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Background: Although clinical supervision is considered to be a major component of the development and maintenance of psychotherapeutic competencies, and despite an increase in supervision research, the empirical evidence on the topic remains sparse.
Methods: Because most previous reviews lack methodological rigor, we aimed to review the status and quality of the empirical literature on clinical supervision, and to provide suggestions for future research. MEDLINE, PsycInfo and the Web of Science Core Collection were searched and the review was conducted according to current guidelines. From the review results, we derived suggestions for future research on clinical supervision.
Results: The systematic literature search identified 19 publications from 15 empirical studies. Taking into account the review results, the following suggestions for further research emerged: Supervision research would benefit from proper descriptions of how studies are conducted according to current guidelines, more methodologically rigorous empirical studies, the investigation of active supervision interventions, from taking diverse outcome domains into account, and from investigating supervision from a meta-theoretical perspective.
Conclusions: In all, the systematic review supported the notion that supervision research often lags behind psychotherapy research in general. Still, the results offer detailed starting points for further supervision research.
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.
Background: Agility in general and change-of-direction speed (CoD) in particular represent important performance determinants in elite soccer.
Objectives: The objectives of this study were to determine the effects of a 6-week neuromuscular training program on agility performance, and to determine differences in movement times between the slower and faster turning directions in elite soccer players. Materials and Methods: Twenty male elite soccer players from the Stade Rennais Football Club (Ligue 1, France) participated in this study. The players were randomly assigned to a neuromuscular training group (NTG, n = 10) or an active control (CG, n = 10) according to their playing position. NTG participated in a 6-week, twice per week neuromuscular training program that included CoD, plyometric and dynamic stability exercises. Neuromuscular training replaced the regular warm-up program. Each training session lasted 30 min. CG continued their regular training program. Training volume was similar between groups. Before and after the intervention, the two groups performed a reactive agility test that included 180° left and right body rotations followed by a 5-m linear sprint. The weak side was defined as the left/right turning direction that produced slower overall movement times (MT). Reaction time (RT) was assessed and defined as the time from the first appearance of a visual stimulus until the athlete’s first movement. MT corresponded to the time from the first movement until the athlete reached the arrival gate (5 m distance).
Results: No significant between-group baseline differences were observed for RT or MT. Significant group x time interactions were found for MT (p = 0.012, effect size = 0.332, small) for the slower and faster directions (p = 0.011, effect size = 0.627, moderate). Significant pre-to post improvements in MT were observed for NTG but not CG (p = 0.011, effect size = 0.877, moderate). For NTG, post hoc analyses revealed significant MT improvements for the slower (p = 0.012, effect size = 0.897, moderate) and faster directions (p = 0.017, effect size = 0.968, moderate).
Conclusion: Our results illustrate that 6 weeks of neuromuscular training with two sessions per week included in the warm-up program, significantly enhanced agility performance in elite soccer players. Moreover, improvements were found on both sides during body rotations. Thus, practitioners are advised to focus their training programs on both turning directions.
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.
Objectives
The aims of this study were to investigate the effects of a six-week in-season period of soccer training and games (congested period) on plasma volume variations (PV), hematological parameters, and physical fitness in elite players. In addition, we analyzed relationships between training load, hematological parameters and players’ physical fitness.
Methods
Eighteen elite players were evaluated before (T1) and after (T2) a six-week in-season period interspersed with 10 soccer matches. At T1 and T2, players performed the Yo-Yo intermittent recovery test level 1 (YYIR1), the repeated shuttle sprint ability test (RSSA), the countermovement jump test (CMJ), and the squat jump test (SJ). In addition, PV and hematological parameters (erythrocytes [M/mm3], hematocrit [%], hemoglobin [g/dl], mean corpuscular volume [fl], mean corpuscular hemoglobin content [pg], and mean hemoglobin concentration [%]) were assessed. Daily ratings of perceived exertion (RPE) were monitored in order to quantify the internal training load.
Results
From T1 to T2, significant performance declines were found for the YYIR1 (p<0.001, effect size [ES] = 0.5), RSSA (p<0.01, ES = 0.6) and SJ tests (p< 0.046, ES = 0.7). However, no significant changes were found for the CMJ (p = 0.86, ES = 0.1). Post-exercise, RSSA blood lactate (p<0.012, ES = 0.2) and PV (p<0.01, ES = 0.7) increased significantly from T1 to T2. A significant decrease was found from T1 to T2 for the erythrocyte value (p<0.002, ES = 0.5) and the hemoglobin concentration (p<0.018, ES = 0.8). The hematocrit percentage rate was also significantly lower (p<0.001, ES = 0.6) at T2. The mean corpuscular volume, mean corpuscular hemoglobin content and the mean hemoglobin content values were not statistically different from T1 to T2. No significant relationships were detected between training load parameters and percentage changes of hematological parameters. However, a significant relationship was observed between training load and changes in RSSA performance (r = -0.60; p<0.003).
Conclusions
An intensive period of “congested match play” over 6 weeks significantly compromised players’ physical fitness. These changes were not related to hematological parameters, even though significant alterations were detected for selected measures.
Alcohol in the Aging Brain
(2019)
As our society grows older new challenges for medicine and healthcare emerge. Agerelated changes of the body have been observed in essential body functions, particularly in the loco-motor system, in the cardiovascular system and in cognitive functions concerning both brain plasticity and changes in behavior. Nutrition and lifestyle, such as nicotine intake and chronic alcohol consumption, also contribute to biological changes in the brain. This review addresses the effect of alcohol consumption on cognitive decline, changes in brain plasticity in the aging brain and on cardiovascular health in aging. Thus, studies on the interplay of chronic alcohol intake and either cognitive decline or cognitive preservation are outlined. Because of the inconsistency in the literature of whether alcohol consumption preserves cognitive functions in the aging brain or whether it accelerates cognitive decline, it is crucial to consider individual contributing factors such as culture, health and lifestyle in future studies.
The concurrent performance of cognitive and postural tasks is particularly impaired in old adults and associated with an increased risk of falls. Biological aging of the cognitive and postural control system appears to be responsible for increased cognitive-motor interference effects. We examined neural and behavioral markers of motor-cognitive dual-task performance in young and old adults performing spatial one-back working memory single and dual tasks during semitandem stance. On the neural level, we used EEG to test for age-related modulations in the frequency domain related to cognitive-postural task load. Twenty-eight healthy young and 30 old adults participated in this study. The tasks included a postural single task, a cognitive-postural dual task, and a cognitive-postural triple task (cognitive dual-task with postural demands). Postural sway (i.e., total center of pressure displacements) was recorded in semistance position on an unstable surface that was placed on top of a force plate while performing cognitive tasks. Neural activation was recorded using a 64-channel mobile EEG system. EEG frequencies were attenuated by the baseline postural single-task condition and demarcated in nine Regions-of-Interest (ROIs), i.e., anterior, central, posterior, over the cortical midline, and both hemispheres. Our findings revealed impaired cognitive dual-task performance in old compared to young participants in the form of significantly lower cognitive performance in the triple-task condition. Furthermore, old adults compared with young adults showed significantly larger postural sway, especially in cognitive-postural task conditions. With respect to EEG frequencies, young compared to old participants showed significantly lower alpha-band activity in cognitive-cognitive-postural triple-task conditions compared with cognitive-postural dual tasks. In addition, with increasing task difficulty, we observed synchronized theta and delta frequencies, irrespective of age. Taskdependent alterations of the alpha frequency band were most pronounced over frontal and central ROIs, while alterations of the theta and delta frequency bands were found in frontal, central, and posterior ROIs. Theta and delta synchronization exhibited a decrease from anterior to posterior regions. For old adults, task difficulty was reflected by theta synchronization in the posterior ROI. For young adults, it was reflected by alpha desynchronization in bilateral anterior ROIs. In addition, we could not identify any effects of task difficulty and age on the beta frequency band. Our results shed light on age-related cognitive and postural declines and how they interact. Modulated alpha frequencies during high cognitive-postural task demands in young but not old adults might be reflective of a constrained neural adaptive potential in old adults. Future studies are needed to elucidate associations between the identified age-related performance decrements with task difficulty and changes in brain activity.
Purpose: To examine the effects of fatiguing isometric contractions on maximal eccentric strength and electromechanical delay (EMD) of the knee flexors in healthy young adults of different training status.
Methods: Seventy-five male participants (27.7 ± 5.0 years) were enrolled in this study and allocated to three experimental groups according to their training status: athletes (ATH, n = 25), physically active adults (ACT, n = 25), and sedentary participants (SED, n = 25). The fatigue protocol comprised intermittent isometric knee flexions (6-s contraction, 4-s rest) at 60% of the maximum voluntary contraction until failure. Pre- and post-fatigue, maximal eccentric knee flexor strength and EMDs of the biceps femoris, semimembranosus, and semitendinosus muscles were assessed during maximal eccentric knee flexor actions at 60, 180, and 300°/s angular velocity. An analysis of covariance was computed with baseline (unfatigued) data included as a covariate.
Results: Significant and large-sized main effects of group (p ≤ 0.017, 0.87 ≤ d ≤ 3.69) and/or angular velocity (p < 0.001, d = 1.81) were observed. Post hoc tests indicated that regardless of angular velocity, maximal eccentric knee flexor strength was lower and EMD was longer in SED compared with ATH and ACT (p ≤ 0.025, 0.76 ≤ d ≤ 1.82) and in ACT compared with ATH (p = ≤0.025, 0.76 ≤ d ≤ 1.82). Additionally, EMD at post-test was significantly longer at 300°/s compared with 60 and 180°/s (p < 0.001, 2.95 ≤ d ≤ 4.64) and at 180°/s compared with 60°/s (p < 0.001, d = 2.56), irrespective of training status.
Conclusion: The main outcomes revealed significantly higher maximal eccentric strength and shorter eccentric EMDs of knee flexors in individuals with higher training status (i.e., athletes) following fatiguing exercises. Therefore, higher training status is associated with better neuromuscular functioning (i.e., strength, EMD) of the hamstring muscles in fatigued condition. Future longitudinal studies are needed to substantiate the clinical relevance of these findings.
Idioms in the World
(2019)
Physical fatigue and pronated feet constitute two risk factors for running-related lower limb injuries. Accordingly, different running shoe companies designed anti-pronation shoes with medial support to limit over pronation in runners. However, there is little evidence on the effectiveness and clinical relevance of anti-pronation shoes. This study examined lower limb kinematics and kinetics in young female runners with pronated feet during running with antipronation versus regular (neutral) running shoes in unfatigued and fatigued condition. Twenty-six female runners aged 24.1±5.6 years with pronated feet volunteered to participate in this study. Kinetic (3D Kistler force plate) and kinematic analyses (Vicon motion analysis system) were conducted to record participants’ ground reaction forces and joint kinematics when running with anti-pronation compared with neutral running shoes. Physical fatigue was induced through an individualized submaximal running protocol on a motorized treadmill using rate of perceived exertion and heart rate monitoring. The statistical analyses indicated significant main effects of “footwear” for peak ankle inversion, peak ankle eversion, and peak hip internal rotation angles (p<0.03; d = 0.46–0.95). Pair-wise comparisons revealed a significantly greater peak ankle inversion angle (p<0.03; d = 0.95; 2.70°) and smaller peak eversion angle (p<0.03; d = 0.46; 2.53°) when running with anti-pronation shoes compared with neutral shoes. For kinetic data, significant main effects of “footwear” were found for peak ankle dorsiflexor moment, peak knee extensor moment, peak hip flexor moment, peak hip extensor moment, peak hip abductor moment, and peak hip internal rotator moment (p<0.02; d = 1.00–1.79). For peak positive hip power in sagittal and frontal planes and peak negative hip power in horizontal plane, we observed significant main effects of “footwear” (p<0.03; d = 0.92–1.06). Pairwise comparisons revealed that peak positive hip power in sagittal plane (p<0.03; d = 0.98; 2.39 w/kg), peak positive hip power in frontal plane (p = 0.014; d = 1.06; 0.54 w/kg), and peak negative hip power in horizontal plane (p<0.03; d = 0.92; 0.43 w/kg) were greater with anti-pronation shoes. Furthermore, the statistical analyses indicated significant main effects of “Fatigue” for peak ankle inversion, peak ankle eversion, and peak knee external rotation angles. Pair-wise comparisons revealed a fatigue-induced decrease in peak ankle inversion angle (p<0.01; d = 1.23; 2.69°) and a fatigue-induced increase in peak knee external rotation angle (p<0.05; d = 0.83; 5.40°). In addition, a fatigue-related increase was found for peak ankle eversion (p<0.01; d = 1.24; 2.67°). For kinetic data, we observed a significant main effect of “Fatigue” for knee flexor moment, knee internal rotator moment, and hip extensor moment (p<0.05; d = 0.83–1.01). The statistical analyses indicated significant a main effect of “Fatigue” for peak negative ankle power in sagittal plane (p<0.01; d = 1.25). Finally, we could not detect any significant footwear by fatigue interaction effects for all measures of joint kinetics and kinematics. Running in anti-pronation compared with neutral running shoes produced lower peak moments and powers in lower limb joints and better control in rear foot eversion. Physical fatigue increased peak moments and powers in lower limb joints irrespective of the type of footwear.
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.
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.
Regulatory focus is a motivational construct that describes humans’ motivational orientation during goal pursuit. It is conceptualized as a chronic, trait-like, as well as a momentary, state-like orientation. Whereas there is a large number of measures to capture chronic regulatory focus, measures for its momentary assessment are only just emerging. This paper presents the development and validation of a measure of Momentary–Chronic Regulatory Focus. Our development incorporates the distinction between self-guide and reference-point definitions of regulatory focus. Ideals and ought striving are the promotion and prevention dimension in the self-guide system; gain and non-loss regulatory focus are the respective dimensions within the reference-point system. Three-survey-based studies test the structure, psychometric properties, and validity of the measure in its version to assess chronic regulatory focus (two samples of working participants, N = 389, N = 672; one student sample [time 1, N = 105; time 2, n = 91]). In two further studies, an experience sampling study with students (N = 84, k = 1649) and a daily-diary study with working individuals (N = 129, k = 1766), the measure was applied to assess momentary regulatory focus. Multilevel analyses test the momentary measure’s factorial structure, provide support for its sensitivity to capture within-person fluctuations, and provide evidence for concurrent construct validity.
We aimed at unveiling the role of executive functions (EFs) and language-related skills in spelling for mono- versus multilingual primary school children. We focused on EF and language-related skills, in particular lexicon size and phonological awareness (PA), because these factors were found to predict spelling in studies predominantly conducted with monolinguals, and because multilingualism can modulate these factors. There is evidence for (a) a bilingual advantage in EF due to constant high cognitive demands through language control, (b) a smaller mental lexicon in German and (c) possibly better PA. Multilinguals in Germany show on average poorer German language proficiency, what can influence performance on language-based tasks negatively. Thus, we included two spelling tasks to tease apart spelling based on lexical knowledge (i.e., word spelling) from spelling based on non-lexical strategies (i.e., non-word spelling). Our sample consisted of heterogeneous third graders from Germany: 69 monolinguals (age: M = 108 months) and 57 multilinguals (age: M = 111 months). On less language-dependent tasks (e.g., non-word spelling, PA, intelligence, short-term memory (STM) and three EF tasks testing switching, inhibition, and working memory) performance of both groups did not differ significantly. However, multilinguals performed significantly more poorly on tasks measuring German lexicon size and word spelling than monolinguals. Regression analyses revealed that for multilinguals, inhibition was related to spelling, whereas switching was the only EF component to influence word spelling in monolinguals and non-word spelling performance in both groups. By adding lexicon size and other language-related factors to the regression models, the influence of switching was reduced to insignificant effects, but inhibition remained significant for multilinguals. Language-related skills best predicted spelling and both language groups shared those variables: PA for word spelling, and STM for non-word spelling. Additionally, multilinguals’ word spelling performance was also predicted by their German lexicon size, and non-word spelling performance by PA. This study offers an in-depth look at spelling acquisition at a certain point of literacy development. Mono- and multilinguals have the predominant factors for spelling in common, but probably due to superior language knowledge, monolinguals were already able to make use of EF during spelling. For multilinguals, German lexicon size was more important for spelling than EF. For multilinguals’ spelling these functions might come into play only at a later stage.
In canoe sprint, the trunk muscles play an important role in stabilizing the body in an unstable environment (boat) and in generating forces that are transmitted through the shoulders and arms to the paddle for propulsion of the boat. Isokinetic training is well suited for sports in which propulsion is generated through water resistance due to similarities in the resistive mode. Thus, the purpose of this study was to determine the effects of isokinetic training in addition to regular sport-specific training on trunk muscular fitness and body composition in world-class canoeists and to evaluate associations between trunk muscular fitness and canoe-specific performance. Nine world-class canoeists (age: 25.6 ± 3.3 years; three females; four world champions; three Olympic gold medalists) participated in an 8-week progressive isokinetic training with a 6-week block “muscle hypertrophy” and a 2-week block “muscle power.” Pre- and post-tests included the assessment of peak isokinetic torque at different velocities in concentric (30 and 140∘s-1) and eccentric (30 and 90∘s-1) mode, trunk muscle endurance, and body composition (e.g., body fat, segmental lean mass). Additionally, peak paddle force was assessed in the flume at a water current of 3.4 m/s. Significant pre-to-post increases were found for peak torque of the trunk rotators at 30∘s-1 (p = 0.047; d = 0.4) and 140∘s-1 (p = 0.014; d = 0.7) in concentric mode. No significant pre-to-post changes were detected for eccentric trunk rotator torque, trunk muscle endurance, and body composition (p > 0.148). Significant medium-to-large correlations were observed between concentric trunk rotator torque but not trunk muscle endurance and peak paddle force, irrespective of the isokinetic movement velocity (all r ≥ 0.886; p ≤ 0.008). Isokinetic trunk rotator training is effective in improving concentric trunk rotator strength in world-class canoe sprinters. It is recommended to progressively increase angular velocity from 30∘s-1 to 140∘s-1 over the course of the training period.
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.
Although school climate and self-efficacy have received some attention in the literature, as correlates of students’ willingness to intervene in bullying, to date, very little is known about the potential mediating role of self-efficacy in the relationship between classroom climate and students’ willingness to intervene in bullying. To this end, the present study analyzes whether the relationship between classroom cohesion (as one facet of classroom climate) and students’ willingness to intervene in bullying situations is mediated by self-efficacy in social conflicts. This study is based on a representative stratified random sample of two thousand and seventy-one students (51.3% male), between the ages of twelve and seventeen, from twenty-four schools in Germany. Results showed that between 43% and 48% of students reported that they would not intervene in bullying. A mediation test using the structural equation modeling framework revealed that classroom cohesion and self-efficacy in social conflicts were directly associated with students’ willingness to intervene in bullying situations. Furthermore, classroom cohesion was indirectly associated with higher levels of students’ willingness to intervene in bullying situations, due to self-efficacy in social conflicts. We thus conclude that: (1) It is crucial to increase students’ willingness to intervene in bullying; (2) efforts to increase students’ willingness to intervene in bullying should promote students’ confidence in dealing with social conflicts and interpersonal relationships; and (3) self-efficacy plays an important role in understanding the relationship between classroom cohesion and students’ willingness to intervene in bullying. Recommendations are provided to help increase adolescents’ willingness to intervene in bullying and for future research.
There is evidence for cortical contribution to the regulation of human postural control. Interference from concurrently performed cognitive tasks supports this notion, and the lateral prefrontal cortex (lPFC) has been suggested to play a prominent role in the processing of purely cognitive as well as cognitive-postural dual tasks. The degree of cognitive-motor interference varies greatly between individuals, but it is unresolved whether individual differences in the recruitment of specific lPFC regions during cognitive dual tasking are associated with individual differences in cognitive-motor interference. Here, we investigated inter-individual variability in a cognitive-postural multitasking situation in healthy young adults (n = 29) in order to relate these to inter-individual variability in lPFC recruitment during cognitive multitasking. For this purpose, a oneback working memory task was performed either as single task or as dual task in order to vary cognitive load. Participants performed these cognitive single and dual tasks either during upright stance on a balance pad that was placed on top of a force plate or during fMRI measurement with little to no postural demands. We hypothesized dual one-back task performance to be associated with lPFC recruitment when compared to single one-back task performance. In addition, we expected individual variability in lPFC recruitment to be associated with postural performance costs during concurrent dual one-back performance. As expected, behavioral performance costs in postural sway during dual-one back performance largely varied between individuals and so did lPFC recruitment during dual one-back performance. Most importantly, individuals who recruited the right mid-lPFC to a larger degree during dual one-back performance also showed greater postural sway as measured by larger performance costs in total center of pressure displacements. This effect was selective to the high-load dual one-back task and suggests a crucial role of the right lPFC in allocating resources during cognitivemotor interference. Our study provides further insight into the mechanisms underlying cognitive-motor multitasking and its impairments.
Introduction: Studies that combined balance and resistance training induced larger performance improvements compared with single mode training. Agility exercises contain more dynamic and sport-specific movements compared with balance training. Thus, the purpose of this study was to contrast the effects of combined balance and plyometric training with combined agility and plyometric training and an active control on physical fitness in youth.
Methods: Fifty-seven male soccer players aged 10–12 years participated in an 8-week training program (2 × week). They were randomly assigned to a balance-plyometric (BPT: n = 21), agility-plyometric (APT: n = 20) or control group (n = 16). Measures included proxies of muscle power [countermovement jump (CMJ), triple-hop-test (THT)], muscle strength [reactive strength index (RSI), maximum voluntary isometric contraction (MVIC) of handgrip, back extensors, knee extensors], agility [4-m × 9-m shuttle run, Illinois change of direction test (ICODT) with and without the ball], balance (Standing Stork, Y-Balance), and speed (10–30 m sprints).
Results: Significant time × group interactions were found for CMJ, hand grip MVIC force, ICODT without a ball, agility (4 m × 9 m), standing stork balance, Y-balance, 10 and 30-m sprint. The APT pre- to post-test measures displayed large ES improvements for hand grip MVIC force, ICODT without a ball, agility test, CMJ, standing stork balance test, Y-balance test but only moderate ES improvements with the 10 and 30 m sprints. The BPT group showed small (30 m sprint), moderate (hand grip MVIC, ICODTwithout a ball) and large ES [agility (4 m × 9 m) test, CMJ, standing stork balance test, Y-balance] improvements, respectively.
Conclusion: In conclusion, both training groups provided significant improvements in all measures. It is recommended that youth incorporate balance exercises into their training and progress to agility with their strength and power training.