Triangulating Clinically Meaningful Change in the Six-minute Walk Test in Individuals with Chronic Heart Failure: A Systematic Review

Purpose

The purpose of the present review was to use existing, published data to provide an estimate of the amount of change in six-minute walk test distance (Δ6MWT) that represents a clinically meaningful change in individuals with chronic heart failure (CHF).

Methods

The present review included two separate literature searches of the CINAHL and Medline databases for articles that: (1) reported the intraclass correlation coefficient (ICC) of the 6MWT in individuals with CHF, and (2) used the 6MWT along with either aerobic capacity or health-related quality of life (HRQL) as study endpoints in randomized controlled trials (RCTs) of exercise-based intervention for individuals with CHF. The ICCs were used to calculate the minimum detectable difference (MDD) at the 95% confidence interval for each included study. The Δ6MWT associated with aerobic capacity and HRQL within-group effect sizes for the intervention and control groups in each included RCT was analyzed using receiver operating characteristic (ROC) curves.

Results

Thirteen articles reported the ICC for the 6MWT. The mean (standard deviation) MDD calculated based on these data was 43.1(16.8) m. Eighteen RCTs measured the 6MWT and either aerobic capacity and/or HRQL. A Δ6MWT of 40–45 m was associated with at least moderate aerobic capacity and HRQL effect sizes in the intervention groups. The Δ6MWT thresholds that discriminated between intervention and control groups using ROC curves revealed the following sensitivity/specificity for the respective thresholds: 19 m, 94.4/83.3%, 32 m, 83.3/94.4%, and 48 m 44.4/100% (AUC = .935, p = .009, CI_95% .855, 1.015).

Conclusions

A Δ6MWT of approximately 45 m appears to exceed measurement error and be associated with significant changes in either aerobic capacity and/or HRQL.Key Words: heart failure, six-minute walk test, clinically meaningful change, minimum detectable difference     

Doulas as community health workers: lessons learned from a volunteer program

Doulas, women who primarily provide social support during childbirth, have been associated with a number of positive health outcomes. Because the primary model of practice for doulas is a fee-for-service model in which families privately hire a doula, many expectant women who could benefit from doula support are unable to access the service. The Doulas Care program, located in Ann Arbor, Michigan, represents one model in which doulas provide services without charge. As a result of their extended role in the community, doulas who work with the Doulas Care program have unique educational needs. Through the use of focus groups with the program's volunteer doulas, educational needs related to overcoming barriers to being a doula working in the community were identified. Recommendations for education and training are made to improve the support doulas offer as community health outreach workers.     

Katrin Doveling (2005). Emotionen--Medien--Gemeinschaft. Eine kommunikationssoziologische Analyse [Emotions--media--community. A study from the perspective of communication sociology]. Wiesbaden, Germany: VS Verlag, 340 pp., ISBN 3-531-14236-4.

‘Here is a book that makes you want to shout, "Finally!"’That is the opening sentence of a recent book review that theauthor of this review wrote for the International Journal ofPublic Opinion Research about Campaigning for Hearts and Minds:How Emotional Appeals in Political Ads Work by Ted Brader (2006).The remark refers to the fact that Brader’s book focuseson an issue that has thus far received very little attentionin the field of communication studies, or, for that matter,in the fields of political science or sociology, namely, themajor role emotions play in explaining collective behavior,social decisions, opinion formation and—especially inthe case at hand—the effects of media coverage on opinionformation. Now, in the form of Katrin Döveling’scomprehensive new     

UCLA COMMUNITY COLLEGE BIBLIOGRAPHY

The research reported in this article explored the extent of self‐censorship in community college theatre programs across the country. What part of the college administration plays in such censorship is also examined. Censorship does exist in community college theatre. Much of the censorship is self‐imposed. Directors avoid plays that are controversial. The audience is protected from harm. Profanity, racial slurs, and negative religious references are cut. When cuts are not made, disclaimers are often published in programs or placed in the lobby or both. Further research opportunities suggested by this study lie in examinations of how theatre departments deal with copyright issues when cutting objectionable material from plays. Defining the responsibility of the community college theatre program to the community is another area of research that needs to be addressed. Little censorship occurs from external sources. Finally, how the responsibilities of the college and the theatre to truth can be resolved with the presence of censorship in academic theatre is an area yet to be adequately explored.     

Academic Outcomes Among a Sample of Learning Support Community College Students

This research examined the relationship between placement in a learning support college program and subsequent academic outcomes. The sample consisted of 275 entering freshmen students who were enrolled in the Learning Support reading courses in the fall of 2005. Data were collected from the Gordon College Office of Institutional Research. The data showed that of the 275 students who enrolled in a Learning Support reading course in the fall 2005 semester, 189 returned for the spring 2006 semester. Data also showed that 58% of the 275 students enrolled in Learning Support reading during fall 2005 successfully completed a basic reading intensive course upon completion of their remedial reading class. One hundred eighty seven students who had previously completed Learning Support reading enrolled (spring 2006 or later) in Introductory English 101 and 121 passed. Fifty-five students who had completed Learning Support reading enrolled (spring 2006 or later) in History 1121, Western Civilization, and 20 students passed. Six of the 205 students who completed Learning Support reading graduated Gordon College within a three-year period. The results of the present study indicate that the Learning Support Reading Program in place at Gordon College has proven to be a beneficial tool for at-risk college students. It is assumed that programs such as the Learning Support Program described here may help students build a foundation that will aid them throughout their college career.     

Treatment Fidelity Challenges in a Five-State Consultation Study

Consultation is a promising approach to creating change in early childhood programs, from innovations in instructional strategies to the enhancement of global program quality. Studies of consultation effectiveness have been hampered by limited reports of implementation fidelity related to consultation procedures. This article describes the challenges of supporting and measuring implementation fidelity in a 5-state study in which community consultants followed a collaborative consultation model to enhance global quality in childcare programs. The authors consider the limitations of using a randomized experimental design to study the effectiveness of consultation and share lessons learned in their efforts to enhance treatment fidelity without compromising the basic tenets of the model or the rigorous design.     

Structure and development of pre-service physics teachers’ professional knowledge

ABSTRACT

Teachers’ professional knowledge is considered one of the most important predictors of instructional quality. According to Shulman, such professional knowledge includes content, pedagogical content and pedagogical knowledge. Although recent research shed some light on the structure of the dimensions of professional knowledge, little is known how teacher education impacts pre-service physics teachers’ professional knowledge. In an effort to address this issue, we examined the content, pedagogical content and pedagogical knowledge of N?=?200 pre-service physics teachers enrolled in different years of teacher education at 12 major teacher education universities in Germany. We used structural equation modelling (1) to examine the relations amongst pre-service physics teachers’ content, pedagogical content and pedagogical knowledge, (2) to explore how the three kinds of knowledge and their relations differ across different stages of teacher education and (3) to identify factors affecting the level of each component of professional knowledge. Our findings suggest that content, pedagogical content and pedagogical knowledge represent distinct types of knowledge. Furthermore, our findings show that in the first years of professional education, pedagogical content knowledge is more closely related with general pedagogical knowledge while in later years, it is more closely related with content knowledge, suggesting that it develops from a general knowledge about teaching and learning into knowledge about the teaching and learning of specific content. Finally, beyond school achievement and years of enrolment as predictors, we find in particular the amount of classroom observations to have a positive impact on the professional knowledge of pre-service physics teachers.     

Claiming expertise from betwixt and between: Digital humanities librarians,emotional labor,and genre theory

ABSTRACT

Librarians' liminal (intermediate) position within academia situates us to make unique contributions to digital humanities (DH). In this article, we use genre theory, feminist theory, and theories of emotional labor to explore the importance of discourse mediation and affective labor to DH and the interplay between these areas and academic structural inequality. By claiming our expertise and making explicit work that is often not visible, we can advocate for new and varied roles for librarians in digital humanities. Our analysis is informed by both theory and practice, and it takes a dialogic approach that depends upon the interactions between the two.     

Courting Apocalypse: Creating a Zombie-Themed Evidence-Based Medicine Game

In 2015, two librarians at the Hardin Library for the Health Sciences at the University of Iowa turned their dreams into a reality and secured funding to build a zombie-themed evidence-based medicine game. The game features a “choose your own adventure” style that takes students through a scenario where a disease outbreak is taking place and a resident is asked to use evidence-based medicine skills to select a screening and diagnostic tool to use on potentially infected patients. Feedback on the game has been positive, and future plans include building additional modules on therapy, harm, and prognosis.