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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.
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.
Comparative literature on institutional reforms in multi-level systems proceeds from a global trend towards the decentralization of state functions. However, there is only scarce knowledge about the impact that decentralization has had, in particular, upon the sub-central governments involved. How does it affect regional and local governments? Do these reforms also have unintended outcomes on the sub-central level and how can this be explained? This article aims to develop a conceptual framework to assess the impacts of decentralization on the sub-central level from a comparative and policyoriented perspective. This framework is intended to outline the major patterns and models of decentralization and the theoretical assumptions regarding de-/re-centralization impacts, as well as pertinent cross-country approaches meant to evaluate and compare institutional reforms. It will also serve as an analytical guideline and a structural basis for all the country-related articles in this Special Issue.
Although there is ample evidence linking insecure attachment styles and intimate partner violence (IPV), little is known about the psychological processes underlying this association, especially from the victim’s perspective. The present study examined how attachment styles relate to the experience of sexual and psychological abuse, directly or indirectly through destructive conflict resolution strategies, both self-reported and attributed to their opposite-sex romantic partner. In an online survey, 216 Spanish undergraduates completed measures of adult attachment style, engagement and withdrawal conflict resolution styles shown by self and partner, and victimization by an intimate partner in the form of sexual coercion and psychological abuse. As predicted, anxious and avoidant attachment styles were directly related to both forms of victimization. Also, an indirect path from anxious attachment to IPV victimization was detected via destructive conflict resolution strategies. Specifically, anxiously attached participants reported a higher use of conflict engagement by themselves and by their partners. In addition, engagement reported by the self and perceived in the partner was linked to an increased probability of experiencing sexual coercion and psychological abuse. Avoidant attachment was linked to higher withdrawal in conflict situations, but the paths from withdrawal to perceived partner engagement, sexual coercion, and psychological abuse were non-significant. No gender differences in the associations were found. The discussion highlights the role of anxious attachment in understanding escalating patterns of destructive conflict resolution strategies, which may increase the vulnerability to IPV victimization.
School shooters are often described as narcissistic, but empirical evidence is scant. To provide more reliable and detailed information, we conducted an exploratory study, analyzing police investigation files on seven school shootings in Germany, looking for symptoms of narcissistic personality disorder as defined by the Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM-IV) in witnesses' and offenders' reports and expert psychological evaluations. Three out of four offenders who had been treated for mental disorders prior to the offenses displayed detached symptoms of narcissism, but none was diagnosed with narcissistic personality disorder. Of the other three, two displayed narcissistic traits. In one case, the number of symptoms would have justified a diagnosis of narcissistic personality disorder. Offenders showed low and high self-esteem and a range of other mental disorders. Thus, narcissism is not a common characteristic of school shooters, but possibly more frequent than in the general population. This should be considered in developing adequate preventive and intervention measures.