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.     

A Survey of Opinion on Methods of Professional Development for Secondary Heads

This paper describes a school management development programme aimed at developing managerial skills and responsibilities across the whole school staff. The paper describes why there is possibly some antipathy to this topic for in‐service education and training (INSET). The approach chosen was to use teachers’ current managerial tasks as the focus for the development so that in conjunction with extant self‐study materials, teachers could design their own INSET appropriate to their current perceived needs.     

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.     

MAGIS: mobile augmented-reality games for instructional support

ABSTRACT

We present Mobile Augmented-Reality Games for Instructional Support (MAGIS), a framework for the development of mobile augmented-reality (AR) games for education. The framework supports off-the-shelf, state-of-the-art technologies that enable AR tracking and rendering on consumer-level mobile devices, and integrates these technologies with content-generation tools that simplify the development of educational AR games, especially those that extensively use narrative-based game design and player-location tracking such as location-based historical or museum adventure games. We use Igpaw: Intramuros, a proof-of-concept game developed using MAGIS, to help describe the current state of the framework and to show its efficacy for implementing outdoor location-based educational games, and we briefly outline future development plans to improve MAGIS’ AR support (especially those involving indoor scenarios) as well as to improve the instructional design and authoring phases of AR applications written using this framework.     

Reviews

The Development of Scientific Thinking Skills. Deanna Kuhn, Eric Amsel, and Michael O'Loughlin, Academic Press, 1988. 249 pp.

Understanding the Representational Mind, Josef Perner, MIT Press, 1991. 348 pp.

Literacy as Involvement: The Acts of Writers and Readers, and Texts. Deborah Brandt. Carbondaie: Southern Illinois, 1990. 159 pp.

Dialogue, Dialectic, and Conversation: A Social Perspective on the Function of Writing. Gregory Clark. Carbondale: Southern Illinois, 1990. 93 pp.

Hypermedia and Literary Studies. Ed. Paul Delany and George P. Landow. Cambridge: MIT P, 1991. 352 pp.

Writing Space: The Computer, Hypertext, and the History of Writing. Jay David Bolter. Hillsdale: Lawrence Erlbaum, 1991. 258 pp. Also from Erlbaum, Writing Space: A Hypertext for Macintosh.

Writing and Speaking in Business. Gretchen N. Vik, Clyde W. Wilkinson, and Dorothy C. Wilkinson. 10th ed. Homewood: Irwin, 1990. 636 pp.

Communication for Management and Business. Norman B. Sigband and Arthur H. Bell. 5th ed. Glenview: Scott, 1989. 783 pp.

Business Communication Today. Courtland L. Bovee and John V. Thill. 2nd ed. New York: Random, 1989. 680 pp.

Guidelines for Preparing Proposals: A Manual on How to Organize Winning Proposals. Roy Meador. Chelsea: Lewis, 1985. 116 pp.