Myocardial Infarction - Stress PRevention INTervention (MI-SPRINT) to reduce the incidence of posttraumatic stress after acute myocardial infarction through trauma-focused psychological counseling: study protocol for a randomized controlled trial

BACKGROUND Posttraumatic Stress Disorder (PTSD) may occur in patients after exposure to a life-threatening illness. About one out of six patients develop clinically relevant levels of PTSD symptoms after acute myocardial infarction (MI). Symptoms of PTSD are associated with impaired quality of life and increase the risk of recurrent cardiovascular events. The main hypothesis of the MI-SPRINT study is that trauma-focused psychological counseling is more effective than non-trauma focused counseling in preventing posttraumatic stress after acute MI. METHODS/DESIGN The study is a single-center, randomized controlled psychological trial with two active intervention arms. The sample consists of 426 patients aged 18 years or older who are at 'high risk' to develop clinically relevant posttraumatic stress symptoms. 'High risk' patients are identified with three single-item questions with a numeric rating scale (0 to 10) asking about 'pain during MI', 'fear of dying until admission' and/or 'worrying and feeling helpless when being told about having MI'. Exclusion criteria are emergency heart surgery, severe comorbidities, current severe depression, disorientation, cognitive impairment and suicidal ideation. Patients will be randomly allocated to a single 45-minute counseling session targeting either specific MI-triggered traumatic reactions (that is, the verum intervention) or the general role of psychosocial stress in coronary heart disease (that is, the control intervention). The session will take place in the coronary care unit within 48 hours, by the bedside, after patients have reached stable circulatory conditions. Each patient will additionally receive an illustrated information booklet as study material. Sociodemographic factors, psychosocial and medical data, and cardiometabolic risk factors will be assessed during hospitalization. The primary outcome is the interviewer-rated posttraumatic stress level at three-month follow-up, which is hypothesized to be at least 20% lower in the verum group than in the control group using the t-test. Secondary outcomes are posttraumatic stress levels at 12-month follow-up, and psychosocial functioning and cardiometabolic risk factors at both follow-up assessments. DISCUSSION If the verum intervention proves to be effective, the study will be the first to show that a brief trauma-focused psychological intervention delivered within a somatic health care setting can reduce the incidence of posttraumatic stress in acute MI patients. TRIAL REGISTRATION ClinicalTrials.gov: NCT01781247.

The effect of ego depletion on sprint start reaction time

In the current study, we consider that optimal sprint start performance requires the self-control of responses. Therefore, start performance should depend on athletes' self-control strength. We assumed that momentary depletion of self-control strength (ego depletion) would either speed up or slow down the initiation of a sprint start, where an initiation that was sped up would carry the increased risk of a false start. Applying a mixed between- (depletion vs. nondepletion) and within- (before vs. after manipulation of depletion) subjects design, we tested the start reaction times of 37 sport students. We found that participants' start reaction times decelerated after finishing a depleting task, whereas it remained constant in the nondepletion condition. These results indicate that sprint start performance can be impaired by unrelated preceding actions that lower momentary self-control strength. We discuss practical implications in terms of optimizing sprint starts and related overall sprint performance.

The influence of ego depletion on sprint start performance in athletes without track and field experience

We tested the assumption that ego depletion would affect the sprint start in a sample of N = 38 athletes without track and field experience in an experiment by applying a mixed between- (depletion vs. non-depletion) within- (T1: before manipulation of ego depletion vs. T2: after manipulation of ego depletion) subjects design. We assumed that ego depletion would increase the possibility for a false start, as regulating the impulse to initiate the sprinting movement too soon before the starting signal requires self-control. In line with our assumption, we found a significant interaction as there was only a significant increase in the number of false starts from T1 to T2 for the depletion group while this was not the case for the non-depletion group. We conclude that ego depletion has a detrimental influence on the sprint start in athletes without track and field experience.

Basistests Suisse Sport Test Konzept: Validierung einer sportmotorischen Basistestbatterie für den Schul- und Nachwuchssport

Physical fitness can be evaluated in competitive and school sports with different field tests under different conditions and goals. To produce valid results, a field test must be practical and reach high standards of test criteria (objectivity, reliability, validity). The purpose of this study was to investigate the test criteria and the practicability of a group of field tests called «SUISSE Sport Test Konzept Basis Feldtestbatterie». For 20-m sprint, ventral trunk muscle test, standing long jump, 2-kg medicine ball shot, obstacle course and cooper-test, test quality and practicability were evaluated. 221 children and adolescents from competitive sports and different school levels took part in the study. According to school level, they were divided into 3 groups (P: 7–11.5 y, S1: 11.6–15.5 y, S2: 15.6–21.8 y). Objectivity was tested for time or distance measurement in all tests as well as for error rating in obstacle test. For reliability measurement, 162 subjects performed the field tests twice within a few weeks. For validity results of standing long jump were compared with counter movement jump performance on a force plate. Correlation analysis was performed and level of significance was set for p < 0.05. For accuracy standard error was calculated. All tests achieved sufficient to excellent objectiv - ity with correlation-coefficient (r) lying between 0.85 and 0.99. Reliability was very good (r = 0.84–0.97). In cooper- and trunk test, reliability was higher for athletes than for pupils (trunk test: r = 0.95 vs. r = 0.62, cooper-test: r = 0.90 vs. r = 0.78). In those tests the reliability decreases with increasing age (cooper-test: P: r = 0.84, S1: r = 0.69, S2: r = 0.52; trunk-test: P: r = 0.69, S1: r = 0.71; S2: r = 0.39). Validity for standing long jump was good (r = 0.75–0.86). The standard error of the mean was between 4–8%, with the exception for cooper-test (athletes: 6%, pupils: 11%) and trunk test (athletes: 14%, pupils: 46%). The results show that the evaluated group of field tests is a practicable, objective and reliable tool to determine physical skills in young athletes as well as in a scholar setting over a broad age range. Most of the tests achieved the test criteria with the grades good to excellent. The lower coefficient of reliability for cooper- and trunk test by the pupils could be explained by motivational problems in this setting. For up to 20 subjects, a tester can accomplish the tests within 3 h. Finally, age-dependent grades were elaborated

Back to the future in one week - implementing a Smalltalk VM in PyPy

We report on our experiences with the Spy project, including implementation details and benchmark results. Spy is a re-implementation of the Squeak (i.e., Smalltalk-80) VM using the PyPy toolchain. The PyPy project allows code written in RPython, a subset of Python, to be translated to a multitude of different backends and architectures. During the translation, many aspects of the implementation can be independently tuned, such as the garbage collection algorithm or threading implementation. In this way, a whole host of interpreters can be derived from one abstract interpreter definition. Spy aims to bring these benefits to Squeak, allowing for greater portability and, eventually, improved performance. The current Spy codebase is able to run a small set of benchmarks that demonstrate performance superior to many similar Smalltalk VMs, but which still run slower than in Squeak itself. Spy was built from scratch over the course of a week during a joint Squeak-PyPy Sprint in Bern last autumn.

Hybrid bodies in cyborg sports? The case of Oscar Pistorius

The capabilities of postmodern biotechnology inevitably lead to questioning if it is morally acceptable to use all possibilities offered by technology. In sport, this very complex issue is dealt with by drawing clear boundaries between naturalness and artificiality. Currently, new biotechnology is constantly being produced and with this, boundaries between naturalness and artificiality, between normal and abnormal, human and hybrid are constantly shifting . “Human enhancement” is a fascinating prism that reflects contemporary questions of participation, justice, equality and the autonomy of the subject in all social fields. The area of elite sports is particularly affected by “human enhancement”, according to the principle of exceeding what has come before, of aiming higher, faster and further. This paper analyses the postulated “naturalness” in the regulative and normalising function in the area of elite sports, in connection with Foucault’s theory of governmentality. The example of the South African sprinter Oscar Pistorius appears to be particularly suited to illustrate current definition difficulties in the area of disabled and non-disabled people in differentiated competitive sports. His is a vivid example of a multifaceted body-sociological analysis of current sport culture and the construction of reality or naturalness in the framework of the discourse of drafting and negotiating the accreditation for sprint competitions of non-disabled athletes, most recently in the London Olympics 2012. Using the case study of Oscar Pistorius, the negotiating processes in relation to the argumentation logic, dynamics and resistance in shifting distinctions are presented in detail using the fundamental documents of the IOC, IPC, CAS and IAAF. Represented through the inclusion and exclusion processes are hierarchies of the body that are (re)consolidated and transformed. The central question emerges as to how the worth of equal opportunity and fairness in regard to “naturalness” can be reconsolidated or transformed.

Selbstkontrolle und Handlungsinitiierung

Gemäß den Annahmen des Kraftspeichermodells der Selbstkontrolle basiert die Fähigkeit, eigene Impulse zu kontrollieren, auf einer limitierten Ressource, die vorübergehend erschöpfen kann. Während dieses Erschöpfungszustandes können anschließende Selbstkontrollhandlungen weniger erfolgreich ausgeführt werden. Die Regulation des Impulses, einen Sprint möglichst zeitnah zu einem akustischen Startsignal zu initiieren, erfordert Selbstkontrolle. Daher testeten wir an einer Stichprobe aus N = 37 Sportstudierenden die Annahme, dass die Initiierung von Sprints in Leichtathletik von der momentan verfügbaren Selbstkontrollkraft abhängt. Zur Untersuchung dieser Fragestellung führten die Versuchspersonen zunächst zu T1 drei Sprints über ca. 20 Meter aus einem Startblock aus und mittels Kontaktplatten wurde die Reaktionszeit (in Millisekunden) gemessen, die die Versuchspersonen benötigten, um den Sprint nach einem akustischen Signal zu initiieren. Im Anschluss daran wurde die temporär verfügbare Selbstkontrollkraft mittels einer Abschreibaufgabe experimentell manipuliert: Die Versuchspersonen wurden zufällig einer Ego Depletion Bedingung zugeordnet, in der die Selbstkontrollkraft temporär erschöpft wurde oder einer Kontrollgruppe, in der die Selbstkontrollkraft intakt gehalten wurde. Im Anschluss daran zu T2 wurden die Versuchspersonen erneut gebeten, drei Sprints über ca. 20 Meter auszuführen und die Reaktionszeiten wurden wieder mittels Kontaktplatten erfasst. Die Ergebnisse einer mixed between (Ego Depletion, kein Ego Depletion) within (T1, T2) Varianzanalyse unterstützen unsere Hypothese, so dass in der Ego Depletion Bedingung die Reaktionszeiten von T1 (M = 0.35, SD = 0.03) zu T2 signifikant zunahmen (M = 0.38, SD = 0.04), F(1, 35) = 6.77, p = .01, η2partial = .16, wohingegen sich in der Kontrollgruppe keine statistisch bedeutsamen Veränderungen der Reaktionszeiten zeigten (T1: M = 0.36, SD = 0.03; T2: M = 0.35, SD = 0.04), F(1, 35) = 0.47, p = .50, η2partial = .01. Eine Stärkung der Selbstkontrollkraft könnte Athleten dabei helfen, ihr Leistungsoptimum abzurufen.

Ego depletion and action initiation

Optimal sprint start performance requires the self-control of responses. Therefore, start performance should depend on self-control strength. It was expected that momentary depletion of self-control strength (ego depletion) would slow down the initiation of a sprint start, resulting in impaired reaction times. N = 37 participants performed three sprint starts at T1 and the average reaction times were measured with a foot-pressure release system attached under the starting block (in ms). Next, participants were randomly assigned to a depletion or a non-depletion condition and self-control strength was experimentally manipulated by applying the transcription task. Following the depletion manipulation, participants performed another series of three sprints (T2). The results of a mixed between (ego depletion: yes vs. no) within (T1 vs. T2) ANOVA supported the hypothesis as average reaction times in the depletion condition significantly increased from T1 (M = 0.35, SD = 0.03) to T2 (M = 0.38, SD = 0.04), F(1, 35) = 6.77, p = .01, η2p = .16. Average reaction times in the non-depletion condition did not differ significantly between T1 (M = 0.36, SD = 0.03) and T2 (M = 0.35, SD = 0.04), F(1, 35) = 0.47, p = .50, η2p = .01. In line with the hypothesis, higher levels of self-control strength were associated with quicker movement initiations. Therefore, improving self-control strength may serve as a buffer against the negative effects of ego depletion on performance.

Failure Rate and Conductor Externalization of the Biotronik Linox / Sorin Vigila Implantable Cardioverter Defibrillator Lead

BACKGROUND We observed a case of conductor externalization in a Biotronik Linox lead. OBJECTIVE To investigate lead performance of the Linox and identical Sorin Vigila lead and prevalence of conductor externalization. METHODS We compared lead performance of all Linox and Vigila leads implanted at our center (BL group; n=93) with all Boston Scientific Endotak Reliance leads (ER group; n=190) and Medtronic Sprint Quattro leads (SQ group; n=202) implanted during the same period. We screened all BL group patients for conductor externalization. RESULTS We identified 8 cases of lead failures in the BL group (index case of conductor externalization; 6 cases of non-physiological high rate sensing; one case of high voltage conductor fracture). Prospective, fluoroscopic screening of 98% of all active BL group cases revealed one additional case of conductor externalization. Median follow-up was 41, 27 and 29 months for the BL group, ER group and SQ group, respectively, lead survival 94.9%, 99.2% and 100% at 3 years, and 88%, 97.5% and 100% at 5 years (p=0.038 for BL group vs. ER group, and p=0.007 for BL group vs. SQ group by the log-rank test). Younger age at implant was an independent predictor for lead failure in the BL group (adjusted HR 0.85 [95% confidence interval 0.77-0.94]; p=0.001). CONCLUSION At our center, survival of the Linox lead is 88% at five years and significantly worse than its comparators. Conductor externalization is present in a minority of failed Linox leads. Younger age at implant is an independent predictor of Linox lead failure.

Accuracy of continuous glucose monitoring during differing exercise conditions.

AIM Depending on intensity, exercise may induce a strong hormonal and metabolic response, including acid-base imbalances and changes in microcirculation, potentially interfering with the accuracy of continuous glucose monitoring (CGM). The present study aimed at comparing the accuracy of the Dexcom G4 Platinum (DG4P) CGM during continuous moderate and intermittent high-intensity exercise (IHE) in adults with type 1 diabetes (T1DM). METHODS Ten male individuals with well-controlled T1DM (HbA1c 7.0±0.6% [54±6mmol/mol]) inserted the DG4P sensor 2 days prior to a 90min cycling session (50% VO2peak) either with (IHE) or without (CONT) a 10s all-out sprint every 10min. Venous blood samples for reference glucose measurement were drawn every 10min and euglycemia (target 7mmol/l) was maintained using an oral glucose solution. Additionally, lactate and venous blood gas variables were determined. RESULTS Mean reference blood glucose was 7.6±0.2mmol/l during IHE and 6.7±0.2mmol/l during CONT (p<0.001). IHE resulted in significantly higher levels of lactate (7.3±0.5mmol/l vs. 2.6±0.3mmol/l, p<0.001), while pH values were significantly lower in the IHE group (7.27 vs. 7.38, p=0.001). Mean absolute relative difference (MARD) was 13.3±2.2% for IHE and 13.6±2.8% for CONT suggesting comparable accuracy (p=0.90). Using Clarke Error Grid Analysis, 100% of CGM values during both IHE and CONT were in zones A and B (IHE: 77% and 23%; CONT: 78% and 22%). CONCLUSIONS The present study revealed good and comparable accuracy of the DG4P CGM system during intermittent high intensity and continuous moderate intensity exercise, despite marked differences in metabolic conditions. This corroborates the clinical robustness of CGM under differing exercise conditions. CLINICAL TRIAL REGISTRATION NUMBER ClinicalTrials.gov NCT02068638.