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     

(Ig)noble Lies: Personal Historicism and Richard Mulcaster’s Positions Concerning the Bringing Up of Children (1581)

Attempting to push early modern presentism to the radical, logical conclusion of a more personal historicism, this essay draws on a number of interpretive practices and theoretical insights – Stephen Greenblatt’s self-reflectivity, Toni Morrison’s ‘rememory’, Marianne Hirsch’s ‘postmemory’, bell hooks’s ‘passion of experience’, and Linda Charnes’s alternative historicism – to establish the ethical and interpretive significance of my own painful situatedness as an African American man in Renaissance/Early Modern studies. Specifically, I illustrate that significance in a reading of Richard Mulcaster’s Positions Concerning the Bringing Up of Children, a sixteenth-century educational treatise that responds, as I argue, to early modern educational access and social mobility with an insidiously complex, exclusionary admissions policy.     

International inter‐organisational arrangements in higher education: Towards a typology

Abstract

This article attempts to provide clarity in the maze of international inter‐organisational arrangements in higher education. Developments that fuel the establishment of such linkages are identified. First, the changes in the production of knowledge, changes in resource dependencies and increased opportunities for interaction through new technologies, demand interaction with other universities and organisations, in activities that previously took place within the organisational boundaries of the university. In addition, universities increasingly cross national borders. Students, scholars and employers demand and value the experience gained through international experiences. Liberalisation of trade markets and new modes of delivery expand opportunities for transnational education and the need for inter‐organisational interaction. On the basis of several classifications of cooperation in higher education and using concepts from organisational and management studies, we develop a multidimensional typology of international inter‐organisational cooperation. Critical dimensions identified in this typology are size, scope, nature of integration and intensity.     

Ecological dynamics as a theoretical framework for development of sustainable behaviours towards the environment

This paper proposes how the theoretical framework of ecological dynamics can provide an influential model of the learner and the learning process to pre-empt effective behaviour changes. Here we argue that ecological dynamics supports a well-established model of the learner ideally suited to the environmental education context because of its emphasis on the learner–environment relationship. The model stems from perspectives on behaviour change in ecological psychology and dynamical systems theory. The salient points of the model are highlighted for educators interested in manipulating environmental constraints in the learning process, with the aim of designing effective learning programmes in environmental education. We conclude by providing generic principles of application which might define the learning process in environmental education programmes.     

No Child Left Behind and the Denigration of Race

Race is the social expression of power and privilege, and new racial configurations take shape in conjuction with alterations in the political economy of American society. This article examines the relationship of educational policy to the emergence of a new conception of racism that has appeared in the post-civil rights era: colorblind racism. Colorblind policies are championed as fair and just, congruent with the egalitarian aspirations of the Civil Rights Movement that culminated in the passage of the Civil Rights Act in 1964. In rendering invisible the salience of race, the goal of colorblindness is to make advantage appear as a logical consequence of the natural order of things. The non-recognition of race as a form of political power tacitly enables the colorblind ideal to steer education policy toward the reinforcement of the dominant culture as the norm and the maintenance of hegemonic social arrangements. The insinuation of colorblindness into the culture of educational policymaking, and of No Child Left Behind in particular, suggests that substantive educational restructuring may not be part of the nation's racial agenda.     

Embedded Mathematics Remediation Using The Math You Need,When You Need It: A 21st‐Century Solution to an Age‐Old Problem

Using the need for math skills in geoscience courses as an example, Helen E. Burn and Eric M. D. Baer from Highline Community College and Jennifer M. Wenner from the University of Wisconsin Oshkosh make the case for just‐in‐time embedded remediation to improve student learning while using class time efficiently.     

On Going (Way) Beyond One’s Data: A Proposal to Restrict Recommendations for Practice in Primary Educational Research Journals

To counteract what we see as a growing research-reporting concern, we propose the following editorial-policy change regarding the content of primary research articles in educational research journals: Contributors should restrict their discussion and conclusions to their data and not offer recommendations for educational practice nor speculate about the educational policy implications of their research. We believe that this change will be beneficial for maintaining a separation between evidence and opinion concerning the legitimate warrants of empirical research. We suggest viable accompaniments and alternatives to authors offering practical recommendations and policy speculations in primary-research journal articles. Among these is to rely on all sources of evidence, including systematic research syntheses based on the aggregated contribution of multiple research studies from different sources, with recommendations for practice tailored to specific situations so that both their validity and utility will be increased. It is hoped that our proposed policy change will initiate a conversation among researchers, editors, reviewers, and educational-policy experts with respect to the scope and purpose of primary research journal articles.