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Aim: We aimed to identify patient characteristics and comorbidities that correlate with the initial exercise capacity of
cardiac rehabilitation (CR) patients and to study the significance of patient characteristics, comorbidities and training
methods for training achievements and final fitness of CR patients.
Methods: We studied 557 consecutive patients (51.7 Æ 6.9 years; 87.9% men) admitted to a three-week in-patient CR.
Cardiopulmonary exercise testing (CPX) was performed at discharge. Exercise capacity (watts) at entry, gain in training
volume and final physical fitness (assessed by peak O 2 utilization (VO 2peak ) were analysed using analysis of covariance
(ANCOVA) models.
Results: Mean training intensity was 90.7 Æ 9.7% of maximum heart rate (81% continuous/19% interval training, 64%
additional strength training). A total of 12.2 Æ 2.6 bicycle exercise training sessions were performed. Increase of training
volume by an average of more than 100% was achieved (difference end/beginning of CR: 784 Æ 623 watts  min). In the
multivariate model the gain in training volume was significantly associated with smoking, age and exercise capacity at
entry of CR. The physical fitness level achieved at discharge from CR as assessed by VO 2peak was mainly dependent on
age, but also on various factors related to training, namely exercise capacity at entry, increase of training volume and
training method.
Conclusion: CR patients were trained in line with current guidelines with moderate-to-high intensity and reached a
considerable increase of their training volume. The physical fitness level achieved at discharge from CR depended on
various factors associated with training, which supports the recommendation that CR should be offered to all cardiac
patients.
Background The prognostic effect of multi-component cardiac rehabilitation (CR) in the modern era of statins and acute revascularisation remains controversial. Focusing on actual clinical practice, the aim was to evaluate the effect of CR on total mortality and other clinical endpoints after an acute coronary event.
Design Structured review and meta-analysis.
Methods Randomised controlled trials (RCTs), retrospective controlled cohort studies (rCCSs) and prospective controlled cohort studies (pCCSs) evaluating patients after acute coronary syndrome (ACS), coronary artery bypass grafting (CABG) or mixed populations with coronary artery disease (CAD) were included, provided the index event was in 1995 or later.
Results Out of n=18,534 abstracts, 25 studies were identified for final evaluation (RCT: n=1; pCCS: n=7; rCCS: n=17), including n=219,702 patients (after ACS: n=46,338; after CABG: n=14,583; mixed populations: n=158,781; mean follow-up: 40 months). Heterogeneity in design, biometrical assessment of results and potential confounders was evident. CCSs evaluating ACS patients showed a significantly reduced mortality for CR participants (pCCS: hazard ratio (HR) 0.37, 95% confidence interval (CI) 0.20-0.69; rCCS: HR 0.64, 95% CI 0.49-0.84; odds ratio 0.20, 95% CI 0.08-0.48), but the single RCT fulfilling Cardiac Rehabilitation Outcome Study (CROS) inclusion criteria showed neutral results. CR participation was also associated with reduced mortality after CABG (rCCS: HR 0.62, 95% CI 0.54-0.70) and in mixed CAD populations.
Conclusions CR participation after ACS and CABG is associated with reduced mortality even in the modern era of CAD treatment. However, the heterogeneity of study designs and CR programmes highlights the need for defining internationally accepted standards in CR delivery and scientific evaluation.
SOPARSE predicts so-called local coherence effects: locally plausible but globally impossible parses of substrings can exert a distracting influence during sentence processing. Additionally, it predicts digging-in effects: the longer the parser stays committed to a particular analysis, the harder it becomes to inhibit that analysis. We investigated the interaction of these two predictions using German sentences. Results from a self-paced reading study show that the processing difficulty caused by a local coherence can be reduced by first allowing the globally correct parse to become entrenched, which supports SOPARSE’s assumptions.
Consonants have been proposed to carry more of the weight of lexical processing than vowels. This consonant bias has consistently been found in adults and has been proposed to facilitate early language acquisition. We explore the origins of this bias over the course of development and in infants learning different languages. Although the consonant bias was originally thought to be present at birth, evidence suggests that it arises from the early stages of phonological and (pre-)lexical acquisition. We discuss two theories that account for the acquisition of the consonant bias: the lexical and acoustic-phonetic hypotheses.
Skipping a grade, one specific form of acceleration, is an intervention used for gifted students. Quantitative research has shown acceleration to be a highly successful intervention regarding academic achievement, but less is known about the social-emotional outcomes of grade-skipping. In the present study, the authors used the grounded theory approach to examine the experiences of seven gifted students aged 8 to 16 years who skipped a grade. The interviewees perceived their feeling of being in the wrong place before the grade-skipping as strongly influenced by their teachers, who generally did not respond adequately to their needs. We observed a close interrelationship between the gifted students' intellectual fit and their social situation in class. Findings showed that the grade-skipping in most of the cases bettered the situation in school intellectually as well as socially, but soon further interventions, for instance, a specialized and demanding class- or subject-specific acceleration were added to provide sufficiently challenging learning opportunities.
The present study explored teachers' perspectives on one specific type of acceleration, namely, grade skipping. In addition, we investigated the extent to which teachers' beliefs about students' academic, motivational, and social development after grade skipping may explain teachers' acceptance of this accelerative strategy. Moreover, we examined whether teachers' acceptance is linked to their decisions about using this intervention. Using data from the PARS project, which included 316 teachers from 18 secondary schools in the German federal state of North Rhine-Westphalia, we assessed teachers' acceptance, beliefs, and perceived knowledge about grade skipping using 4-point rating scales. Teachers also reported whether they had advised a student to skip a grade. Multilevel regression analyses indicated that teachers' beliefs about students' social, motivational, and academic development largely explained their acceptance. Teachers who showed a higher level of acceptance and perceived knowledge were more likely to have recommended grade skipping before. Educational implications are discussed.
Frailty is a geriatric syndrome characterised by a vulnerability status associated with declining function of multiple physiological systems and loss of physiological reserves. Two main models of frailty have been advanced: the phenotypic model (primary frailty) or deficits accumulation model (secondary frailty), and different instruments have been proposed and validated to measure frailty. However measured, frailty correlates to medical outcomes in the elderly, and has been shown to have prognostic value for patients in different clinical settings, such as in patients with coronary artery disease, after cardiac surgery or transvalvular aortic valve replacement, in patients with chronic heart failure or after left ventricular assist device implantation.
The prevalence, clinical and prognostic relevance of frailty in a cardiac rehabilitation setting has not yet been well characterised, despite the increasing frequency of elderly patients in cardiac rehabilitation, where frailty is likely to influence the onset, type and intensity of the exercise training programme and the design of tailored rehabilitative interventions for these patients.
Therefore, we need to start looking for frailty in elderly patients entering cardiac rehabilitation programmes and become more familiar with some of the tools to recognise and evaluate the severity of this condition. Furthermore, we need to better understand whether exercise-based cardiac rehabilitation may change the course and the prognosis of frailty in cardiovascular patients.
The Pathological Narcissism Inventory (PNI) is a multidimensional measure for assessing grandiose and vulnerable features in narcissistic pathology. The aim of the present research was to construct and validate a German translation of the PNI and to provide further information on the PNI's nomological net. Findings from a first study confirm the psychometric soundness of the PNI and replicate its seven-factor first-order structure. A second-order structure was also supported but with several equivalent models. A second study investigating associations with a broad range of measures (DSM Axis I and II constructs, emotions, personality traits, interpersonal and dysfunctional behaviors, and well-being) supported the concurrent validity of the PNI. Discriminant validity with the Narcissistic Personality Inventory was also shown. Finally, in a third study an extension in a clinical inpatient sample provided further evidence that the PNI is a useful tool to assess the more pathological end of narcissism.
In the last 10 years, the governments of most of the German Lander initiated administrative reforms. All of these ventures included the municipalization of substantial sets of tasks. As elsewhere, governments argue that service delivery by communes is more cost-efficient, effective and responsive. Empirical evidence to back these claims is inconsistent at best: a considerable number of case studies cast doubt on unconditionally positive appraisals. Decentralization effects seem to vary depending on the performance dimension and task considered. However, questions of generalizability arise as these findings have not yet been backed by more 'objective' archival data. We provide empirical evidence on decentralization effects for two different policy fields based on two studies. Thereby, the article presents alternative avenues for research on decentralization effects and matches the theoretical expectations on decentralization effects with more robust results. The analysis confirms that overly positive assertions concerning decentralization effects are only partially warranted. As previous case studies suggested, effects have to be looked at in a much more differentiated way, including starting conditions and distinguishing between the various relevant performance dimensions and policy fields.
We elicited the production of various types of relative clauses in a group of German-speaking children with specific language impairment (SLI) and typically developing controls in order to test the movement optionality account of grammatical difficulty in SLI. The results show that German-speaking children with SLI are impaired in relative clause production compared to typically developing children. The alternative structures that they produce consist of simple main clauses, as well as nominal and prepositional phrases produced in isolation, sometimes contextually appropriate, and sometimes not. Crucially for evaluating the movement optionality account, children with SLI produce very few instances of embedded clauses where the relative clause head noun is pronounced in situ; in fact, such responses are more common among the typically developing child controls. These results underscore the difficulty German-speaking children with SLI have with structures involving movement, but provide no specific support for the movement optionality account.