 nur wenig Relevanz für das eigene Überleben hatten.
Als Präsident der Universität Potsdam freut es mich ganz besonders, dass sich die hier vertretenen Wissenschaftler bereit erklärt haben, ihre Überlegungen mit den Studierenden und ihren Kolleginnen und Kollegen zu teilen. Herrn Kollegen Hans-Joachim Petsche möchte ich für sein Engagement danken und ihm zu dieser gelungenen Reihe gratulieren. Der Geist der Wissenschaft, der nicht nur einsam im Büro oder Labor gelebt wird, sondern gerade an einer Universität auch aktiv nach außen getragen werden sollte, wird hier in besonderer Weise sichtbar. Ich wünsche Ihnen viel Freude bei der Lektüre des Bandes und freue mich auf weitere Veröffentlichungen in dieser Reihe.
Stress-levels experienced by school-aged elite athletes are pronounced, but data on their mental health status are widely lacking. In our study, we examined self-reported psychological symptoms and chronic mood. Data from a representative sample of 866 elite student-athletes (aged 12-15 years), enrolled in high-performance sport programming in German Elite Schools of Sport, were compared with data from 80 student-athletes from the same schools who have just been deselected from elite sport promotion, and from 432 age-and sex-matched non-sport students from regular schools (without such programming). Anxiety symptoms were least prevalent in female elite student-athletes. In male elite student-athletes, only symptoms of posttraumatic stress were less prevalent than in the other groups. Somatoform symptoms were generally more frequent in athletes, a trend that was significantly pronounced in deselected athletes. Deselected athletes showed an increased risk for psychological symptoms compared with both other groups. Regarding chronic mood, again deselected athletes showed less positive scores. While there was a trend toward high-performance sport being associated with better psychological health at least in girls, preventative programs should take into account that deselection from elite sport programming may be associated with specific risks for mental disorders.
Ziel ist die Überprüfung der kurz- und mittelfristigen Wirksamkeit einer vorschulischen Förderung des Mengen- und Zahlenverständnisses bei Kindern mit einem Risiko für die Entwicklung einer Rechenstörung. Es wurden 32 Risikokinder mit einer Kombination aus den Förderprogrammen Mathematik im Vorschulalter und Mengen, zählen, Zahlen im letzten Kindergartenjahr von den Erzieherinnen trainiert und mit 38 untrainierten Risikokindern verglichen. Hinsichtlich der kurzfristigen Wirksamkeit zeigten sich positive Trainingseffekte auf die numerischen Leistungen im letzten Kindergartenjahr. Es ließen sich keine signifikanten mittelfristigen Trainingseffekte auf die Rechenleistungen im zweiten Halbjahr der 1. Klasse finden. Das eingesetzte vorschulische Präventionsprogramm leistete danach einen wichtigen Beitrag zur kurzfristigen Verbesserung der mathematischen Basiskompetenzen.
Prosody and information status in typological perspective - Introduction to the Special Issue
(2015)
The aim of this review was to describe and summarize the scientific literature on programming parameters related to jump or plyometric training in male and female soccer players of different ages and fitness levels. A literature search was conducted in the electronic databases PubMed, Web of Science and Scopus using keywords related to the main topic of this study (e.g., “ballistic” and “plyometric”). According to the PICOS framework, the population for the review was restricted to soccer players, involved in jump or plyometric training. Among 7556 identified studies, 90 were eligible for inclusion. Only 12 studies were found for females. Most studies (n = 52) were conducted with youth male players. Moreover, only 35 studies determined the effectiveness of a given jump training programming factor. Based on the limited available research, it seems that a dose of 7 weeks (1–2 sessions per week), with ~80 jumps (specific of combined types) per session, using near-maximal or maximal intensity, with adequate recovery between repetitions (<15 s), sets (≥30 s) and sessions (≥24–48 h), using progressive overload and taper strategies, using appropriate surfaces (e.g., grass), and applied in a well-rested state, when combined with other training methods, would increase the outcome of effective and safe plyometric-jump training interventions aimed at improving soccer players physical fitness. In conclusion, jump training is an effective and easy-to-administer training approach for youth, adult, male and female soccer players. However, optimal programming for plyometric-jump training in soccer is yet to be determined in future research.
The aim of this review was to describe and summarize the scientific literature on programming parameters related to jump or plyometric training in male and female soccer players of different ages and fitness levels. A literature search was conducted in the electronic databases PubMed, Web of Science and Scopus using keywords related to the main topic of this study (e.g., “ballistic” and “plyometric”). According to the PICOS framework, the population for the review was restricted to soccer players, involved in jump or plyometric training. Among 7556 identified studies, 90 were eligible for inclusion. Only 12 studies were found for females. Most studies (n = 52) were conducted with youth male players. Moreover, only 35 studies determined the effectiveness of a given jump training programming factor. Based on the limited available research, it seems that a dose of 7 weeks (1–2 sessions per week), with ~80 jumps (specific of combined types) per session, using near-maximal or maximal intensity, with adequate recovery between repetitions (<15 s), sets (≥30 s) and sessions (≥24–48 h), using progressive overload and taper strategies, using appropriate surfaces (e.g., grass), and applied in a well-rested state, when combined with other training methods, would increase the outcome of effective and safe plyometric-jump training interventions aimed at improving soccer players physical fitness. In conclusion, jump training is an effective and easy-to-administer training approach for youth, adult, male and female soccer players. However, optimal programming for plyometric-jump training in soccer is yet to be determined in future research.
Purpose: Although subjective knowledge about the prognosis of an advanced disease is extremely important for coping and treatment planning, the concept of prognostic awareness (PA) remains inconsistently defined. The aims of the scoping review were to synthesize a definition of PA from the most recent literature, describe preconditions, correlates and consequences, and suggest a conceptual model.
Methods: By using scoping review methodology, we searched the Web of Science and PubMed databases, and included publications, reviews, meta-analyses or guidelines on all physical diagnoses, as well as publications offering a conceptual or an operational definition of PA. The data were analyzed by means of content analysis techniques.
Results: Of the 24 included publications, 21 referred exclusively to cancer, one to patients with hip fractures and two to palliative care in general. The deduced definition of PA comprised the following facets: adequate estimation of chances for recovery, knowledge of limited time to live, adequate estimation of life expectancy, knowledge of therapy goals, and knowledge of the course of the disease. Further content analysis results were mapped graphically and in a detailed table.
Conclusion: There appears to be a lack of theoretical embedding of PA that in turn influences the methods used for empirical investigation. Drawing on a clear conceptual definition, longitudinal or experimental studies would be desirable.
Purpose: Although subjective knowledge about the prognosis of an advanced disease is extremely important for coping and treatment planning, the concept of prognostic awareness (PA) remains inconsistently defined. The aims of the scoping review were to synthesize a definition of PA from the most recent literature, describe preconditions, correlates and consequences, and suggest a conceptual model.
Methods: By using scoping review methodology, we searched the Web of Science and PubMed databases, and included publications, reviews, meta-analyses or guidelines on all physical diagnoses, as well as publications offering a conceptual or an operational definition of PA. The data were analyzed by means of content analysis techniques.
Results: Of the 24 included publications, 21 referred exclusively to cancer, one to patients with hip fractures and two to palliative care in general. The deduced definition of PA comprised the following facets: adequate estimation of chances for recovery, knowledge of limited time to live, adequate estimation of life expectancy, knowledge of therapy goals, and knowledge of the course of the disease. Further content analysis results were mapped graphically and in a detailed table.
Conclusion: There appears to be a lack of theoretical embedding of PA that in turn influences the methods used for empirical investigation. Drawing on a clear conceptual definition, longitudinal or experimental studies would be desirable.
For life-long learning, an effective learning strategy repertoire is particularly important during acquisition of knowledge in lower secondary school—an educational level characterized with transition into more autonomous learning environments with increased complex academic demands. Using latent profile analysis, we explored the occurrence of different secondary school learner profiles depending on their various combinations of cognitive and metacognitive learning strategy use, as well as their differences in perceived autonomy support, intrinsic motivation, and gender. Data were collected from 576 ninth grade students in Uganda using self-report questionnaires. Four learner profiles were identified: competent strategy user, struggling user, surface-level learner, and deep-level learner profiles. Gender differences were noted in students’ use of elaboration and organization strategies to learn Physics, in favor of girls. In terms of profile memberships, significant differences in gender, intrinsic motivation and perceived autonomy support were also noted. Girls were 2.4–2.7 times more likely than boys to be members of the competent strategy user and surface-level learner profiles. Additionally, higher levels of intrinsic motivation predicted an increased likelihood membership into the deep-level learner profile, while higher levels of perceived teacher autonomy predicted an increased likelihood membership into the competent strategy user profile as compared to other profiles. Further, implications of the findings were discussed.
For life-long learning, an effective learning strategy repertoire is particularly important during acquisition of knowledge in lower secondary school—an educational level characterized with transition into more autonomous learning environments with increased complex academic demands. Using latent profile analysis, we explored the occurrence of different secondary school learner profiles depending on their various combinations of cognitive and metacognitive learning strategy use, as well as their differences in perceived autonomy support, intrinsic motivation, and gender. Data were collected from 576 ninth grade students in Uganda using self-report questionnaires. Four learner profiles were identified: competent strategy user, struggling user, surface-level learner, and deep-level learner profiles. Gender differences were noted in students’ use of elaboration and organization strategies to learn Physics, in favor of girls. In terms of profile memberships, significant differences in gender, intrinsic motivation and perceived autonomy support were also noted. Girls were 2.4–2.7 times more likely than boys to be members of the competent strategy user and surface-level learner profiles. Additionally, higher levels of intrinsic motivation predicted an increased likelihood membership into the deep-level learner profile, while higher levels of perceived teacher autonomy predicted an increased likelihood membership into the competent strategy user profile as compared to other profiles. Further, implications of the findings were discussed.
Recent studies have suggested that musical rhythm perception ability can affect the phonological system. The most prevalent causal account for developmental dyslexia is the phonological deficit hypothesis. As rhythm is a subpart of phonology, we hypothesized that reading deficits in dyslexia are associated with rhythm processing in speech and in music. In a rhythmic grouping task, adults with diagnosed dyslexia and age-matched controls listened to speech streams with syllables alternating in intensity, duration, or neither, and indicated whether they perceived a strong-weak or weak-strong rhythm pattern. Additionally, their reading and musical rhythm abilities were measured. Results showed that adults with dyslexia had lower musical rhythm abilities than adults without dyslexia. Moreover, lower musical rhythm ability was associated with lower reading ability in dyslexia. However, speech grouping by adults with dyslexia was not impaired when musical rhythm perception ability was controlled: like adults without dyslexia, they showed consistent preferences. However, rhythmic grouping was predicted by musical rhythm perception ability, irrespective of dyslexia. The results suggest associations among musical rhythm perception ability, speech rhythm perception, and reading ability. This highlights the importance of considering individual variability to better understand dyslexia and raises the possibility that musical rhythm perception ability is a key to phonological and reading acquisition.
Recent studies have suggested that musical rhythm perception ability can affect the phonological system. The most prevalent causal account for developmental dyslexia is the phonological deficit hypothesis. As rhythm is a subpart of phonology, we hypothesized that reading deficits in dyslexia are associated with rhythm processing in speech and in music. In a rhythmic grouping task, adults with diagnosed dyslexia and age-matched controls listened to speech streams with syllables alternating in intensity, duration, or neither, and indicated whether they perceived a strong-weak or weak-strong rhythm pattern. Additionally, their reading and musical rhythm abilities were measured. Results showed that adults with dyslexia had lower musical rhythm abilities than adults without dyslexia. Moreover, lower musical rhythm ability was associated with lower reading ability in dyslexia. However, speech grouping by adults with dyslexia was not impaired when musical rhythm perception ability was controlled: like adults without dyslexia, they showed consistent preferences. However, rhythmic grouping was predicted by musical rhythm perception ability, irrespective of dyslexia. The results suggest associations among musical rhythm perception ability, speech rhythm perception, and reading ability. This highlights the importance of considering individual variability to better understand dyslexia and raises the possibility that musical rhythm perception ability is a key to phonological and reading acquisition.
In a self-paced reading study on German sluicing, Paape (Paape, 2016) found that reading times were shorter at the ellipsis site when the antecedent was a temporarily ambiguous garden-path structure. As a post-hoc explanation of this finding, Paape assumed that the antecedent’s memory representation was reactivated during syntactic reanalysis, making it easier to retrieve. In two eye tracking experiments, we subjected the reactivation hypothesis to further empirical scrutiny. Experiment 1, carried out in French, showed no evidence in favor in the reactivation hypothesis. Instead, results for one out of the three types of garden-path sentences that were tested suggest that subjects sometimes failed to resolve the temporary ambiguity in the antecedent clause, and subsequently failed to resolve the ellipsis. The results of Experiment 2, a conceptual replication of Paape’s (Paape, 2016) original study carried out in German, are compatible with the reactivation hypothesis, but leave open the possibility that the observed speedup for ambiguous antecedents may be due to occasional retrievals of an incorrect structure.
In a self-paced reading study on German sluicing, Paape (Paape, 2016) found that reading times were shorter at the ellipsis site when the antecedent was a temporarily ambiguous garden-path structure. As a post-hoc explanation of this finding, Paape assumed that the antecedent’s memory representation was reactivated during syntactic reanalysis, making it easier to retrieve. In two eye tracking experiments, we subjected the reactivation hypothesis to further empirical scrutiny. Experiment 1, carried out in French, showed no evidence in favor in the reactivation hypothesis. Instead, results for one out of the three types of garden-path sentences that were tested suggest that subjects sometimes failed to resolve the temporary ambiguity in the antecedent clause, and subsequently failed to resolve the ellipsis. The results of Experiment 2, a conceptual replication of Paape’s (Paape, 2016) original study carried out in German, are compatible with the reactivation hypothesis, but leave open the possibility that the observed speedup for ambiguous antecedents may be due to occasional retrievals of an incorrect structure.
Processing negative imperatives in Bulgarian : evidence from normal, aphasic and child language
(2010)
The incremental nature of sentence processing raises questions about the way the information of incoming functional elements is accessed and subsequently employed in building the syntactic structure which sustains interpretation processes. The present work approaches these questions by investigating the negative particle ne used for sentential negation in Bulgarian and its impact on the overt realisation and the interpretation of imperative inflexion, bound aspectual morphemes and clitic pronouns in child, adult and aphasic language. In contrast to other Slavic languages, Bulgarian negative imperatives (NI) are grammatical only with imperfective verbs. We argue that NI are instantiations of overt aspectual coercion induced by the presence of negation as a temporally sensitive sentential operator. The scope relation between imperative mood, negation, and aspect yields the configuration of the imperfective present which in Bulgarian has to be overtly expressed and prompts the imperfective marking of the predicate. The regular and transparent application of the imperfectivising mechanism relates to the organisation of the TAM categories in Bulgarian which not only promotes the representation of fine perspective shifts but also provides for their distinct morphological expression. Using an elicitation task with NI, we investigated the way 3- and 4-year-old children represent negation in deontic contexts as reflected in their use of aspectually appropriate predicates. Our findings suggest that children are sensitive to the imperfectivity requirement in NI from early on. The imperfectivisation strategies reveal some differences from the target morphological realisation. The relatively low production of target imperfectivised prefixed verbs cannot be explained with morphological processing deficits, but rather indicates that up to the age of five children experience difficulties to apply a progressive view point to accomplishments. Two self-paced reading studies present evidence that neurologically unimpaired Bulgarian speakers profit from the syntactic and prosodic properties of negation during online sentence comprehension. The imperfectivity requirement negation imposes on the predicate speeds up lexical access to imperfective verbs. Similarly, clitic pronouns are more accessible after negation due to the phono-syntactic properties of clitic clusters. As the experimental stimuli do not provide external discourse referents, personal pronouns are parsed as object agreement markers. Without subsequent resolution, personal pronouns appear to be less resource demanding than reflexive clitics. This finding is indicative of the syntax-driven co-reference establishment processes triggered through the lexical specification of reflexive clitics. The results obtained from Bulgarian Broca's aphasics show that they exhibit processing patterns similar to those of the control group. Notwithstanding their slow processing speed, the agrammatic group showed no impairment of negation as reflected by their sensitivity to the aspectual requirements of NI, and to the prosodic constraints on clitic placement. The aphasics were able to parse the structural dependency between mood, negation and aspect as functional categories and to represent it morphologically. The prolonged reaction times (RT) elicited by prefixed verbs indicate increasing processing costs due to the semantic integration of prefixes as perfectivity markers into an overall imperfective construal. This inference is supported by the slower RT to reflexive clitics, which undergo a structurally triggered resolution. Evaluated against cross-linguistic findings, the obtained result strongly suggests that aphasic performance with pronouns depends on the interpretation efforts associated with co-reference establishment and varies due to availability of discourse referents. The investigation of normal and agrammatic processing of Bulgarian NI presents support for the hypothesis that the comprehension deficits in Broca's aphasia result from a slowed-down implementation of syntactic operations. The protracted structure building consumes processing resources and causes temporal mismatches with other processes sustaining sentence comprehension. The investigation of the way Bulgarian children and aphasic speakers process NI reveals that both groups are highly sensitive to the imperfective constraint on the aspectual construal imposed by the presence of negation. The imperfective interpretation requires access to morphologically complex verb forms which contain aspectual morphemes with conflicting semantic information – perfective prefixes and imperfective suffixes. Across modalities, both populations exhibit difficulties in processing prefixed imperfectivised verbs which as predicates of negative imperative sentences reflect the inner perspective the speaker and the addressee need to take towards a potentially bounded situation description.
Proceedings of KogWis 2010 : 10th Biannual Meeting of the German Society for Cognitive Science
(2010)
As the latest biannual meeting of the German Society for Cognitive Science (Gesellschaft für Kognitionswissenschaft, GK), KogWis 2010 at Potsdam University reflects the current trends in a fascinating domain of research concerned with human and artificial cognition and the interaction of mind and brain. The Plenary talks provide a venue for questions of the numerical capacities and human arithmetic (Brian Butterworth), of the theoretical development of cognitive architectures and intelligent virtual agents (Pat Langley), of categorizations induced by linguistic constructions (Claudia Maienborn), and of a cross-level account of the “Self as a complex system“ (Paul Thagard). KogWis 2010 integrates a wealth of experimental research, cognitive modelling, and conceptual analysis in 5 invited symposia, over 150 individual talks, 6 symposia, and more than 40 poster contributions. Some of the invited symposia reflect local and regional strenghts of research in the Berlin-Brandenburg area: the two largests research fields of the university Cognitive Sciences Area of Excellence in Potsdam are represented by an invited symposium on “Information Structure” by the Special Research Area 632 (“Sonderforschungsbereich”, SFB) of the same name, of Potsdam University and Humboldt-University Berlin, and by a satellite conference of the research group “Mind and Brain Dynamics”. The Berlin School of Mind and Brain at Humboldt-University Berlin takes part with an invited symposium on “Decision Making” from a perspective of cognitive neuroscience and philosophy and the DFG Cluster of Excellence “Languages of Emotion” of Free University presents interdisciplinary research results in an invited symposium on “Symbolising Emotions”.
Sexual aggression is a major public health issue worldwide, but most knowledge is derived from studies conducted in North America and Western Europe. Little research has been conducted on the prevalence of sexual aggression in developing countries, including Chile. This article presents the first systematic review of the evidence on the prevalence of sexual aggression victimization and perpetration among women and men in Chile. Furthermore, it reports differences in prevalence rates in relation to victim and perpetrator characteristics and victim–perpetrator relationships. A total of N = 28 studies were identified by a three-stage literature search, including the screening of academic databases, publications of Chilean institutions, and reference lists. A great heterogeneity was found for prevalence rates of sexual victimization, ranging between 1.0% and 51.9% for women and 0.4% and 48.0% for men. Only four studies provided perpetration rates, which varied between 0.8% and 26.8% for men and 0.0% and 16.5% for women. No consistent evidence emerged for differences in victimization rates in relation to victims’ gender, age, and education. Perpetrators were more likely to be persons known to the victim. Conceptual and methodological differences between the studies are discussed as reasons for the great variability in prevalence rates, and recommendations are provided for a more harmonized and gender-inclusive approach for future research on sexual aggression in Chile.
Presupposition triggers differ with respect to whether their presupposition is easily accommodatable. The presupposition of focus-sensitive additive particles like also or too is often classified as hard to accommodate, i.e., these triggers are infelicitous if their presupposition is not entailed by the immediate linguistic or non-linguistic context. We tested two competing accounts for the German additive particle auch concerning this requirement: First, that it requires a focus alternative to the whole proposition to be salient, and second, that it merely requires an alternative to the focused constituent (e.g., an individual) to be salient. We conducted two experiments involving felicity judgments as well as questions asking for the truth of the presupposition to be accommodated. Our results suggest that the latter account is too weak: mere previous mention of a potential alternative to the focused constituent is not enough to license the use of auch. However, our results also suggest that the former account is too strong: when an alternative of the focused constituent is prementioned and certain other accommodation-enhancing factors are present, the context does not have to entail the presupposed proposition. We tested the following two potentially accommodation-enhancing factors: First, whether the discourse can be construed to be from the perspective of the individual that the presupposition is about, and second, whether the presupposition is needed to establish coherence between the host sentence of the additive particle and the preceding context. The factor coherence was found to play a significant role. Our results thus corroborate the results of other researchers showing that discourse participants go to great lengths in order to identify a potential presupposition to accommodate, and we contribute to these results by showing that coherence is one of the factors that enhance accommodation.
Presupposition triggers differ with respect to whether their presupposition is easily accommodatable. The presupposition of focus-sensitive additive particles like also or too is often classified as hard to accommodate, i.e., these triggers are infelicitous if their presupposition is not entailed by the immediate linguistic or non-linguistic context. We tested two competing accounts for the German additive particle auch concerning this requirement: First, that it requires a focus alternative to the whole proposition to be salient, and second, that it merely requires an alternative to the focused constituent (e.g., an individual) to be salient. We conducted two experiments involving felicity judgments as well as questions asking for the truth of the presupposition to be accommodated. Our results suggest that the latter account is too weak: mere previous mention of a potential alternative to the focused constituent is not enough to license the use of auch. However, our results also suggest that the former account is too strong: when an alternative of the focused constituent is prementioned and certain other accommodation-enhancing factors are present, the context does not have to entail the presupposed proposition. We tested the following two potentially accommodation-enhancing factors: First, whether the discourse can be construed to be from the perspective of the individual that the presupposition is about, and second, whether the presupposition is needed to establish coherence between the host sentence of the additive particle and the preceding context. The factor coherence was found to play a significant role. Our results thus corroborate the results of other researchers showing that discourse participants go to great lengths in order to identify a potential presupposition to accommodate, and we contribute to these results by showing that coherence is one of the factors that enhance accommodation.
A large body of research now supports the presence of both syntactic and lexical predictions in sentence processing. Lexical predictions, in particular, are considered to indicate a deep level of predictive processing that extends past the structural features of a necessary word (e.g. noun), right down to the phonological features of the lexical identity of a specific word (e.g. /kite/; DeLong et al., 2005). However, evidence for lexical predictions typically focuses on predictions in very local environments, such as the adjacent word or words (DeLong et al., 2005; Van Berkum et al., 2005; Wicha et al., 2004). Predictions in such local environments may be indistinguishable from lexical priming, which is transient and uncontrolled, and as such may prime lexical items that are not compatible with the context (e.g. Kukona et al., 2014). Predictive processing has been argued to be a controlled process, with top-down information guiding preactivation of plausible upcoming lexical items (Kuperberg & Jaeger, 2016). One way to distinguish lexical priming from prediction is to demonstrate that preactivated lexical content can be maintained over longer distances.
In this dissertation, separable German particle verbs are used to demonstrate that preactivation of lexical items can be maintained over multi-word distances. A self-paced reading time and an eye tracking experiment provide some support for the idea that particle preactivation triggered by a verb and its context can be observed by holding the sentence context constant and manipulating the predictabilty of the particle. Although evidence of an effect of particle predictability was only seen in eye tracking, this is consistent with previous evidence suggesting that predictive processing facilitates only some eye tracking measures to which the self-paced reading modality may not be sensitive (Staub, 2015; Rayner1998). Interestingly, manipulating the distance between the verb and the particle did not affect reading times, suggesting that the surprisal-predicted faster reading times at long distance may only occur when the additional distance is created by information that adds information about the lexical identity of a distant element (Levy, 2008; Grodner & Gibson, 2005). Furthermore, the results provide support for models proposing that temporal decay is not major influence on word processing (Lewandowsky et al., 2009; Vasishth et al., 2019).
In the third and fourth experiments, event-related potentials were used as a method for detecting specific lexical predictions. In the initial ERP experiment, we found some support for the presence of lexical predictions when the sentence context constrained the number of plausible particles to a single particle. This was suggested by a frontal post-N400 positivity (PNP) that was elicited when a lexical prediction had been violated, but not to violations when more than one particle had been plausible. The results of this study were highly consistent with previous research suggesting that the PNP might be a much sought-after ERP marker of prediction failure (DeLong et al., 2011; DeLong et al., 2014; Van Petten & Luka, 2012; Thornhill & Van Petten, 2012; Kuperberg et al., 2019). However, a second experiment in a larger sample experiment failed to replicate the effect, but did suggest the relationship of the PNP to predictive processing may not yet be fully understood. Evidence for long-distance lexical predictions was inconclusive.
The conclusion drawn from the four experiments is that preactivation of the lexical entries of plausible upcoming particles did occur and was maintained over long distances. The facilitatory effect of this preactivation at the particle site therefore did not appear to be the result of transient lexical priming. However, the question of whether this preactivation can also lead to lexical predictions of a specific particle remains unanswered. Of particular interest to future research on predictive processing is further characterisation of the PNP. Implications for models of sentence processing may be the inclusion of long-distance lexical predictions, or the possibility that preactivation of lexical material can facilitate reading times and ERP amplitude without commitment to a specific lexical item.
Postural control is important to cope with demands of everyday life. It has been shown that both attentional demand (i.e., cognitive processing) and fatigue affect postural control in young adults. However, their combined effect is still unresolved. Therefore, we investigated the effects of fatigue on single- (ST) and dual-task (DT) postural control. Twenty young subjects (age: 23.7 ± 2.7) performed an all-out incremental treadmill protocol. After each completed stage, one-legged-stance performance on a force platform under ST (i.e., one-legged-stance only) and DT conditions (i.e., one-legged-stance while subtracting serial 3s) was registered. On a second test day, subjects conducted the same balance tasks for the control condition (i.e., non-fatigued). Results showed that heart rate, lactate, and ventilation increased following fatigue (all p < 0.001; d = 4.2–21). Postural sway and sway velocity increased during DT compared to ST (all p < 0.001; d = 1.9–2.0) and fatigued compared to non-fatigued condition (all p < 0.001; d = 3.3–4.2). In addition, postural control deteriorated with each completed stage during the treadmill protocol (all p < 0.01; d = 1.9–3.3). The addition of an attention-demanding interference task did not further impede one-legged-stance performance. Although both additional attentional demand and physical fatigue affected postural control in healthy young adults, there was no evidence for an overadditive effect (i.e., fatigue-related performance decrements in postural control were similar under ST and DT conditions). Thus, attentional resources were sufficient to cope with the DT situations in the fatigue condition of this experiment.
Postural control is important to cope with demands of everyday life. It has been shown that both attentional demand (i.e., cognitive processing) and fatigue affect postural control in young adults. However, their combined effect is still unresolved. Therefore, we investigated the effects of fatigue on single- (ST) and dual-task (DT) postural control. Twenty young subjects (age: 23.7 ± 2.7) performed an all-out incremental treadmill protocol. After each completed stage, one-legged-stance performance on a force platform under ST (i.e., one-legged-stance only) and DT conditions (i.e., one-legged-stance while subtracting serial 3s) was registered. On a second test day, subjects conducted the same balance tasks for the control condition (i.e., non-fatigued). Results showed that heart rate, lactate, and ventilation increased following fatigue (all p < 0.001; d = 4.2–21). Postural sway and sway velocity increased during DT compared to ST (all p < 0.001; d = 1.9–2.0) and fatigued compared to non-fatigued condition (all p < 0.001; d = 3.3–4.2). In addition, postural control deteriorated with each completed stage during the treadmill protocol (all p < 0.01; d = 1.9–3.3). The addition of an attention-demanding interference task did not further impede one-legged-stance performance. Although both additional attentional demand and physical fatigue affected postural control in healthy young adults, there was no evidence for an overadditive effect (i.e., fatigue-related performance decrements in postural control were similar under ST and DT conditions). Thus, attentional resources were sufficient to cope with the DT situations in the fatigue condition of this experiment.
Increased Achilles (AT) and Patellar tendon (PT) thickness in adolescent athletes compared to non-athletes could be shown. However, it is unclear, if changes are of pathological or physiological origin due to training. The aim of this study was to determine physiological AT and PT thickness adaptation in adolescent elite athletes compared to non-athletes, considering sex and sport. In a longitudinal study design with two measurement days (M1/M2) within an interval of 3.2 ± 0.8 years, 131 healthy adolescent elite athletes (m/f: 90/41) out of 13 different sports and 24 recreationally active controls (m/f: 6/18) were included. Both ATs and PTs were measured at standardized reference points. Athletes were divided into 4 sport categories [ball (B), combat (C), endurance (E) and explosive strength sports (S)]. Descriptive analysis (mean ± SD) and statistical testing for group differences was performed (α = 0.05). AT thickness did not differ significantly between measurement days, neither in athletes (5.6 ± 0.7 mm/5.6 ± 0.7 mm) nor in controls (4.8 ± 0.4 mm/4.9 ± 0.5 mm, p > 0.05). For PTs, athletes presented increased thickness at M2 (M1: 3.5 ± 0.5 mm, M2: 3.8 ± 0.5 mm, p < 0.001). In general, males had thicker ATs and PTs than females (p < 0.05). Considering sex and sports, only male athletes from B, C, and S showed significant higher PT-thickness at M2 compared to controls (p ≤ 0.01). Sport-specific adaptation regarding tendon thickness in adolescent elite athletes can be detected in PTs among male athletes participating in certain sports with high repetitive jumping and strength components. Sonographic microstructural analysis might provide an enhanced insight into tendon material properties enabling the differentiation of sex and influence of different sports.
Increased Achilles (AT) and Patellar tendon (PT) thickness in adolescent athletes compared to non-athletes could be shown. However, it is unclear, if changes are of pathological or physiological origin due to training. The aim of this study was to determine physiological AT and PT thickness adaptation in adolescent elite athletes compared to non-athletes, considering sex and sport. In a longitudinal study design with two measurement days (M1/M2) within an interval of 3.2 ± 0.8 years, 131 healthy adolescent elite athletes (m/f: 90/41) out of 13 different sports and 24 recreationally active controls (m/f: 6/18) were included. Both ATs and PTs were measured at standardized reference points. Athletes were divided into 4 sport categories [ball (B), combat (C), endurance (E) and explosive strength sports (S)]. Descriptive analysis (mean ± SD) and statistical testing for group differences was performed (α = 0.05). AT thickness did not differ significantly between measurement days, neither in athletes (5.6 ± 0.7 mm/5.6 ± 0.7 mm) nor in controls (4.8 ± 0.4 mm/4.9 ± 0.5 mm, p > 0.05). For PTs, athletes presented increased thickness at M2 (M1: 3.5 ± 0.5 mm, M2: 3.8 ± 0.5 mm, p < 0.001). In general, males had thicker ATs and PTs than females (p < 0.05). Considering sex and sports, only male athletes from B, C, and S showed significant higher PT-thickness at M2 compared to controls (p ≤ 0.01). Sport-specific adaptation regarding tendon thickness in adolescent elite athletes can be detected in PTs among male athletes participating in certain sports with high repetitive jumping and strength components. Sonographic microstructural analysis might provide an enhanced insight into tendon material properties enabling the differentiation of sex and influence of different sports.
Background
Generating percentile values is helpful for the identification of children with specific fitness characteristics (i.e., low or high fitness level) to set appropriate fitness goals (i.e., fitness/health promotion and/or long-term youth athlete development). Thus, the aim of this longitudinal study was to assess physical fitness development in healthy children aged 9–12 years and to compute sex- and age-specific percentile values.
Methods
Two-hundred and forty children (88 girls, 152 boys) participated in this study and were tested for their physical fitness. Physical fitness was assessed using the 50-m sprint test (i.e., speed), the 1-kg ball push test, the triple hop test (i.e., upper- and lower- extremity muscular power), the stand-and-reach test (i.e., flexibility), the star run test (i.e., agility), and the 9-min run test (i.e., endurance). Age- and sex-specific percentile values (i.e., P10 to P90) were generated using the Lambda, Mu, and Sigma method. Adjusted (for change in body weight, height, and baseline performance) age- and sex-differences as well as the interactions thereof were expressed by calculating effect sizes (Cohen’s d).
Results
Significant main effects of Age were detected for all physical fitness tests (d = 0.40–1.34), whereas significant main effects of Sex were found for upper-extremity muscular power (d = 0.55), flexibility (d = 0.81), agility (d = 0.44), and endurance (d = 0.32) only. Further, significant Sex by Age interactions were observed for upper-extremity muscular power (d = 0.36), flexibility (d = 0.61), and agility (d = 0.27) in favor of girls. Both, linear and curvilinear shaped curves were found for percentile values across the fitness tests. Accelerated (curvilinear) improvements were observed for upper-extremity muscular power (boys: 10–11 yrs; girls: 9–11 yrs), agility (boys: 9–10 yrs; girls: 9–11 yrs), and endurance (boys: 9–10 yrs; girls: 9–10 yrs). Tabulated percentiles for the 9-min run test indicated that running distances between 1,407–1,507 m, 1,479–1,597 m, 1,423–1,654 m, and 1,433–1,666 m in 9- to 12-year-old boys and 1,262–1,362 m, 1,329–1,434 m, 1,392–1,501 m, and 1,415–1,526 m in 9- to 12-year-old girls correspond to a “medium” fitness level (i.e., P40 to P60) in this population.
Conclusions
The observed differences in physical fitness development between boys and girls illustrate that age- and sex-specific maturational processes might have an impact on the fitness status of healthy children. Our statistical analyses revealed linear (e.g., lower-extremity muscular power) and curvilinear (e.g., agility) models of fitness improvement with age which is indicative of timed and capacity-specific fitness development pattern during childhood. Lastly, the provided age- and sex-specific percentile values can be used by coaches for talent identification and by teachers for rating/grading of children’s motor performance.
Physical fitness is an important marker of health that enables people to carry out activities of daily living with vigour and alertness but without undue fatigue and with sufficient reserve to enjoy active leisure pursuits and to meet unforeseen emergencies. Especially, due to scientific findings that the onset of civilization diseases (e.g., obesity, cardiovascular disease) begins in childhood and that physical fitness tracks (at least) into young adulthood, the regular monitoring and promotion of physical fitness in children is risen up to a public health issue. In relation to the evaluation of a child’s physical fitness over time (i.e., development) the use of longitudinally-based percentile values is of particular interest due to their underlined dedication of true physical fitness development within subjects (i.e., individual changes in timing and tempo of growth and maturation). Besides its genetic determination (e.g., sex, body height), physical fitness is influenced by factors that refer to children’s environment and behaviour. For instance, disparities in physical fitness according to children’s living area are frequently reported concerning the fact that living in rural areas as compared to urban areas seems to be more favourable for children’s physical fitness. In addition, cross-sectional studies found higher fitness values in children participating in sports clubs as compared to non-participants. However, up to date, the observed associations between both (i.e., living area and sports club participating) and children’s physical fitness are unresolved concerning a long-term effect. In addition, social inequality as determined by the socioeconomic status (SES) extends through many areas of children’s life. While evidence indicates that the SES is inversely related to various indices of child’s daily life and behaviour like educational success, nutritional habits, and sedentary- and physical activity behaviour, a potential relationship between child’s physical fitness and the SES is hardly investigated and indicated inconsistent results.
The present thesis addressed three objectives: (1) to generate physical fitness percentiles for 9- to 12- year-old boys and girls using a longitudinal approach and to analyse the age- and sex-specific development of physical fitness, (2) to investigate the long-term effect of living area and sports club participation on physical fitness in third- to sixth-grade primary school students, and (3) to examine associations between the SES and physical fitness in a large and representative (i.e., for a German federal state) sample of third grade primary school students.
Methods
(i/ii) Healthy third graders were followed over four consecutive years (up to grade 6), including annually assessment of physical fitness and parental questionnaire (i.e., status of sports club participation and living area). Six tests were conducted to estimate various components of physical fitness: speed (50-m sprint test), upper body muscular power (1-kg ball push test), lower body muscular power (triple hop test), flexibility (stand-and-reach test), agility (star agility run test), and cardiorespiratory fitness (CRF) (9-min run test). (iii) Within a cross-sectional study (i.e., third objective), physical fitness of third graders was assessed by six physical fitness tests including: speed (20-m sprint test), upper body muscular power (1-kg ball push test), lower body muscular power (standing long jump [SLJ] test), flexibility (stand-and-reach test), agility (star agility run test), and CRF (6-min run test). By means of questionnaire, students reported their status of organized sports participation (OSP).
Results
(i) With respect to percentiles of physical fitness development, test performances increased in boys and girls from age 9 to 12, except for males’ flexibility (i.e., stable performance over time). Girls revealed significantly better performance in flexibility, whereas boys scored significantly higher in the remaining physical fitness tests. In girls as compared to boys, physical fitness development was slightly faster for upper body muscular power but substantially faster for flexibility. Generated physical fitness percentile curves indicated a timed and capacity-specific physical fitness development (curvilinear) for upper body muscular power, agility, and CRF. (ii) Concerning the effect of living area and sports club participation on physical fitness development, children living in urban areas showed a significantly faster performance development in physical fitness components of upper and lower body muscular power as compared to peers from rural areas. The same direction was noted as a trend in CRF. Additionally, children that regularly participated in a sports club, when compared to those that not continuously participated in a sports club demonstrated a significantly faster performance development in lower body muscular power. A trend of faster performance development in sports club participants occurred in CRF too. (iii) Regarding the association of SES with physical fitness, the percentage of third graders that achieved a high physical fitness level in lower body muscular power and CRF was significantly higher in students attending schools in communities with high SES as compared to middle and low SES, irrespective of sex. Similar, students from the high SES-group performed significantly better in lower body muscular power and CRF than students from the middle and/or the low SES-group.
Conclusion
(i) The generated percentile values provide an objective tool to estimate childrenʼs physical fitness within the frame of physical education (e.g., age- and sex-specific grading of motor performance) and further to detect children with specific fitness characteristics (low fit or high fit) that may be indicative for the necessity of preventive health promotion or long term athlete development. (ii) It is essential to consider variables of different domains (e.g., environment and behavior) in order to improve knowledge of potential factors which influence physical fitness during childhood. In this regard, the present thesis provide a first input to clarify the causality of living area and sports club participation on physical fitness development in school-aged children. Living in urban areas as well as a regular participation in sports clubs positively affected children´s physical fitness development (i.e., muscular power and CRF). Herein, sports club participation seems to be a key factor within the relationship between living area and physical fitness. (iii) The findings of the present thesis imply that attending schools in communities with high SES refers to better performance in specific physical fitness test items (i.e., muscular power, CRF) in third graders. Extra-curricular physical education classes may represent an important equalizing factor for physical activity opportunities in children of different SES backgrounds. In regard to strong evidence of a positive relationship between physical fitness - in particular muscular fitness/ CRF - and health, more emphasis should be laid on establishing sports clubs and extra-curricular physical education classes as an easy and attractive means to promote fitness-, and hence health- enhancing daily physical activity for all children (i.e. public health approach).
Background
The aim of this study was to analyze the shoulder functional profile (rotation range of motion [ROM] and strength), upper and lower body performance, and throwing speed of U13 versus U15 male handball players, and to establish the relationship between these measures of physical fitness and throwing speed.
Methods
One-hundred and nineteen young male handball players (under (U)-13 (U13) [n = 85]) and U15 [n = 34]) volunteered to participate in this study. The participating athletes had a mean background of sytematic handball training of 5.5 ± 2.8 years and they exercised on average 540 ± 10.1 min per week including sport-specific team handball training and strength and conditioning programs. Players were tested for passive shoulder range-of-motion (ROM) for both internal (IR) and external rotation (ER) and isometric strength (i.e., IR and ER) of the dominant/non-dominant shoulders, overhead medicine ball throw (OMB), hip isometric abductor (ABD) and adductor (ADD) strength, hip ROM, jumps (countermovement jump [CMJ] and triple leg-hop [3H] for distance), linear sprint test, modified 505 change-of-direction (COD) test and handball throwing speed (7 m [HT7] and 9 m [HT9]).
Results
U15 players outperformed U13 in upper (i.e., HT7 and HT9 speed, OMB, absolute IR and ER strength of the dominant and non-dominant sides; Cohen’s d: 0.76–2.13) and lower body (i.e., CMJ, 3H, 20-m sprint and COD, hip ABD and ADD; d: 0.70–2.33) performance measures. Regarding shoulder ROM outcomes, a lower IR ROM was found of the dominant side in the U15 group compared to the U13 and a higher ER ROM on both sides in U15 (d: 0.76–1.04). It seems that primarily anthropometric characteristics (i.e., body height, body mass) and upper body strength/power (OMB distance) are the most important factors that explain the throw speed variance in male handball players, particularly in U13.
Conclusions
Findings from this study imply that regular performance monitoring is important for performance development and for minimizing injury risk of the shoulder in both age categories of young male handball players. Besides measures of physical fitness, anthropometric data should be recorded because handball throwing performance is related to these measures.
Background
The aim of this study was to analyze the shoulder functional profile (rotation range of motion [ROM] and strength), upper and lower body performance, and throwing speed of U13 versus U15 male handball players, and to establish the relationship between these measures of physical fitness and throwing speed.
Methods
One-hundred and nineteen young male handball players (under (U)-13 (U13) [n = 85]) and U15 [n = 34]) volunteered to participate in this study. The participating athletes had a mean background of sytematic handball training of 5.5 ± 2.8 years and they exercised on average 540 ± 10.1 min per week including sport-specific team handball training and strength and conditioning programs. Players were tested for passive shoulder range-of-motion (ROM) for both internal (IR) and external rotation (ER) and isometric strength (i.e., IR and ER) of the dominant/non-dominant shoulders, overhead medicine ball throw (OMB), hip isometric abductor (ABD) and adductor (ADD) strength, hip ROM, jumps (countermovement jump [CMJ] and triple leg-hop [3H] for distance), linear sprint test, modified 505 change-of-direction (COD) test and handball throwing speed (7 m [HT7] and 9 m [HT9]).
Results
U15 players outperformed U13 in upper (i.e., HT7 and HT9 speed, OMB, absolute IR and ER strength of the dominant and non-dominant sides; Cohen’s d: 0.76–2.13) and lower body (i.e., CMJ, 3H, 20-m sprint and COD, hip ABD and ADD; d: 0.70–2.33) performance measures. Regarding shoulder ROM outcomes, a lower IR ROM was found of the dominant side in the U15 group compared to the U13 and a higher ER ROM on both sides in U15 (d: 0.76–1.04). It seems that primarily anthropometric characteristics (i.e., body height, body mass) and upper body strength/power (OMB distance) are the most important factors that explain the throw speed variance in male handball players, particularly in U13.
Conclusions
Findings from this study imply that regular performance monitoring is important for performance development and for minimizing injury risk of the shoulder in both age categories of young male handball players. Besides measures of physical fitness, anthropometric data should be recorded because handball throwing performance is related to these measures.
Objective: To determine immediate performance measures for short-term, multicomponent cardiac rehabilitation (CR) in clinical routine in patients of working age, taking into
account cardiovascular risk factors, physical performance, social medicine, and subjective health parameters and to explore the underlying dimensionality.
Design: Prospective observational multicenter register study in 12 rehabilitation centers throughout Germany.
Setting: Comprehensive 3-week CR.
Objective: To determine immediate performance measures for short-term, multicomponent cardiac rehabilitation (CR) in clinical routine in patients of working age, taking into
account cardiovascular risk factors, physical performance, social medicine, and subjective health parameters and to explore the underlying dimensionality.
Design: Prospective observational multicenter register study in 12 rehabilitation centers throughout Germany.
Setting: Comprehensive 3-week CR.
The present study explores the perceptual span, that is, the physical extent of
the area from which useful visual information is obtained during a single
fixation, during oral reading of Chinese sentences. Characters outside a
window of legible text were replaced by visually similar characters. Results
show that the influence of window size on the perceptual span was consistent
across different fixation and oculomotor measures. To maintain normal
reading behavior when reading aloud, it was necessary to have information
provided from three characters to the right of the fixation. Together with
findings from previous research, our findings suggest that the physical size of
the perceptual span is smaller when reading aloud than in silent reading. This
is in agreement with previous studies in English, suggesting that the mechanisms
causing the reduced span in oral reading have a common base that
generalizes across languages and writing systems.
Importance Alcohol consumption (AC) leads to death and disability worldwide. Ongoing discussions on potential negative effects of the COVID-19 pandemic on AC need to be informed by real-world evidence.
Objective To examine whether lockdown measures are associated with AC and consumption-related temporal and psychological within-person mechanisms.
Design, Setting, and Participants This quantitative, intensive, longitudinal cohort study recruited 1743 participants from 3 sites from February 20, 2020, to February 28, 2021. Data were provided before and within the second lockdown of the COVID-19 pandemic in Germany: before lockdown (October 2 to November 1, 2020); light lockdown (November 2 to December 15, 2020); and hard lockdown (December 16, 2020, to February 28, 2021).
Main Outcomes and Measures Daily ratings of AC (main outcome) captured during 3 lockdown phases (main variable) and temporal (weekends and holidays) and psychological (social isolation and drinking intention) correlates.
Results Of the 1743 screened participants, 189 (119 [63.0%] male; median [IQR] age, 37 [27.5-52.0] years) with at least 2 alcohol use disorder (AUD) criteria according to the Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition) yet without the need for medically supervised alcohol withdrawal were included. These individuals provided 14 694 smartphone ratings from October 2020 through February 2021. Multilevel modeling revealed significantly higher AC (grams of alcohol per day) on weekend days vs weekdays (β = 11.39; 95% CI, 10.00-12.77; P < .001). Alcohol consumption was above the overall average on Christmas (β = 26.82; 95% CI, 21.87-31.77; P < .001) and New Year’s Eve (β = 66.88; 95% CI, 59.22-74.54; P < .001). During the hard lockdown, perceived social isolation was significantly higher (β = 0.12; 95% CI, 0.06-0.15; P < .001), but AC was significantly lower (β = −5.45; 95% CI, −8.00 to −2.90; P = .001). Independent of lockdown, intention to drink less alcohol was associated with lower AC (β = −11.10; 95% CI, −13.63 to −8.58; P < .001). Notably, differences in AC between weekend and weekdays decreased both during the hard lockdown (β = −6.14; 95% CI, −9.96 to −2.31; P = .002) and in participants with severe AUD (β = −6.26; 95% CI, −10.18 to −2.34; P = .002).
Conclusions and Relevance This 5-month cohort study found no immediate negative associations of lockdown measures with overall AC. Rather, weekend-weekday and holiday AC patterns exceeded lockdown effects. Differences in AC between weekend days and weekdays evinced that weekend drinking cycles decreased as a function of AUD severity and lockdown measures, indicating a potential mechanism of losing and regaining control. This finding suggests that temporal patterns and drinking intention constitute promising targets for prevention and intervention, even in high-risk individuals.
Importance Alcohol consumption (AC) leads to death and disability worldwide. Ongoing discussions on potential negative effects of the COVID-19 pandemic on AC need to be informed by real-world evidence.
Objective To examine whether lockdown measures are associated with AC and consumption-related temporal and psychological within-person mechanisms.
Design, Setting, and Participants This quantitative, intensive, longitudinal cohort study recruited 1743 participants from 3 sites from February 20, 2020, to February 28, 2021. Data were provided before and within the second lockdown of the COVID-19 pandemic in Germany: before lockdown (October 2 to November 1, 2020); light lockdown (November 2 to December 15, 2020); and hard lockdown (December 16, 2020, to February 28, 2021).
Main Outcomes and Measures Daily ratings of AC (main outcome) captured during 3 lockdown phases (main variable) and temporal (weekends and holidays) and psychological (social isolation and drinking intention) correlates.
Results Of the 1743 screened participants, 189 (119 [63.0%] male; median [IQR] age, 37 [27.5-52.0] years) with at least 2 alcohol use disorder (AUD) criteria according to the Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition) yet without the need for medically supervised alcohol withdrawal were included. These individuals provided 14 694 smartphone ratings from October 2020 through February 2021. Multilevel modeling revealed significantly higher AC (grams of alcohol per day) on weekend days vs weekdays (β = 11.39; 95% CI, 10.00-12.77; P < .001). Alcohol consumption was above the overall average on Christmas (β = 26.82; 95% CI, 21.87-31.77; P < .001) and New Year’s Eve (β = 66.88; 95% CI, 59.22-74.54; P < .001). During the hard lockdown, perceived social isolation was significantly higher (β = 0.12; 95% CI, 0.06-0.15; P < .001), but AC was significantly lower (β = −5.45; 95% CI, −8.00 to −2.90; P = .001). Independent of lockdown, intention to drink less alcohol was associated with lower AC (β = −11.10; 95% CI, −13.63 to −8.58; P < .001). Notably, differences in AC between weekend and weekdays decreased both during the hard lockdown (β = −6.14; 95% CI, −9.96 to −2.31; P = .002) and in participants with severe AUD (β = −6.26; 95% CI, −10.18 to −2.34; P = .002).
Conclusions and Relevance This 5-month cohort study found no immediate negative associations of lockdown measures with overall AC. Rather, weekend-weekday and holiday AC patterns exceeded lockdown effects. Differences in AC between weekend days and weekdays evinced that weekend drinking cycles decreased as a function of AUD severity and lockdown measures, indicating a potential mechanism of losing and regaining control. This finding suggests that temporal patterns and drinking intention constitute promising targets for prevention and intervention, even in high-risk individuals.
Objective: We aimed to characterize patients after an acute cardiac event regarding their negative expectations around returning to work and the impact on work capacity upon discharge from cardiac rehabilitation (CR).
Methods: We analyzed routine data of 884 patients (52±7 years, 76% men) who attended 3 weeks of inpatient CR after an acute coronary syndrome (ACS) or cardiac surgery between October 2013 and March 2015. The primary outcome was their status determining their capacity to work (fit vs unfit) at discharge from CR. Further, sociodemographic data (eg, age, sex, and education level), diagnoses, functional data (eg, exercise stress test and 6-min walking test [6MWT]), the Hospital Anxiety and Depression Scale (HADS) and self-assessment of the occupational prognosis (negative expectations and/or unemployment, Würzburger screening) at admission to CR were considered.
Results: A negative occupational prognosis was detected in 384 patients (43%). Out of these, 368 (96%) expected not to return to work after CR and/or were unemployed before CR at 29% (n=113). Affected patients showed a reduced exercise capacity (bicycle stress test: 100 W vs 118 W, P<0.01; 6MWT: 380 m vs 421 m, P<0.01) and were more likely to receive a depression diagnosis (12% vs 3%, P<0.01), as well as higher levels on the HADS. At discharge from CR, 21% of this group (n=81) were fit for work (vs 35% of patients with a normal occupational prognosis (n=175, P<0.01)). Sick leave before the cardiac event (OR 0.4, 95% CI 0.2–0.6, P<0.01), negative occupational expectations (OR 0.4, 95% CI 0.3–0.7, P<0.01) and depression (OR 0.3, 95% CI 0.1–0.8, P=0.01) reduced the likelihood of achieving work capacity upon discharge. In contrast, higher exercise capacity was positively associated.
Conclusion: Patients with a negative occupational prognosis often revealed a reduced physical performance and suffered from a high psychosocial burden. In addition, patients’ occupational expectations were a predictor of work capacity at discharge from CR. Affected patients should be identified at admission to allow for targeted psychosocial care.
Objective: We aimed to characterize patients after an acute cardiac event regarding their negative expectations around returning to work and the impact on work capacity upon discharge from cardiac rehabilitation (CR).
Methods: We analyzed routine data of 884 patients (52±7 years, 76% men) who attended 3 weeks of inpatient CR after an acute coronary syndrome (ACS) or cardiac surgery between October 2013 and March 2015. The primary outcome was their status determining their capacity to work (fit vs unfit) at discharge from CR. Further, sociodemographic data (eg, age, sex, and education level), diagnoses, functional data (eg, exercise stress test and 6-min walking test [6MWT]), the Hospital Anxiety and Depression Scale (HADS) and self-assessment of the occupational prognosis (negative expectations and/or unemployment, Würzburger screening) at admission to CR were considered.
Results: A negative occupational prognosis was detected in 384 patients (43%). Out of these, 368 (96%) expected not to return to work after CR and/or were unemployed before CR at 29% (n=113). Affected patients showed a reduced exercise capacity (bicycle stress test: 100 W vs 118 W, P<0.01; 6MWT: 380 m vs 421 m, P<0.01) and were more likely to receive a depression diagnosis (12% vs 3%, P<0.01), as well as higher levels on the HADS. At discharge from CR, 21% of this group (n=81) were fit for work (vs 35% of patients with a normal occupational prognosis (n=175, P<0.01)). Sick leave before the cardiac event (OR 0.4, 95% CI 0.2–0.6, P<0.01), negative occupational expectations (OR 0.4, 95% CI 0.3–0.7, P<0.01) and depression (OR 0.3, 95% CI 0.1–0.8, P=0.01) reduced the likelihood of achieving work capacity upon discharge. In contrast, higher exercise capacity was positively associated.
Conclusion: Patients with a negative occupational prognosis often revealed a reduced physical performance and suffered from a high psychosocial burden. In addition, patients’ occupational expectations were a predictor of work capacity at discharge from CR. Affected patients should be identified at admission to allow for targeted psychosocial care.
Background
Postoperative delirium is a common disorder in older adults that is associated with higher morbidity and mortality, prolonged cognitive impairment, development of dementia, higher institutionalization rates, and rising healthcare costs. The probability of delirium after surgery increases with patients’ age, with pre-existing cognitive impairment, and with comorbidities, and its diagnosis and treatment is dependent on the knowledge of diagnostic criteria, risk factors, and treatment options of the medical staff. In this study, we will investigate whether a cross-sectoral and multimodal intervention for preventing delirium can reduce the prevalence of delirium and postoperative cognitive decline (POCD) in patients older than 70 years undergoing elective surgery. Additionally, we will analyze whether the intervention is cost-effective.
Methods
The study will be conducted at five medical centers (with two or three surgical departments each) in the southwest of Germany. The study employs a stepped-wedge design with cluster randomization of the medical centers. Measurements are performed at six consecutive points: preadmission, preoperative, and postoperative with daily delirium screening up to day 7 and POCD evaluations at 2, 6, and 12 months after surgery. Recruitment goals are to enroll 1500 patients older than 70 years undergoing elective operative procedures (cardiac, thoracic, vascular, proximal big joints and spine, genitourinary, gastrointestinal, and general elective surgery procedures.
Discussion
Results of the trial should form the basis of future standards for preventing delirium and POCD in surgical wards. Key aims are the improvement of patient safety and quality of life, as well as the reduction of the long-term risk of conversion to dementia. Furthermore, from an economic perspective, we expect benefits and decreased costs for hospitals, patients, and healthcare insurances.
Trial registration
German Clinical Trials Register, DRKS00013311. Registered on 10 November 2017.
Background
Postoperative delirium is a common disorder in older adults that is associated with higher morbidity and mortality, prolonged cognitive impairment, development of dementia, higher institutionalization rates, and rising healthcare costs. The probability of delirium after surgery increases with patients’ age, with pre-existing cognitive impairment, and with comorbidities, and its diagnosis and treatment is dependent on the knowledge of diagnostic criteria, risk factors, and treatment options of the medical staff. In this study, we will investigate whether a cross-sectoral and multimodal intervention for preventing delirium can reduce the prevalence of delirium and postoperative cognitive decline (POCD) in patients older than 70 years undergoing elective surgery. Additionally, we will analyze whether the intervention is cost-effective.
Methods
The study will be conducted at five medical centers (with two or three surgical departments each) in the southwest of Germany. The study employs a stepped-wedge design with cluster randomization of the medical centers. Measurements are performed at six consecutive points: preadmission, preoperative, and postoperative with daily delirium screening up to day 7 and POCD evaluations at 2, 6, and 12 months after surgery. Recruitment goals are to enroll 1500 patients older than 70 years undergoing elective operative procedures (cardiac, thoracic, vascular, proximal big joints and spine, genitourinary, gastrointestinal, and general elective surgery procedures.
Discussion
Results of the trial should form the basis of future standards for preventing delirium and POCD in surgical wards. Key aims are the improvement of patient safety and quality of life, as well as the reduction of the long-term risk of conversion to dementia. Furthermore, from an economic perspective, we expect benefits and decreased costs for hospitals, patients, and healthcare insurances.
Trial registration
German Clinical Trials Register, DRKS00013311. Registered on 10 November 2017.
The pathophysiology of Parkinson’s disease (PD) is still not understood. There are investigations which show a changed oscillatory behaviour of brain circuits or changes in variability of, e.g., gait parameters in PD. The aim of this study was to investigate whether or not the motor output differs between PD patients and healthy controls. Thereby, patients without tremor are investigated in the medication off state performing a special bilateral isometric motor task. The force and accelerations (ACC) were recorded as well as the Mechanomyography (MMG) of the biceps brachii, the brachioradialis and of the pectoralis major muscles using piezoelectric-sensors during the bilateral motor task at 60% of the maximal isometric contraction. The frequency, a specific power ratio, the amplitude variation and the slope of amplitudes were analysed. The results indicate that the oscillatory behaviour of motor output in PD patients without tremor deviates from controls: thereby, the 95%-confidence-intervals of power ratio and of amplitude variation of all signals are disjoint between PD and controls and show significant differences in group comparisons (power ratio: p = 0.000–0.004, r = 0.441–0.579; amplitude variation: p = 0.000–0.001, r = 0.37–0.67). The mean frequency shows a significant difference for ACC (p = 0.009, r = 0.43), but not for MMG. It remains open, whether this muscular output reflects changes of brain circuits and whether the results are reproducible and specific for PD.
The pathophysiology of Parkinson’s disease (PD) is still not understood. There are investigations which show a changed oscillatory behaviour of brain circuits or changes in variability of, e.g., gait parameters in PD. The aim of this study was to investigate whether or not the motor output differs between PD patients and healthy controls. Thereby, patients without tremor are investigated in the medication off state performing a special bilateral isometric motor task. The force and accelerations (ACC) were recorded as well as the Mechanomyography (MMG) of the biceps brachii, the brachioradialis and of the pectoralis major muscles using piezoelectric-sensors during the bilateral motor task at 60% of the maximal isometric contraction. The frequency, a specific power ratio, the amplitude variation and the slope of amplitudes were analysed. The results indicate that the oscillatory behaviour of motor output in PD patients without tremor deviates from controls: thereby, the 95%-confidence-intervals of power ratio and of amplitude variation of all signals are disjoint between PD and controls and show significant differences in group comparisons (power ratio: p = 0.000–0.004, r = 0.441–0.579; amplitude variation: p = 0.000–0.001, r = 0.37–0.67). The mean frequency shows a significant difference for ACC (p = 0.009, r = 0.43), but not for MMG. It remains open, whether this muscular output reflects changes of brain circuits and whether the results are reproducible and specific for PD.
Speech and action sequences are continuous streams of information that can be segmented into sub-units. In both domains, this segmentation can be facilitated by perceptual cues contained within the information stream. In speech, prosodic cues (e.g., a pause, pre-boundary lengthening, and pitch rise) mark boundaries between words and phrases, while boundaries between actions of an action sequence can be marked by kinematic cues (e.g., a pause, pre-boundary deceleration). The processing of prosodic boundary cues evokes an Event-related Potentials (ERP) component known as the Closure Positive Shift (CPS), and it is possible that the CPS reflects domaingeneral cognitive processes involved in segmentation, given that the CPS is also evoked by boundaries between subunits of non-speech auditory stimuli. This study further probed the domain-generality of the CPS and its underlying processes by investigating electrophysiological correlates of the processing of boundary cues in sequences of spoken verbs (auditory stimuli; Experiment 1; N = 23 adults) and actions (visual stimuli; Experiment 2; N = 23 adults). The EEG data from both experiments revealed a CPS-like broadly distributed positivity during the 250 ms prior to the onset of the post-boundary word or action, indicating similar electrophysiological correlates of boundary processing across domains, suggesting that the cognitive processes underlying speech and action segmentation might also be shared.
Speech and action sequences are continuous streams of information that can be segmented into sub-units. In both domains, this segmentation can be facilitated by perceptual cues contained within the information stream. In speech, prosodic cues (e.g., a pause, pre-boundary lengthening, and pitch rise) mark boundaries between words and phrases, while boundaries between actions of an action sequence can be marked by kinematic cues (e.g., a pause, pre-boundary deceleration). The processing of prosodic boundary cues evokes an Event-related Potentials (ERP) component known as the Closure Positive Shift (CPS), and it is possible that the CPS reflects domaingeneral cognitive processes involved in segmentation, given that the CPS is also evoked by boundaries between subunits of non-speech auditory stimuli. This study further probed the domain-generality of the CPS and its underlying processes by investigating electrophysiological correlates of the processing of boundary cues in sequences of spoken verbs (auditory stimuli; Experiment 1; N = 23 adults) and actions (visual stimuli; Experiment 2; N = 23 adults). The EEG data from both experiments revealed a CPS-like broadly distributed positivity during the 250 ms prior to the onset of the post-boundary word or action, indicating similar electrophysiological correlates of boundary processing across domains, suggesting that the cognitive processes underlying speech and action segmentation might also be shared.
Degenerative disc disease is associated with increased expression of pro-inflammatory cytokines in the intervertebral disc (IVD). However, it is not completely clear how inflammation arises in the IVD and which cellular compartments are involved in this process. Recently, the endoplasmic reticulum (ER) has emerged as a possible modulator of inflammation in age-related disorders. In addition, ER stress has been associated with the microenvironment of degenerated IVDs. Therefore, the aim of this study was to analyze the effects of ER stress on inflammatory responses in degenerated human IVDs and associated molecular mechanisms. Gene expression of ER stress marker GRP78 and pro-inflammatory cytokines IL-6, IL-8, IL-1 beta, and TNF-alpha was analyzed in human surgical IVD samples (n = 51, Pfirrmann grade 2-5). The expression of GRP78 positively correlated with the degeneration grade in lumbar IVDs and IL-6, but not with IL-1 beta and TNF-alpha. Another set of human surgical IVD samples (n = 25) was used to prepare primary cell cultures. ER stress inducer thapsigargin (Tg, 100 and 500 nM) activated gene and protein expression of IL-6 and induced phosphorylation of p38 MAPK. Both inhibition of p38 MAPK by SB203580 (10 mu M) and knockdown of ER stress effector CCAAT-enhancer-binding protein homologous protein (CHOP) reduced gene and protein expression of IL-6 in Tg-treated cells. Furthermore, the effects of an inflammatory microenvironment on ER stress were tested. TNF-alpha (5 and 10 ng/mL) did not activate ER stress, while IL-1 beta (5 and 10 ng/mL) activated gene and protein expression of GRP78, but did not influence [Ca2+](i) flux and expression of CHOP, indicating that pro-inflammatory cytokines alone may not induce ER stress in vivo. This study showed that IL-6 release in the IVD can be initiated following ER stress and that ER stress mediates IL-6 release through p38 MAPK and CHOP. Therapeutic targeting of ER stress response may reduce the consequences of the harsh microenvironment in degenerated IVD.
Background: Outcome quality management requires the consecutive registration of defined variables. The aim was to identify relevant parameters in order to objectively assess the in-patient rehabilitation outcome.
Methods: From February 2009 to June 2010 1253 patients (70.9 +/- 7.0 years, 78.1% men) at 12 rehabilitation clinics were enrolled. Items concerning sociodemographic data, the impairment group (surgery, conservative/interventional treatment), cardiovascular risk factors, structural and functional parameters and subjective health were tested in respect of their measurability, sensitivity to change and their propensity to be influenced by rehabilitation.
Results: The majority of patients (61.1%) were referred for rehabilitation after cardiac surgery, 38.9% after conservative or interventional treatment for an acute coronary syndrome. Functionally relevant comorbidities were seen in 49.2% (diabetes mellitus, stroke, peripheral artery disease, chronic obstructive lung disease). In three key areas 13 parameters were identified as being sensitive to change and subject to modification by rehabilitation: cardiovascular risk factors (blood pressure, low-density lipoprotein cholesterol, triglycerides), exercise capacity (resting heart rate, maximal exercise capacity, maximal walking distance, heart failure, angina pectoris) and subjective health (IRES-24 (indicators of rehabilitation status): pain, somatic health, psychological well-being and depression as well as anxiety on the Hospital Anxiety and Depression Scale).
Conclusion: The outcome of in-patient rehabilitation in elderly patients can be comprehensively assessed by the identification of appropriate key areas, that is, cardiovascular risk factors, exercise capacity and subjective health. This may well serve as a benchmark for internal and external quality management.
Aim: The aim of the study was to identify common orthopedic sports injury profiles in adolescent elite athletes with respect to age, sex, and anthropometrics.
Methods: A retrospective data analysis of 718 orthopedic presentations among 381 adolescent elite athletes from 16 different sports to a sports medical department was performed. Recorded data of history and clinical examination included area, cause and structure of acute and overuse injuries. Injury-events were analyzed in the whole cohort and stratified by age (11–14/15–17 years) and sex. Group differences were tested by chi-squared-tests. Logistic regression analysis was applied examining the influence of factors age, sex, and body mass index (BMI) on the outcome variables area and structure (a = 0.05).
Results: Higher proportions of injury-events were reported for females (60%) and athletes of the older age group (66%) than males and younger athletes. The most frequently injured area was the lower extremity (47%) followed by the spine (30.5%) and the upper extremity (12.5%). Acute injuries were mainly located at the lower extremity (74.5%), while overuse injuries were predominantly observed at the lower extremity (41%) as well as the spine (36.5%). Joints (34%), muscles (22%), and tendons (21.5%) were found to be the most often affected structures. The injured structures were different between the age groups (p = 0.022), with the older age group presenting three times more frequent with ligament pathology events (5.5%/2%) and less frequent with bony problems (11%/20.5%) than athletes of the younger age group. The injured area differed between the sexes (p = 0.005), with males having fewer spine injury-events (25.5%/34%) but more upper extremity injuries (18%/9%) than females. Regression analysis showed statistically significant influence for BMI (p = 0.002) and age (p = 0.015) on structure, whereas the area was significantly influenced by sex (p = 0.005).
Conclusion: Events of soft-tissue overuse injuries are the most common reasons resulting in orthopedic presentations of adolescent elite athletes. Mostly, the lower extremity and the spine are affected, while sex and age characteristics on affected area and structure must be considered. Therefore, prevention strategies addressing the injury-event profiles should already be implemented in early adolescence taking age, sex as well as injury entity into account.
Aim: The aim of the study was to identify common orthopedic sports injury profiles in adolescent elite athletes with respect to age, sex, and anthropometrics.
Methods: A retrospective data analysis of 718 orthopedic presentations among 381 adolescent elite athletes from 16 different sports to a sports medical department was performed. Recorded data of history and clinical examination included area, cause and structure of acute and overuse injuries. Injury-events were analyzed in the whole cohort and stratified by age (11–14/15–17 years) and sex. Group differences were tested by chi-squared-tests. Logistic regression analysis was applied examining the influence of factors age, sex, and body mass index (BMI) on the outcome variables area and structure (a = 0.05).
Results: Higher proportions of injury-events were reported for females (60%) and athletes of the older age group (66%) than males and younger athletes. The most frequently injured area was the lower extremity (47%) followed by the spine (30.5%) and the upper extremity (12.5%). Acute injuries were mainly located at the lower extremity (74.5%), while overuse injuries were predominantly observed at the lower extremity (41%) as well as the spine (36.5%). Joints (34%), muscles (22%), and tendons (21.5%) were found to be the most often affected structures. The injured structures were different between the age groups (p = 0.022), with the older age group presenting three times more frequent with ligament pathology events (5.5%/2%) and less frequent with bony problems (11%/20.5%) than athletes of the younger age group. The injured area differed between the sexes (p = 0.005), with males having fewer spine injury-events (25.5%/34%) but more upper extremity injuries (18%/9%) than females. Regression analysis showed statistically significant influence for BMI (p = 0.002) and age (p = 0.015) on structure, whereas the area was significantly influenced by sex (p = 0.005).
Conclusion: Events of soft-tissue overuse injuries are the most common reasons resulting in orthopedic presentations of adolescent elite athletes. Mostly, the lower extremity and the spine are affected, while sex and age characteristics on affected area and structure must be considered. Therefore, prevention strategies addressing the injury-event profiles should already be implemented in early adolescence taking age, sex as well as injury entity into account.
The purpose of this study was to compare static balance performance and muscle activity during one-leg standing on the dominant and nondominant leg under various sensory conditions with increased levels of task difficulty. Thirty healthy young adults (age: 23 +/- 2 years) performed one-leg standing tests for 30 s under three sensory conditions (ie, eyes open/firm ground; eyes open/foam ground [elastic pad on top of the balance plate]; eyes closed/firm ground). Center of pressure displacements and activity of four lower leg muscles (ie, m. tibialis anterior [TA], m. soleus [SOL], m. gastrocnemius medialis [GAS], m. peroneus longus [PER]) were analyzed. An increase in sensory task difficulty resulted in deteriorated balance performance (P < .001, effect size [ES] = .57-2.54) and increased muscle activity (P < .001, ES = .50-1.11) for all but two muscles (ie, GAS, PER). However, regardless of the sensory condition, one-leg standing on the dominant as compared with the nondominant limb did not produce statistically significant differences in various balance (P > .05, ES = .06-.22) and electromyographic (P > .05, ES = .03-.13) measures. This indicates that the dominant and the nondominant leg can be used interchangeably during static one-leg balance testing in healthy young adults.
Various behavioural studies show that semantic typicality (TYP) and age of acquisition (AOA) of a specific word influence processing time and accuracy during the performance of lexical-semantic tasks. This study examines the influence of TYP and AOA on semantic processing at behavioural (response times and accuracy data) and electrophysiological levels using an auditory category-member-verification task. Reaction time data reveal independent TYP and AOA effects, while in the accuracy data and the event-related potentials predominantly effects of TYP can be found. The present study thus confirms previous findings and extends evidence found in the visual modality to the auditory modality. A modality-independent influence on semantic word processing is manifested. However, with regard to the influence of AOA, the diverging results raise questions on the origin of AOA effects as well as on the interpretation of offline and online data. Hence, results will be discussed against the background of recent theories on N400 correlates in semantic processing. In addition, an argument in favour of a complementary use of research techniques will be made. (C) 2015 Elsevier Ltd. All rights reserved.
In the first years of life, children differ greatly from adults in the temporal organization of their speech gestures in fluent language production. However, dissent remains as to the maturational direction of such organization. The present study sheds new light on this process by tracking the development of anticipatory vowel-to-vowel coarticulation in a cross-sectional investigation of 62 German children (from 3.5 to 7 years of age) and 13 adults. It focuses on gestures of the tongue, a complex organ whose spatiotemporal control is indispensable for speech production. The goal of the study was threefold: 1) investigate whether children as well as adults initiate the articulation for a target vowel in advance of its acoustic onset, 2) test if the identity of the intervocalic consonant matters and finally, 3) describe age-related developments of these lingual coarticulatory patterns. To achieve this goal, ultrasound tongue imaging was used to record lingual movements and quantify changes in coarticulation degree as a function of consonantal context and age. Results from linear mixed effects models indicate that like adults, children initiate vowels' lingual gestures well ahead of their acoustic onset. Second, while the identity of the intervocalic consonant affects the degree of vocalic anticipation in adults, it does not in children at any age. Finally, the degree of vowelto-vowel coarticulation is significantly higher in all cohorts of children than in adults. However, among children, a developmental decrease of vocalic coarticulation is only found for sequences including the alveolar stop /d/ which requires finer spatiotemporal coordination of the tongue's subparts compared to labial and velar stops. Altogether, results suggest greater gestural overlap in child than in adult speech and support the view of a non-uniform and protracted maturation of lingual coarticulation calling for thorough considerations of the articulatory intricacies from which subtle developmental differences may originate.
In the first years of life, children differ greatly from adults in the temporal organization of their speech gestures in fluent language production. However, dissent remains as to the maturational direction of such organization. The present study sheds new light on this process by tracking the development of anticipatory vowel-to-vowel coarticulation in a cross-sectional investigation of 62 German children (from 3.5 to 7 years of age) and 13 adults. It focuses on gestures of the tongue, a complex organ whose spatiotemporal control is indispensable for speech production. The goal of the study was threefold: 1) investigate whether children as well as adults initiate the articulation for a target vowel in advance of its acoustic onset, 2) test if the identity of the intervocalic consonant matters and finally, 3) describe age-related developments of these lingual coarticulatory patterns. To achieve this goal, ultrasound tongue imaging was used to record lingual movements and quantify changes in coarticulation degree as a function of consonantal context and age. Results from linear mixed effects models indicate that like adults, children initiate vowels' lingual gestures well ahead of their acoustic onset. Second, while the identity of the intervocalic consonant affects the degree of vocalic anticipation in adults, it does not in children at any age. Finally, the degree of vowelto-vowel coarticulation is significantly higher in all cohorts of children than in adults. However, among children, a developmental decrease of vocalic coarticulation is only found for sequences including the alveolar stop /d/ which requires finer spatiotemporal coordination of the tongue's subparts compared to labial and velar stops. Altogether, results suggest greater gestural overlap in child than in adult speech and support the view of a non-uniform and protracted maturation of lingual coarticulation calling for thorough considerations of the articulatory intricacies from which subtle developmental differences may originate.
Background: Castilian-Spanish, Catalan, Galician, and European Portuguese are the most widely spoken languages of the Ibero-Romance group. An increasing number of authors have addressed the impact of aphasia on the morphosyntax of these varieties. However, accurate linguistic characterisations are scarce and the different sources of data have not been yet compiled.Aims: To stimulate state-of-the-art research, we provided a comprehensive summary of morphosyntactic aspects of Ibero-Romance and a review of how these are affected in non-fluent aphasia. The topics we dealt with are the use of verb argument structure and morphology, sentential negation and word order, definite articles, personal and reflexive pronouns, passives, topicalised constructions, questions, and relative clauses.Methods & Procedures: An exhaustive fieldwork and search of PubMed, Web of Science, and Medline records were performed to retrieve studies focused on morphosyntactic issues concerning the Ibero-Romance varieties. A total of 27 studies produced by 46 authors of varying background emerged. We did not review studies of category-specific deficits and aspects related to bilingual aphasia, although we assume that most speakers of Galician and Catalan are bilingual. Studies of spontaneous speech were included when no controlled experimental tasks were available.Outcomes & Results: The morphosyntactic commonalities of Ibero-Romance have been tackled from different theoretical perspectives. There exist asymmetries in findings which we explain with the use of different tasks (and task complexity) and individual differences between participants.Conclusions: Discourse-linking factors as well as deviations from the canonical pattern are recurrent answers to these asymmetries. A comprehensive theory of impairments in non-fluent aphasia integrating relevant aspects of both structural and processing accounts seems necessary.
Walking while concurrently performing cognitive and/or motor interference tasks is the norm rather than the exception during everyday life and there is evidence from behavioral studies that it negatively affects human locomotion. However, there is hardly any information available regarding the underlying neural correlates of single- and dual-task walking. We had 12 young adults (23.8 ± 2.8 years) walk while concurrently performing a cognitive interference (CI) or a motor interference (MI) task. Simultaneously, neural activation in frontal, central, and parietal brain areas was registered using a mobile EEG system. Results showed that the MI task but not the CI task affected walking performance in terms of significantly decreased gait velocity and stride length and significantly increased stride time and tempo-spatial variability. Average activity in alpha and beta frequencies was significantly modulated during both CI and MI walking conditions in frontal and central brain regions, indicating an increased cognitive load during dual-task walking. Our results suggest that impaired motor performance during dual-task walking is mirrored in neural activation patterns of the brain. This finding is in line with established cognitive theories arguing that dual-task situations overstrain cognitive capabilities resulting in motor performance decrements.
Walking while concurrently performing cognitive and/or motor interference tasks is the norm rather than the exception during everyday life and there is evidence from behavioral studies that it negatively affects human locomotion. However, there is hardly any information available regarding the underlying neural correlates of single- and dual-task walking. We had 12 young adults (23.8 ± 2.8 years) walk while concurrently performing a cognitive interference (CI) or a motor interference (MI) task. Simultaneously, neural activation in frontal, central, and parietal brain areas was registered using a mobile EEG system. Results showed that the MI task but not the CI task affected walking performance in terms of significantly decreased gait velocity and stride length and significantly increased stride time and tempo-spatial variability. Average activity in alpha and beta frequencies was significantly modulated during both CI and MI walking conditions in frontal and central brain regions, indicating an increased cognitive load during dual-task walking. Our results suggest that impaired motor performance during dual-task walking is mirrored in neural activation patterns of the brain. This finding is in line with established cognitive theories arguing that dual-task situations overstrain cognitive capabilities resulting in motor performance decrements.
Objective: Alexithymia relates to difficulties recognizing and describing emotions. It has been linked to subjectively increased interoceptive awareness (IA) and to psychiatric illnesses such as major depressive disorder (MDD) and somatization. MDD in turn is characterized by aberrant emotion processing and IA on the subjective as well as on the neural level. However, a link between neural activity in response to IA and alexithymic traits in health and depression remains unclear.
Methods: A well-established fMRI task was used to investigate neural activity during IA (heartbeat counting) and exteroceptive awareness (tone counting) in non-psychiatric controls (NC) and MDD. Firstly, comparing MDD and NC, a linear relationship between IA-related activity and scores of the Toronto Alexithymia Scale (TAS) was investigated through whole-brain regression. Secondly, NC were divided by median-split of TAS scores into groups showing low (NC-low) or high (NC-high) alexithymia. MDD and NC-high showed equally high TAS scores. Subsequently, IA-related neural activity was compared on a whole-brain level between the three independent samples (MDD, NC-low, NC-high).
Results: Whole-brain regressions between MDD and NC revealed neural differences during IA as a function of TAS-DD (subscale difficulty describing feelings) in the supragenual anterior cingulate cortex (sACC; BA 24/32), which were due to negative associations between TAS-DD and IA-related activity in NC. Contrasting NC subgroups after median-split on a whole-brain level, high TAS scores were associated with decreased neural activity during IA in the sACC and increased insula activity. Though having equally high alexithymia scores, NC-high showed increased insula activity during IA compared to MDD, whilst both groups showed decreased activity in the sACC.
Conclusions: Within the context of decreased sACC activity during IA in alexithymia (NC-high and MDD), increased insula activity might mirror a compensatory mechanism in NC-high, which is disrupted in MDD.
Objective: Alexithymia relates to difficulties recognizing and describing emotions. It has been linked to subjectively increased interoceptive awareness (IA) and to psychiatric illnesses such as major depressive disorder (MDD) and somatization. MDD in turn is characterized by aberrant emotion processing and IA on the subjective as well as on the neural level. However, a link between neural activity in response to IA and alexithymic traits in health and depression remains unclear.
Methods: A well-established fMRI task was used to investigate neural activity during IA (heartbeat counting) and exteroceptive awareness (tone counting) in non-psychiatric controls (NC) and MDD. Firstly, comparing MDD and NC, a linear relationship between IA-related activity and scores of the Toronto Alexithymia Scale (TAS) was investigated through whole-brain regression. Secondly, NC were divided by median-split of TAS scores into groups showing low (NC-low) or high (NC-high) alexithymia. MDD and NC-high showed equally high TAS scores. Subsequently, IA-related neural activity was compared on a whole-brain level between the three independent samples (MDD, NC-low, NC-high).
Results: Whole-brain regressions between MDD and NC revealed neural differences during IA as a function of TAS-DD (subscale difficulty describing feelings) in the supragenual anterior cingulate cortex (sACC; BA 24/32), which were due to negative associations between TAS-DD and IA-related activity in NC. Contrasting NC subgroups after median-split on a whole-brain level, high TAS scores were associated with decreased neural activity during IA in the sACC and increased insula activity. Though having equally high alexithymia scores, NC-high showed increased insula activity during IA compared to MDD, whilst both groups showed decreased activity in the sACC.
Conclusions: Within the context of decreased sACC activity during IA in alexithymia (NC-high and MDD), increased insula activity might mirror a compensatory mechanism in NC-high, which is disrupted in MDD.
Background
Doping presents a potential health risk for young athletes. Prevention programs are intended to prevent doping by educating athletes about banned substances. However, such programs have their limitations in practice. This led Germany to introduce the National Doping Prevention Plan (NDPP), in hopes of ameliorating the situation among young elite athletes. Two studies examined 1) the degree to which the NDPP led to improved prevention efforts in elite sport schools, and 2) the extent to which newly developed prevention activities of the national anti-doping agency (NADA) based on the NDPP have improved knowledge among young athletes within elite sports schools.
Methods
The first objective was investigated in a longitudinal study (Study I: t0 = baseline, t1 = follow-up 4 years after NDPP introduction) with N = 22 teachers engaged in doping prevention in elite sports schools. The second objective was evaluated in a cross-sectional comparison study (Study II) in N = 213 elite sports school students (54.5 % male, 45.5 % female, age M = 16.7 ± 1.3 years (all students had received the improved NDDP measure in school; one student group had received additionally NADA anti-doping activities and a control group did not). Descriptive statistics were calculated, followed by McNemar tests, Wilcoxon tests and Analysis of Covariance (ANCOVA).
Results
Results indicate that 4 years after the introduction of the NDPP there have been limited structural changes with regard to the frequency, type, and scope of doping prevention in elite sport schools. On the other hand, in study II, elite sport school students who received further NADA anti-doping activities performed better on an anti-doping knowledge test than students who did not take part (F(1, 207) = 33.99, p <0.001), although this difference was small.
Conclusion
The integration of doping-prevention in elite sport schools as part of the NDPP was only partially successful. The results of the evaluation indicate that the introduction of the NDPP has contributed more to a change in the content of doping prevention activities than to a structural transformation in anti-doping education in elite sport schools. Moreover, while students who did receive additional education in the form of the NDPP“booster sessions” had significantly more knowledge about doping than students who did not receive such education, this difference was only small and may not translate to actual behavior.
Background
Doping presents a potential health risk for young athletes. Prevention programs are intended to prevent doping by educating athletes about banned substances. However, such programs have their limitations in practice. This led Germany to introduce the National Doping Prevention Plan (NDPP), in hopes of ameliorating the situation among young elite athletes. Two studies examined 1) the degree to which the NDPP led to improved prevention efforts in elite sport schools, and 2) the extent to which newly developed prevention activities of the national anti-doping agency (NADA) based on the NDPP have improved knowledge among young athletes within elite sports schools.
Methods
The first objective was investigated in a longitudinal study (Study I: t0 = baseline, t1 = follow-up 4 years after NDPP introduction) with N = 22 teachers engaged in doping prevention in elite sports schools. The second objective was evaluated in a cross-sectional comparison study (Study II) in N = 213 elite sports school students (54.5 % male, 45.5 % female, age M = 16.7 ± 1.3 years (all students had received the improved NDDP measure in school; one student group had received additionally NADA anti-doping activities and a control group did not). Descriptive statistics were calculated, followed by McNemar tests, Wilcoxon tests and Analysis of Covariance (ANCOVA).
Results
Results indicate that 4 years after the introduction of the NDPP there have been limited structural changes with regard to the frequency, type, and scope of doping prevention in elite sport schools. On the other hand, in study II, elite sport school students who received further NADA anti-doping activities performed better on an anti-doping knowledge test than students who did not take part (F(1, 207) = 33.99, p <0.001), although this difference was small.
Conclusion
The integration of doping-prevention in elite sport schools as part of the NDPP was only partially successful. The results of the evaluation indicate that the introduction of the NDPP has contributed more to a change in the content of doping prevention activities than to a structural transformation in anti-doping education in elite sport schools. Moreover, while students who did receive additional education in the form of the NDPP“booster sessions” had significantly more knowledge about doping than students who did not receive such education, this difference was only small and may not translate to actual behavior.
Different systems for habitual versus goal-directed control are thought to underlie human decision-making. Working memory is known to shape these decision-making systems and
their interplay, and is known to support goal-directed decision making even under stress. Here, we investigated if and how decision systems are differentially influenced by breaks filled with diverse everyday life activities known to modulate working memory performance. We used a within-subject design where young adults listened to music and played a video game during breaks interleaved with trials of a sequential two-step Markov decision task, designed to assess habitual as well as goal-directed decision making. Based on a neurocomputational model of task performance, we observed that for individuals with a rather limited working memory capacity video gaming as compared to music reduced reliance on the goal-directed decision-making system, while a rather large working memory capacity prevented such a decline. Our findings suggest differential effects of everyday activities on key decision-making processes.
Different systems for habitual versus goal-directed control are thought to underlie human decision-making. Working memory is known to shape these decision-making systems and
their interplay, and is known to support goal-directed decision making even under stress. Here, we investigated if and how decision systems are differentially influenced by breaks filled with diverse everyday life activities known to modulate working memory performance. We used a within-subject design where young adults listened to music and played a video game during breaks interleaved with trials of a sequential two-step Markov decision task, designed to assess habitual as well as goal-directed decision making. Based on a neurocomputational model of task performance, we observed that for individuals with a rather limited
working memory capacity video gaming as compared to music reduced reliance on the goal-directed decision-making system, while a rather large working memory capacity prevented such a decline. Our findings suggest differential effects of everyday activities on key decision-making processes.
The improvement of power is an objective in training of athletes. In order to detect effective methods of exercise, basic research is required regarding the mechanisms of muscular activity. The purpose of this study is to investigate whether or not a muscular pre-activation prior to an external impulse-like force impact has an effect on the maximal explosive eccentric Adaptive Force (xpAFeccmax). This power capability combines different probable power enhancing mechanisms. To measure the xpAFeccmax an innovative pneumatic device was used. During measuring, the subject tries to hold an isometric position as long as possible. In the moment in which the subjects’ maximal isometric holding strength is exceeded, it merges into eccentric muscle action. This process is very close to motions in sports, where an adaptation of the neuromuscular system is required, e.g., force impacts caused by uneven surfaces during skiing. For investigating the effect of pre-activation on the xpAFeccmax of the quadriceps femoris muscle, n = 20 subjects had to pass three different pre-activation levels in a randomized order (level 1: 0.4 bar, level 2: 0.8 bar, level 3: 1.2 bar). After adjusting the standardized pre-pressure by pushing against the interface, an impulse-like load impacted on the distal tibia of the subject. During this, the xpAFeccmax was detected. The maximal voluntary isometric contraction (MVIC) was also measured. The torque values of the xpAFeccmax were compared with regard to the pre-activation levels. The results show a significant positive relation between the pre-activation of the quadriceps femoris muscle and the xpAFeccmax (male: p = 0.000, η2= 0.683; female: p = 0.000, η2= 0.907). The average percentage increase of torque amounted +28.15 ± 25.4% between MVIC and xpAFeccmax with pre-pressure level 1, +12.09 ± 7.9% for the xpAFeccmax comparing pre-pressure levels 1 vs. 2 and +2.98 ± 4.2% comparing levels 2 and 3. A higher but not maximal muscular activation prior to a fast impacting eccentric load seems to produce an immediate increase of force outcome. Different possible physiological explanatory approaches and the use as a potential training method are discussed.
The improvement of power is an objective in training of athletes. In order to detect effective methods of exercise, basic research is required regarding the mechanisms of muscular activity. The purpose of this study is to investigate whether or not a muscular pre-activation prior to an external impulse-like force impact has an effect on the maximal explosive eccentric Adaptive Force (xpAFeccmax). This power capability combines different probable power enhancing mechanisms. To measure the xpAFeccmax an innovative pneumatic device was used. During measuring, the subject tries to hold an isometric position as long as possible. In the moment in which the subjects’ maximal isometric holding strength is exceeded, it merges into eccentric muscle action. This process is very close to motions in sports, where an adaptation of the neuromuscular system is required, e.g., force impacts caused by uneven surfaces during skiing. For investigating the effect of pre-activation on the xpAFeccmax of the quadriceps femoris muscle, n = 20 subjects had to pass three different pre-activation levels in a randomized order (level 1: 0.4 bar, level 2: 0.8 bar, level 3: 1.2 bar). After adjusting the standardized pre-pressure by pushing against the interface, an impulse-like load impacted on the distal tibia of the subject. During this, the xpAFeccmax was detected. The maximal voluntary isometric contraction (MVIC) was also measured. The torque values of the xpAFeccmax were compared with regard to the pre-activation levels. The results show a significant positive relation between the pre-activation of the quadriceps femoris muscle and the xpAFeccmax (male: p = 0.000, η2= 0.683; female: p = 0.000, η2= 0.907). The average percentage increase of torque amounted +28.15 ± 25.4% between MVIC and xpAFeccmax with pre-pressure level 1, +12.09 ± 7.9% for the xpAFeccmax comparing pre-pressure levels 1 vs. 2 and +2.98 ± 4.2% comparing levels 2 and 3. A higher but not maximal muscular activation prior to a fast impacting eccentric load seems to produce an immediate increase of force outcome. Different possible physiological explanatory approaches and the use as a potential training method are discussed.
Background
Isometric muscle actions can be performed either by initiating the action, e.g., pulling on an immovable resistance (PIMA), or by reacting to an external load, e.g., holding a weight (HIMA). In the present study, it was mainly examined if these modalities could be differentiated by oxygenation variables as well as by time to task failure (TTF). Furthermore, it was analyzed if variables are changed by intermittent voluntary muscle twitches during weight holding (Twitch). It was assumed that twitches during a weight holding task change the character of the isometric muscle action from reacting (≙ HIMA) to acting (≙ PIMA).
Methods
Twelve subjects (two drop outs) randomly performed two tasks (HIMA vs. PIMA or HIMA vs. Twitch, n = 5 each) with the elbow flexors at 60% of maximal torque maintained until muscle failure with each arm. Local capillary venous oxygen saturation (SvO2) and relative hemoglobin amount (rHb) were measured by light spectrometry.
Results
Within subjects, no significant differences were found between tasks regarding the behavior of SvO2 and rHb, the slope and extent of deoxygenation (max. SvO2 decrease), SvO2 level at global rHb minimum, and time to SvO2 steady states. The TTF was significantly longer during Twitch and PIMA (incl. Twitch) compared to HIMA (p = 0.043 and 0.047, respectively). There was no substantial correlation between TTF and maximal deoxygenation independently of the task (r = − 0.13).
Conclusions
HIMA and PIMA seem to have a similar microvascular oxygen and blood supply. The supply might be sufficient, which is expressed by homeostatic steady states of SvO2 in all trials and increases in rHb in most of the trials. Intermittent voluntary muscle twitches might not serve as a further support but extend the TTF. A changed neuromuscular control is discussed as possible explanation.
Background
Isometric muscle actions can be performed either by initiating the action, e.g., pulling on an immovable resistance (PIMA), or by reacting to an external load, e.g., holding a weight (HIMA). In the present study, it was mainly examined if these modalities could be differentiated by oxygenation variables as well as by time to task failure (TTF). Furthermore, it was analyzed if variables are changed by intermittent voluntary muscle twitches during weight holding (Twitch). It was assumed that twitches during a weight holding task change the character of the isometric muscle action from reacting (≙ HIMA) to acting (≙ PIMA).
Methods
Twelve subjects (two drop outs) randomly performed two tasks (HIMA vs. PIMA or HIMA vs. Twitch, n = 5 each) with the elbow flexors at 60% of maximal torque maintained until muscle failure with each arm. Local capillary venous oxygen saturation (SvO2) and relative hemoglobin amount (rHb) were measured by light spectrometry.
Results
Within subjects, no significant differences were found between tasks regarding the behavior of SvO2 and rHb, the slope and extent of deoxygenation (max. SvO2 decrease), SvO2 level at global rHb minimum, and time to SvO2 steady states. The TTF was significantly longer during Twitch and PIMA (incl. Twitch) compared to HIMA (p = 0.043 and 0.047, respectively). There was no substantial correlation between TTF and maximal deoxygenation independently of the task (r = − 0.13).
Conclusions
HIMA and PIMA seem to have a similar microvascular oxygen and blood supply. The supply might be sufficient, which is expressed by homeostatic steady states of SvO2 in all trials and increases in rHb in most of the trials. Intermittent voluntary muscle twitches might not serve as a further support but extend the TTF. A changed neuromuscular control is discussed as possible explanation.
Multicomponent cardiac rehabilitation in patients after transcatheter aortic valve implantation
(2017)
Background: In the last decade, transcatheter aortic valve implantation has become a promising treatment modality for patients with aortic stenosis and a high surgical risk. Little is known about influencing factors of function and quality of life during multicomponent cardiac rehabilitation. Methods: From October 2013 to July 2015, patients with elective transcatheter aortic valve implantation and a subsequent inpatient cardiac rehabilitation were enrolled in the prospective cohort multicentre study. Frailty-Index (including cognition, nutrition, autonomy and mobility), Short Form-12 (SF-12), six-minute walk distance (6MWD) and maximum work load in bicycle ergometry were performed at admission and discharge of cardiac rehabilitation. The relation between patient characteristics and improvements in 6MWD, maximum work load or SF-12 scales were studied univariately and multivariately using regression models. Results: One hundred and thirty-six patients (80.6 +/- 5.0 years, 47.8% male) were enrolled. 6MWD and maximum work load increased by 56.3 +/- 65.3 m (p < 0.001) and 8.0 +/- 14.9 watts (p < 0.001), respectively. An improvement in SF-12 (physical 2.5 +/- 8.7, p = 0.001, mental 3.4 +/- 10.2, p = 0.003) could be observed. In multivariate analysis, age and higher education were significantly associated with a reduced 6MWD, whereas cognition and obesity showed a positive predictive value. Higher cognition, nutrition and autonomy positively influenced the physical scale of SF-12. Additionally, the baseline values of SF-12 had an inverse impact on the change during cardiac rehabilitation. Conclusions: Cardiac rehabilitation can improve functional capacity as well as quality of life and reduce frailty in patients after transcatheter aortic valve implantation. An individually tailored therapy with special consideration of cognition and nutrition is needed to maintain autonomy and empower octogenarians in coping with challenges of everyday life.
Childhood compared to adolescence and adulthood is characterized by high neuroplasticity represented by accelerated cognitive maturation and rapid cognitive developmental trajectories. Natural growth, biological maturation and permanent interaction with the physical and social environment fosters motor and cognitive development in children. Of note, the promotion of physical activity, physical fitness, and motor skill learning at an early age is mandatory first, as these aspects are essential for a healthy development and an efficient functioning in everyday life across the life span and second, physical activity behaviors and lifestyle habits tend to track from childhood into adulthood.
The main objective of the present thesis was to optimize and deepen the knowledge of motor and cognitive performance in young children and to develop an effective and age-appropriate exercise program feasible for the implementation in kindergarten and preschool settings. A systematic review with meta-analysis was conducted to examine the effectiveness of fundamental movement skill and exercise interventions in healthy preschool-aged children. Further, the relation between measures of physical fitness (i.e., static balance, muscle strength, power, and coordination) and attention as one domain of cognitive performance in preschool-aged children was analyzed. Subsequently, effects of a strength-dominated kindergarten-based exercise program on physical fitness components (i.e., static balance, muscle strength, power, and coordination) and cognitive performance (i.e., attention) compared to a usual kindergarten curriculum was examined.
The systematic review included trials focusing on healthy young children in kindergarten or preschool settings that applied fundamental movement skill-enhancing intervention programs of at least 4 weeks and further reported standardized motor skill outcome measures for the intervention and the control group. Children aged 4-6 years from three kindergartens participated in the cross-sectional and the longitudinal study. Product-orientated measures were conducted for the assessment of muscle strength (i.e., handgrip strength), muscle power (i.e., standing long jump), balance (i.e., timed single-leg stand), coordination (hopping on right/left leg), and attentional span (i.e., “Konzentrations-Handlungsverfahren für Vorschulkinder” [concentration-action procedure for preschoolers]).
With regards to the scientific literature, exercise and fundamental movement skill interventions are an effective method to promote overall proficiency in motor skills (i.e., object control and locomotor skills) in preschool children particularly when conducted by external experts with a duration of 4 weeks to 5 months. Moreover, significant medium associations were found between the composite score of physical fitness and attention as well as between coordination separately and attention in children aged 4-6 years. A 10-weeks strength-dominated exercise program implemented in kindergarten and preschool settings by educated and trained kindergarten teachers revealed significant improvements for the standing long jump test and the Konzentrations-Handlungsverfahren of intervention children compared to children of the control group.
The findings of the present thesis imply that fundamental movement skill and exercise interventions improve motor skills (i.e., locomotor and object control skills). Nonetheless, more high-quality research is needed. Additionally, physical fitness, particularly high performance in complex fitness components (i.e., coordination measured with the hopping on one leg test), tend to predict attention in preschool age. Furthermore, an exercise program including strength-dominated exercises, fundamental movement skills and elements of gymnastics has a beneficial effect on jumping performance with a concomitant trend toward improvements in attentional capacity in healthy preschool children. Finally, it is recommended to start early with the integration of muscular fitness (i.e., muscle strength, muscle power, muscular endurance) next to coordination, agility, balance, and fundamental movement skill exercises into regular physical activity curriculums in kindergarten settings.
Background
This cluster-randomised monocentric controlled trial focuses on improving the uptake symptoms of mental health care in adolescents with chronic medical conditions who have been identified by screening to have depression or anxiety. The study aims to determine the efficacy of motivational interviewing (MI) delivered by trained physicians to increase 12- to 20-year-old adolescents’ utilisation of psychological health care for symptoms of anxiety or depression.
Methods/design
In this single-centre approach, n = 1,000 adolescents will be screened (using PHQ-9 and GAD-7), and adolescents with results indicative of anxiety or depressive symptoms (n = 162) will be advised to seek psychological health care in clusters from treating physicians in specialised outpatient departments. Participants who screen positive will receive either two sessions of MI or treatment as usual (TAU; regarded as the typical daily clinical practice), which is focused on recommending them to seek psychological health care for further evaluation. MI efficacy will be compared to the current TAU as the control condition. The primary outcome is the utilisation rate of psychological health care after counselling by an MI-trained physician vs. an untrained physician. Additionally, reasons for not claiming psychological support and changes in disease-related parameters will be evaluated in a 6-month follow-up session.
Discussion
This trial will evaluate the feasibility of MI as a way to improve the utilisation of mental health-care services by adolescents who need further support other than that provided by standard care for chronic diseases. Physicians offering MI to adolescents may serve as a model for optimising health-care management in daily clinical practice, which may improve adolescents’ long-term well-being by improving adherence to medical treatment and preventing negative lifelong consequences into adulthood.
Research on problem solving offers insights into how humans process task-related information and which strategies they use (Newell and Simon, 1972; Öllinger et al., 2014). Problem solving can be defined as the search for possible changes in one's mind (Kahneman, 2003). In a recent study, Adams et al. (2021) assessed whether the predominant problem solving strategy when making changes involves adding or subtracting elements. In order to do this, they used several examples of simple problems, such as editing text or making visual patterns symmetrical, either in naturalistic settings or on-line. The essence of the authors' findings is a strong preference to add rather than subtract elements across a diverse range of problems, including the stabilizing of artifacts, creating symmetrical patterns, or editing texts. More specifically, they succeeded in demonstrating that “participants were less likely to identify advantageous subtractive changes when the task did not (vs. did) cue them to consider subtraction, when they had only one opportunity (vs. several) to recognize the shortcomings of an additive search strategy or when they were under a higher (vs. lower) cognitive load” (Adams et al., 2021, p. 258).
Addition and subtraction are generally defined as de-contextualized mathematical operations using abstract symbols (Russell, 1903/1938). Nevertheless, understanding of both symbols and operations is informed by everyday activities, such as making or breaking objects (Lakoff and Núñez, 2000; Fischer and Shaki, 2018). The universal attribution of “addition bias” or “subtraction neglect” to problem solving activities is perhaps a convenient shorthand but it overlooks influential framing effects beyond those already acknowledged in the report and the accompanying commentary (Meyvis and Yoon, 2021).
Most importantly, while Adams et al.'s study addresses an important issue, their very method of verbally instructing participants, together with lack of control over several known biases, might render their findings less than conclusive. Below, we discuss our concerns that emerged from the identified biases, namely those regarding the instructions and the experimental materials. Moreover, we refer to research from mathematical cognition that provides new insights into Adams et al.'s findings.
Research on problem solving offers insights into how humans process task-related information and which strategies they use (Newell and Simon, 1972; Öllinger et al., 2014). Problem solving can be defined as the search for possible changes in one's mind (Kahneman, 2003). In a recent study, Adams et al. (2021) assessed whether the predominant problem solving strategy when making changes involves adding or subtracting elements. In order to do this, they used several examples of simple problems, such as editing text or making visual patterns symmetrical, either in naturalistic settings or on-line. The essence of the authors' findings is a strong preference to add rather than subtract elements across a diverse range of problems, including the stabilizing of artifacts, creating symmetrical patterns, or editing texts. More specifically, they succeeded in demonstrating that “participants were less likely to identify advantageous subtractive changes when the task did not (vs. did) cue them to consider subtraction, when they had only one opportunity (vs. several) to recognize the shortcomings of an additive search strategy or when they were under a higher (vs. lower) cognitive load” (Adams et al., 2021, p. 258).
Addition and subtraction are generally defined as de-contextualized mathematical operations using abstract symbols (Russell, 1903/1938). Nevertheless, understanding of both symbols and operations is informed by everyday activities, such as making or breaking objects (Lakoff and Núñez, 2000; Fischer and Shaki, 2018). The universal attribution of “addition bias” or “subtraction neglect” to problem solving activities is perhaps a convenient shorthand but it overlooks influential framing effects beyond those already acknowledged in the report and the accompanying commentary (Meyvis and Yoon, 2021).
Most importantly, while Adams et al.'s study addresses an important issue, their very method of verbally instructing participants, together with lack of control over several known biases, might render their findings less than conclusive. Below, we discuss our concerns that emerged from the identified biases, namely those regarding the instructions and the experimental materials. Moreover, we refer to research from mathematical cognition that provides new insights into Adams et al.'s findings.
Tracheotomierte Patienten, die sowohl eine Dysphagie als auch respiratorische Defizite aufweisen, haben nach der Dekanülierung häufig Probleme, sich an die translaryngeale Atmung anzupassen. Wir entwickelten ein Dekanülierungsprotokoll für diese Patientengruppe, das optional in unser bestehendes Trachealkanülenmanagement integriert werden kann. Erfüllt ein Patient die hierfür definierten Kriterien, so erfolgt unter laryngoskopischer Kontrolle die Einlage eines Platzhalters, der bis zu 3 Tage in situ verbleibt. Während dieser Probedekanülierungsphase werden die respiratorischen Funktionen und das Speichelmanagement engmaschig überwacht. Auf der Grundlage dieser Evaluation wird dann die Entscheidung für oder gegen eine endgültige Dekanülierung getroffen. Wir stellen den Ablauf, die Kriterienkataloge und die Evaluationsparameter für diese Probedekanülierungsphase vor und illustrieren den Ablauf anhand von 2 Fallbeispielen.
The evaluation of process-oriented cognitive theories through time-ordered observations is crucial for the advancement of cognitive science. The findings presented herein integrate insights from research on eye-movement control and sentence comprehension during reading, addressing challenges in modeling time-ordered data, statistical inference, and interindividual variability. Using kernel density estimation and a pseudo-marginal likelihood for fixation durations and locations, a likelihood implementation of the SWIFT model of eye-movement control during reading (Engbert et al., Psychological Review, 112, 2005, pp. 777–813) is proposed. Within the broader framework of data assimilation, Bayesian parameter inference with adaptive Markov Chain Monte Carlo techniques is facilitated for reliable model fitting. Across the different studies, this framework has shown to enable reliable parameter recovery from simulated data and prediction of experimental summary statistics. Despite its complexity, SWIFT can be fitted within a principled Bayesian workflow, capturing interindividual differences and modeling experimental effects on reading across different geometrical alterations of text. Based on these advancements, the integrated dynamical model SEAM is proposed, which combines eye-movement control, a traditionally psychological research area, and post-lexical language processing in the form of cue-based memory retrieval (Lewis & Vasishth, Cognitive Science, 29, 2005, pp. 375–419), typically the purview of psycholinguistics. This proof-of-concept integration marks a significant step forward in natural language comprehension during reading and suggests that the presented methodology can be useful to develop complex cognitive dynamical models that integrate processes at levels of perception, higher cognition, and (oculo-)motor control. These findings collectively advance process-oriented cognitive modeling and highlight the importance of Bayesian inference, individual differences, and interdisciplinary integration for a holistic understanding of reading processes. Implications for theory and methodology, including proposals for model comparison and hierarchical parameter inference, are briefly discussed.
Introduction: Cardiac rehabilitation is designed for patients suffering from cardiovascular diseases or functional disabilities. The aim of a cardiac rehabilitation is to improve overall physical health, psychological well-being, physical function, the ability to participate in social life and help patients to change their habits. Regarding the heterogeneity of these aims measuring of the effect of cardiac rehabilitation is still a challenge. This study recommends a concept to assess the effects of cardiac rehabilitation regarding the individual change of relevant quality indicators.
Methods: With EVA-Reha; cardiac rehabilitation the Medical Advisory Service of Statutory Health Insurance Funds in Rhineland-Palatinate, Alzey (MDK Rheinland-Pfalz) developed a software to collect data set including sociodemographic and diagnostic data and also the results of specific assessments. The project was funded by the Techniker Krankenkasse, Hamburg, and supported by participating rehabilitation centers. From 01. July 2010 to 30. June 2011 1309 patients (age 71.5 years, 76.1% men) from 13 rehabilitation centers were consecutively enrolled. 13 quality indicators in 3 scales were developed for evaluation of cardiac rehabilitation: 1) cardiovascular risk factors (blood pressure, LDL cholesterol, triglycerides), 2) exercise capacity (resting heart rate, maximal exercise capacity, maximal walking distance, heart failure [NYHA classification], and angina pectoris [CCS classification]) and 3) subjective health (IRES-24: pain, somatic health, psychological wellbeing and depression as well as anxiety on the HADS). The study was prospective; data of patients were assessed at entry and discharge of rehabilitation. To measure the success of rehabilitation each parameter was graded in severity classes at entry and discharge. For each of the 13 quality indicators changes of severity class were rated in a rating matrix. For indicators without a requirement for medical care neither at entry nor at discharge no rating was performed.
Results: The grading into severity classes as well as the minimal important differences were given for the 13 quality indicators. The result of rehabilitation can be demonstrated in suitable form by means of rating of the 13 quality indicators according to a clinical population. The rating model differs well between clinically changed and unchanged patients for the quality indicators.
Conclusion: The result of cardiac rehabilitation can be assessed with 13 quality indicators measured at entry and discharge of the rehabilitation program. If a change into a more favorable category at the end of rehabilitation could be achieved it was counted as a success. The 13 quality indicators can be used to assess the individual result as well as the result of a population - e.g. all patients of a clinic in a specific time period. In addition, the assessment and rating of relevant quality indicators can be used for comparisons of rehabilitation centers.
The present study focuses on an innovative approach in measuring the mechanical oscillations of pre-loaded Achilles tendon by using Mechanotendography (MTG) during application of a short yet powerful mechanical pressure impact. This was applied on the forefoot from the plantar side in direction of dorsiflexion, while the subject stood on the ball of the forefoot on one leg. Participants with Achilles tendinopathy (AT; n = 10) were compared to healthy controls (Con; n = 10). Five trials were performed on each side of the body. For evaluation, two intervals after the impulse began (0-100ms; 30-100ms) were cut from the MTG and pressure raw signals. The intrapersonal variability between the five trials in both intervals were evaluated using the arithmetic mean and coefficient of variation of the mean correlation (Spearman rank correlation) and the normalized averaged mean distances, respectively. The AT-group showed a significantly reduced variability in MTG compared to the Con-group (from p = 0.006 to p = 0.028 for different parameters). The 95% confidence intervals (CI) of MTG results were disjoint, whereas the 95% CIs of the pressure signals were similar (p = 0.192 to p = 0.601). We suggest from this work that the variability of mechanical tendon oscillations could be an indicative parameter of an altered Achilles tendon functionality.
The present study focuses on an innovative approach in measuring the mechanical oscillations of pre-loaded Achilles tendon by using Mechanotendography (MTG) during application of a short yet powerful mechanical pressure impact. This was applied on the forefoot from the plantar side in direction of dorsiflexion, while the subject stood on the ball of the forefoot on one leg. Participants with Achilles tendinopathy (AT; n = 10) were compared to healthy controls (Con; n = 10). Five trials were performed on each side of the body. For evaluation, two intervals after the impulse began (0-100ms; 30-100ms) were cut from the MTG and pressure raw signals. The intrapersonal variability between the five trials in both intervals were evaluated using the arithmetic mean and coefficient of variation of the mean correlation (Spearman rank correlation) and the normalized averaged mean distances, respectively. The AT-group showed a significantly reduced variability in MTG compared to the Con-group (from p = 0.006 to p = 0.028 for different parameters). The 95% confidence intervals (CI) of MTG results were disjoint, whereas the 95% CIs of the pressure signals were similar (p = 0.192 to p = 0.601). We suggest from this work that the variability of mechanical tendon oscillations could be an indicative parameter of an altered Achilles tendon functionality.
The term Adaptive Force (AF) describes the capability of adaptation of the nerve-muscle-system to externally applied forces during isometric and eccentric muscle action. This ability plays an important role in real life motions as well as in sports. The focus of this paper is on the specific measurement method of this neuromuscular action, which can be seen as innovative. A measuring system based on the use of compressed air was constructed and evaluated for this neuromuscular function. It depends on the physical conditions of the subject, at which force level it deviates from the quasi isometric position and merges into eccentric muscle action. The device enables – in contrast to the isokinetic systems – a measure of strength without forced motion. Evaluation of the scientific quality criteria of the devices was done by measurements regarding the intra- and interrater-, the test-retest-reliability and fatiguing measurements. Comparisons of the pneumatic device with a dynamometer were also done. Looking at the mechanical evaluation, the results show a high level of consistency (r²=0.94 to 0.96). The parallel test reliability delivers a very high and significant correlation (ρ=0.976; p=0.000). Including the biological system, the concordance of three different raters is very high (p=0.001, Cronbachs alpha α=0.987). The test retest with 4 subjects over five weeks speaks for the reliability of the device in showing no statistically significant differences. These evaluations indicate that the scientific evaluation criteria are fulfilled. The specific feature of this system is that an isometric position can be maintained while the externally impacting force rises. Moreover, the device can capture concentric, static and eccentric strength values. Fields of application are performance diagnostics in sports and medicine.
The term Adaptive Force (AF) describes the capability of adaptation of the nerve-muscle-system to externally applied forces during isometric and eccentric muscle action. This ability plays an important role in real life motions as well as in sports. The focus of this paper is on the specific measurement method of this neuromuscular action, which can be seen as innovative. A measuring system based on the use of compressed air was constructed and evaluated for this neuromuscular function. It depends on the physical conditions of the subject, at which force level it deviates from the quasi isometric position and merges into eccentric muscle action. The device enables – in contrast to the isokinetic systems – a measure of strength without forced motion. Evaluation of the scientific quality criteria of the devices was done by measurements regarding the intra- and interrater-, the test-retest-reliability and fatiguing measurements. Comparisons of the pneumatic device with a dynamometer were also done. Looking at the mechanical evaluation, the results show a high level of consistency (r²=0.94 to 0.96). The parallel test reliability delivers a very high and significant correlation (ρ=0.976; p=0.000). Including the biological system, the concordance of three different raters is very high (p=0.001, Cronbachs alpha α=0.987). The test retest with 4 subjects over five weeks speaks for the reliability of the device in showing no statistically significant differences. These evaluations indicate that the scientific evaluation criteria are fulfilled. The specific feature of this system is that an isometric position can be maintained while the externally impacting force rises. Moreover, the device can capture concentric, static and eccentric strength values. Fields of application are performance diagnostics in sports and medicine.
Background
Maximal isokinetic strength ratios of joint flexors and extensors are important parameters to indicate the level of muscular balance at the joint. Further, in combat sports athletes, upper and lower limb muscle strength is affected by the type of sport. Thus, this study aimed to examine the differences in maximal isokinetic strength of the flexors and extensors and the corresponding flexor–extensor strength ratios of the elbows and knees in combat sports athletes.
Method
Forty male participants (age = 22.3 ± 2.5 years) from four different combat sports (amateur boxing, taekwondo, karate, and judo; n = 10 per sport) were tested for eccentric peak torque of the elbow/knee flexors (EF/KF) and concentric peak torque of the elbow/knee extensors (EE/KE) at three different angular velocities (60, 120, and 180°/s) on the dominant and non-dominant side using an isokinetic device.
Results
Analyses revealed significant, large-sized group × velocity × limb interactions for EF, EE, and EF–EE ratio, KF, KE, and KF–KE ratio (p ≤ 0.03; 0.91 ≤ d ≤ 1.75). Post-hoc analyses indicated that amateur boxers displayed the largest EE strength values on the non-dominant side at ≤ 120°/s and the dominant side at ≥ 120°/s (p < 0.03; 1.21 ≤ d ≤ 1.59). The largest EF–EE strength ratios were observed on amateur boxers’ and judokas’ non-dominant side at ≥ 120°/s (p < 0.04; 1.36 ≤ d ≤ 2.44). Further, we found lower KF–KE strength measures in karate (p < 0.04; 1.12 ≤ d ≤ 6.22) and judo athletes (p ≤ 0.03; 1.60 ≤ d ≤ 5.31) particularly on the non-dominant side.
Conclusions
The present findings indicated combat sport-specific differences in maximal isokinetic strength measures of EF, EE, KF, and KE particularly in favor of amateur boxers on the non-dominant side.
Background
Maximal isokinetic strength ratios of joint flexors and extensors are important parameters to indicate the level of muscular balance at the joint. Further, in combat sports athletes, upper and lower limb muscle strength is affected by the type of sport. Thus, this study aimed to examine the differences in maximal isokinetic strength of the flexors and extensors and the corresponding flexor–extensor strength ratios of the elbows and knees in combat sports athletes.
Method
Forty male participants (age = 22.3 ± 2.5 years) from four different combat sports (amateur boxing, taekwondo, karate, and judo; n = 10 per sport) were tested for eccentric peak torque of the elbow/knee flexors (EF/KF) and concentric peak torque of the elbow/knee extensors (EE/KE) at three different angular velocities (60, 120, and 180°/s) on the dominant and non-dominant side using an isokinetic device.
Results
Analyses revealed significant, large-sized group × velocity × limb interactions for EF, EE, and EF–EE ratio, KF, KE, and KF–KE ratio (p ≤ 0.03; 0.91 ≤ d ≤ 1.75). Post-hoc analyses indicated that amateur boxers displayed the largest EE strength values on the non-dominant side at ≤ 120°/s and the dominant side at ≥ 120°/s (p < 0.03; 1.21 ≤ d ≤ 1.59). The largest EF–EE strength ratios were observed on amateur boxers’ and judokas’ non-dominant side at ≥ 120°/s (p < 0.04; 1.36 ≤ d ≤ 2.44). Further, we found lower KF–KE strength measures in karate (p < 0.04; 1.12 ≤ d ≤ 6.22) and judo athletes (p ≤ 0.03; 1.60 ≤ d ≤ 5.31) particularly on the non-dominant side.
Conclusions
The present findings indicated combat sport-specific differences in maximal isokinetic strength measures of EF, EE, KF, and KE particularly in favor of amateur boxers on the non-dominant side.
The aim of this study was to establish maturation-, age-, and sex-specific anthropometric and physical fitness percentile reference values of young elite athletes from various sports. Anthropometric (i.e., standing and sitting body height, body mass, body mass index) and physical fitness (i.e., countermovement jump, drop jump, change-of-direction speed [i.e., T-test], trunk muscle endurance [i.e., ventral Bourban test], dynamic lower limbs balance [i.e., Y-balance test], hand grip strength) of 703 male and female elite young athletes aged 8–18 years were collected to aggregate reference values according to maturation, age, and sex. Findings indicate that body height and mass were significantly higher (p<0.001; 0.95≤d≤1.74) in more compared to less mature young athletes as well as with increasing chronological age (p<0.05; 0.66≤d≤3.13). Furthermore, male young athletes were significantly taller and heavier compared to their female counterparts (p<0.001; 0.34≤d≤0.50). In terms of physical fitness, post-pubertal athletes showed better countermovement jump, drop jump, change-of-direction, and handgrip strength performances (p<0.001; 1.57≤d≤8.72) compared to pubertal athletes. Further, countermovement jump, drop jump, change-of-direction, and handgrip strength performances increased with increasing chronological age (p<0.05; 0.29≤d≤4.13). In addition, male athletes outperformed their female counterpart in the countermovement jump, drop jump, change-of-direction, and handgrip strength (p<0.05; 0.17≤d≤0.76). Significant age by sex interactions indicate that sex-specific differences were even more pronounced with increasing age. Conclusively, body height, body mass, and physical fitness increased with increasing maturational status and chronological age. Sex-specific differences appear to be larger as youth grow older. Practitioners can use the percentile values as approximate benchmarks for talent identification and development.
The aim of this study was to establish maturation-, age-, and sex-specific anthropometric and physical fitness percentile reference values of young elite athletes from various sports. Anthropometric (i.e., standing and sitting body height, body mass, body mass index) and physical fitness (i.e., countermovement jump, drop jump, change-of-direction speed [i.e., T-test], trunk muscle endurance [i.e., ventral Bourban test], dynamic lower limbs balance [i.e., Y-balance test], hand grip strength) of 703 male and female elite young athletes aged 8–18 years were collected to aggregate reference values according to maturation, age, and sex. Findings indicate that body height and mass were significantly higher (p<0.001; 0.95≤d≤1.74) in more compared to less mature young athletes as well as with increasing chronological age (p<0.05; 0.66≤d≤3.13). Furthermore, male young athletes were significantly taller and heavier compared to their female counterparts (p<0.001; 0.34≤d≤0.50). In terms of physical fitness, post-pubertal athletes showed better countermovement jump, drop jump, change-of-direction, and handgrip strength performances (p<0.001; 1.57≤d≤8.72) compared to pubertal athletes. Further, countermovement jump, drop jump, change-of-direction, and handgrip strength performances increased with increasing chronological age (p<0.05; 0.29≤d≤4.13). In addition, male athletes outperformed their female counterpart in the countermovement jump, drop jump, change-of-direction, and handgrip strength (p<0.05; 0.17≤d≤0.76). Significant age by sex interactions indicate that sex-specific differences were even more pronounced with increasing age. Conclusively, body height, body mass, and physical fitness increased with increasing maturational status and chronological age. Sex-specific differences appear to be larger as youth grow older. Practitioners can use the percentile values as approximate benchmarks for talent identification and development.
Loss to follow-up in a randomized controlled trial study for pediatric weight management (EPOC)
(2016)
Background
Attrition is a serious problem in intervention studies. The current study analyzed the attrition rate during follow-up in a randomized controlled pediatric weight management program (EPOC study) within a tertiary care setting.
Methods
Five hundred twenty-three parents and their 7–13-year-old children with obesity participated in the randomized controlled intervention trial. Follow-up data were assessed 6 and 12 months after the end of treatment. Attrition was defined as providing no objective weight data. Demographic and psychological baseline characteristics were used to predict attrition at 6- and 12-month follow-up using multivariate logistic regression analyses.
Results
Objective weight data were available for 49.6 (67.0) % of the children 6 (12) months after the end of treatment. Completers and non-completers at the 6- and 12-month follow-up differed in the amount of weight loss during their inpatient stay, their initial BMI-SDS, educational level of the parents, and child’s quality of life and well-being. Additionally, completers supported their child more than non-completers, and at the 12-month follow-up, families with a more structured eating environment were less likely to drop out. On a multivariate level, only educational background and structure of the eating environment remained significant.
Conclusions
The minor differences between the completers and the non-completers suggest that our retention strategies were successful. Further research should focus on prevention of attrition in families with a lower educational background.
Loss to follow-up in a randomized controlled trial study for pediatric weight management (EPOC)
(2016)
Background
Attrition is a serious problem in intervention studies. The current study analyzed the attrition rate during follow-up in a randomized controlled pediatric weight management program (EPOC study) within a tertiary care setting.
Methods
Five hundred twenty-three parents and their 7–13-year-old children with obesity participated in the randomized controlled intervention trial. Follow-up data were assessed 6 and 12 months after the end of treatment. Attrition was defined as providing no objective weight data. Demographic and psychological baseline characteristics were used to predict attrition at 6- and 12-month follow-up using multivariate logistic regression analyses.
Results
Objective weight data were available for 49.6 (67.0) % of the children 6 (12) months after the end of treatment. Completers and non-completers at the 6- and 12-month follow-up differed in the amount of weight loss during their inpatient stay, their initial BMI-SDS, educational level of the parents, and child’s quality of life and well-being. Additionally, completers supported their child more than non-completers, and at the 12-month follow-up, families with a more structured eating environment were less likely to drop out. On a multivariate level, only educational background and structure of the eating environment remained significant.
Conclusions
The minor differences between the completers and the non-completers suggest that our retention strategies were successful. Further research should focus on prevention of attrition in families with a lower educational background.
Previous research has indicated that executive function (EF) is negatively associated with aggressive behavior in childhood. However, there is a lack of longitudinal studies that have examined the effect of deficits in EF on aggression over time and taken into account different forms and functions of aggression at the same time. Furthermore, only few studies have analyzed the role of underlying variables that may explain the association between EF and aggression. The present study examined the prospective paths between EF and different forms (physical and relational) and functions (reactive and proactive) of aggression. The habitual experience of anger was examined as a potential underlying mechanism of the link between EF and aggression, because the tendency to get angry easily has been found to be both a consequence of deficits in EF and a predictor of aggression. The study included 1,652 children (between 6 and 11 years old at the first time point), who were followed over three time points (T1, T2, and T3) covering 3 years. At T1, a latent factor of EF comprised measures of planning, rated via teacher reports, as well as inhibition, set shifting, and working-memory updating, assessed experimentally. Habitual anger experience was assessed via parent reports at T1 and T2. The forms and functions of aggression were measured via teacher reports at all three time points. Structural equation modeling revealed that EF at T1 predicted physical, relational, and reactive aggression at T3, but was unrelated to proactive aggression at T3. Furthermore, EF at T1 was indirectly linked to physical aggression at T3, mediated through habitual anger experience at T2. The results indicate that deficits in EF influence the later occurrence of aggression in middle childhood, and the tendency to get angry easily mediates this relation.