954 resultados para treatment effects
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Visual inspection remains the most frequently applied method for detecting treatment effects in single-case designs. The advantages and limitations of visual inference are here discussed in relation to other procedures for assessing intervention effectiveness. The first part of the paper reviews previous research on visual analysis, paying special attention to the validation of visual analysts" decisions, inter-judge agreement, and false alarm and omission rates. The most relevant factors affecting visual inspection (i.e., effect size, autocorrelation, data variability, and analysts" expertise) are highlighted and incorporated into an empirical simulation study with the aim of providing further evidence about the reliability of visual analysis. Our results concur with previous studies that have reported the relationship between serial dependence and increased Type I rates. Participants with greater experience appeared to be more conservative and used more consistent criteria when assessing graphed data. Nonetheless, the decisions made by both professionals and students did not match sufficiently the simulated data features, and we also found low intra-judge agreement, thus suggesting that visual inspection should be complemented by other methods when assessing treatment effectiveness.
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OBJECTIVE: To assess the efficacy and safety of rivastigmine for the treatment of HIV-associated neurocognitive disorders (HAND) in a cohort of long-lasting aviremic HIV+ patients. METHODS: Seventeen aviremic HIV+ patients with HAND were enrolled in a randomized, double-blind, placebo-controlled, crossover study to receive either oral rivastigmine (up to 12 mg/day for 20 weeks) followed by placebo (20 weeks) or placebo followed by rivastigmine. Efficacy endpoints were improvement on rivastigmine in the Alzheimer's Disease Assessment Scale-Cognitive subscale (ADAS-Cog) and individual neuropsychological scores of information processing speed, attention/working memory, executive functioning, and motor skills. Measures of safety included frequency and nature of adverse events and abnormalities on laboratory tests and on plasma concentrations of antiretroviral drugs. Analyses of variance with repeated measures were computed to look for treatment effects. RESULTS: There was no change on the primary outcome ADAS-Cog on drug. For secondary outcomes, processing speed improved on rivastigmine (Trail Making Test A: F(1,13) = 5.57, p = 0.03). One measure of executive functioning just failed to reach significance (CANTAB Spatial Working Memory [strategy]: F(1,13) = 3.94, p = 0.069). No other change was observed. Adverse events were frequent, but not different from those observed in other populations treated with rivastigmine. No safety issues were recorded. CONCLUSIONS: Rivastigmine in aviremic HIV+ patients with HAND seemed to improve psychomotor speed. A larger trial with the better tolerated transdermal form of rivastigmine is warranted. CLASSIFICATION OF EVIDENCE: This study provides Class III evidence that rivastigmine is ineffective for improving ADAS-Cog scores, but is effective in improving some secondary outcome measures in aviremic HIV+ patients with HAND.
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Background and Aims: Although systemic corticosteroids are successfully administered for the induction of clinical response and remission in the majority of patients with inflammatory bowel disease (IBD) presenting with a flare, a proportion of these patients demonstrate a primary nonresponse to steroids or in the case of an initial response, they develop a resistance or a steroid dependence. Long-term therapy with corticosteroids for treatment of IBD should be avoided, given the high frequency of adverse treatment effects. Knowledge about treatment strategies in case of steroid nonresponse is therefore highly relevant. Methods: A systematic literature research was performed using Medline and Embase to summarize the currently recommended treatment strategies for steroid-resistant IBD. Results: Treatment of steroid-resistant Crohn's disease is based on the introduction of immunomodulators such as azathioprine, 6-mercaptopurine or methotrexate, the anti-TNF drugs infliximab, adalimumab and certolizumab pegol. In the case of steroid resistance in ulcerative colitis, aminosalicylates, the above-mentioned immunomodulators, infliximab, adalimumab or calcineurin inhibitors such as ciclosporin or tacrolimus may be administered. Conclusion: This review summarizes the current evidence for treating steroid-resistant IBD.
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The present work assessed the effects of intracerebroventricular injections (2x5 mg/2.5 ml) of recombined human nerve growth factor (rhNGF) at postnatal days 2 and 3 upon the development of spatial learning capacities in rats. The treated rats were trained at the age of 22 days to escape onto an invisible platform at a fixed position in space in a Morris navigation task. For half of the subjects, the training position was also cued, a procedure aimed at facilitating escape and reducing attention to the distant spatial cues. At the age of 2 months all the rats were retrained in the same task. Treatment effects were found in both immature and adult rats. The injection of NGF induced a slight alteration of the immature rats' performance. In contrast, a marked impairment of spatial abilities was shown in the 2-month-old rats. The most consistent effects were a significant increase in the escape latency and a decrease bias towards the training platform area during probe trials. The reduction of spatial memory was particularly marked if the subjects had been trained in a cued condition. Taken together, these experiments reveal that an acute pharmacological treatment that leads to transient modifications during early development might induce a behavioural change long after treatment. Thus, the development and the maintenance of an accurate spatial representation are tightly related to the development of brain structures that could be altered by precocious NGF administrations.
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Reproductive success is determined by the presence and timing of encounter of mates. The latter depends on species-specific reproductive characteristics (e.g. initiation/duration of the mating window), season, and reproductive strategies (e.g. intensity of choosiness) that may potentially mitigate constraints imposed by mating windows. Despite their potentially crucial role for fitness and population dynamics, limited evidence exists about mating window initiation, duration and reproductive strategies. Here, we experimentally tested the mechanisms of initiation and the duration of the common lizard's Zootoca vivipara mating window, by manipulating the timing of mate encounter and analyzing its effect on (re-)mating probability. We furthermore tested treatment effects on female reproductive strategies, by measuring female choosiness. The timing of mate encounter and season did not significantly affect mating probability. However, a longer delay until mate encounter reduced female choosiness. Re-mating probability decreased with re-mating delay and was independent of mating delay. This indicates that mating window initiation depends on mate encounter, that its duration is fixed, and that plastic reproductive strategies exist. These findings contrast with previous beliefs and shows that mating windows per se may not necessarily constrain reproductive success, which is congruent with rapid range expansion and absence of positive density-effects on reproductive success (Allee effects). In summary, our results show that predicting the effect of mating windows on reproduction is complex and that experimental evidence is essential for evaluating their effect on reproduction and reproductive strategies, both being important determinants of population dynamics and the colonization of new habitats.
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Cultivation of black truffle, Tuber melanosporum Vitt., has become an important agricultural alternative in rural Mediterranean regions due to its success in relatively harsh conditions, its high market value and diminishing production in natural areas. In addition, truffle cultivation requires relatively low agricultural inputs, promotes reforestation and economic restoration of rural lands and land-use stability. However, there remain major issues regarding the management practices to ensure successful black truffle production. We therefore conducted an experiment to evaluate 3 levels of irrigation based on monthly water deficit and the effects of currently applied weed control systems and fertilization. Treatment effects were evaluated by examining the mycorrhizal status of out-planted 1-yr-old Quercus ilex L. seedlings and seedling growth parameters after 18 months in 3 distinct experimental truffle plantations located in the foothills of the Spanish Pyrenees. We found that replacing one-half of the water deficit of the driest month (moderate irrigation) promoted the proliferation of T. melanosporum mycorrhizae, while high irrigation reduced fine root production and truffle mycorrhizae. Glyphosate weed control improved seedling survival by up to 16% over control seedlings without jeopardizing truffle mycorrhizae in the first year. Fertilization did not improve seedling growth or influence its mycorrhizal status. We describe the persistent relationship between this ectomycorrhizal fungus and Q. ilex by quantifying old and new mycorrhizae and we discuss the ecological implications of the symbiosis.
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This study deals with the statistical properties of a randomization test applied to an ABAB design in cases where the desirable random assignment of the points of change in phase is not possible. In order to obtain information about each possible data division we carried out a conditional Monte Carlo simulation with 100,000 samples for each systematically chosen triplet. Robustness and power are studied under several experimental conditions: different autocorrelation levels and different effect sizes, as well as different phase lengths determined by the points of change. Type I error rates were distorted by the presence of autocorrelation for the majority of data divisions. Satisfactory Type II error rates were obtained only for large treatment effects. The relationship between the lengths of the four phases appeared to be an important factor for the robustness and the power of the randomization test.
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BACKGROUND: The recent large randomized controlled trial of glutamine and antioxidant supplementation suggested that high-dose glutamine is associated with increased mortality in critically ill patients with multiorgan failure. The objectives of the present analyses were to reevaluate the effect of supplementation after controlling for baseline covariates and to identify potentially important subgroup effects. MATERIALS AND METHODS: This study was a post hoc analysis of a prospective factorial 2 × 2 randomized trial conducted in 40 intensive care units in North America and Europe. In total, 1223 mechanically ventilated adult patients with multiorgan failure were randomized to receive glutamine, antioxidants, both glutamine and antioxidants, or placebo administered separate from artificial nutrition. We compared each of the 3 active treatment arms (glutamine alone, antioxidants alone, and glutamine + antioxidants) with placebo on 28-day mortality. Post hoc, treatment effects were examined within subgroups defined by baseline patient characteristics. Logistic regression was used to estimate treatment effects within subgroups after adjustment for baseline covariates and to identify treatment-by-subgroup interactions (effect modification). RESULTS: The 28-day mortality rates in the placebo, glutamine, antioxidant, and combination arms were 25%, 32%, 29%, and 33%, respectively. After adjusting for prespecified baseline covariates, the adjusted odds ratio of 28-day mortality vs placebo was 1.5 (95% confidence interval, 1.0-2.1, P = .05), 1.2 (0.8-1.8, P = .40), and 1.4 (0.9-2.0, P = .09) for glutamine, antioxidant, and glutamine plus antioxidant arms, respectively. In the post hoc subgroup analysis, both glutamine and antioxidants appeared most harmful in patients with baseline renal dysfunction. No subgroups suggested reduced mortality with supplements. CONCLUSIONS: After adjustment for baseline covariates, early provision of high-dose glutamine administered separately from artificial nutrition was not beneficial and may be associated with increased mortality in critically ill patients with multiorgan failure. For both glutamine and antioxidants, the greatest potential for harm was observed in patients with multiorgan failure that included renal dysfunction upon study enrollment.
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The present study evaluates the performance of four methods for estimating regression coefficients used to make statistical decisions regarding intervention effectiveness in single-case designs. Ordinary least squares estimation is compared to two correction techniques dealing with general trend and one eliminating autocorrelation whenever it is present. Type I error rates and statistical power are studied for experimental conditions defined by the presence or absence of treatment effect (change in level or in slope), general trend, and serial dependence. The results show that empirical Type I error rates do not approximate the nominal ones in presence of autocorrelation or general trend when ordinary and generalized least squares are applied. The techniques controlling trend show lower false alarm rates, but prove to be insufficiently sensitive to existing treatment effects. Consequently, the use of the statistical significance of the regression coefficients for detecting treatment effects is not recommended for short data series.
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BACKGROUND: Successful lung transplantation for patients with pulmonary fibrosis from telomerase mutations may be limited by systemic complications of telomerase dysfunction, including myelosuppression, cirrhosis, and malignancy. We describe clinical outcomes in 14 lung transplant recipients with telomerase mutations. METHODS: Subjects underwent lung transplantation between February 2005 and April 2014 at 5 transplant centers. Data were abstracted from medical records, focusing on outcomes reflecting post-transplant treatment effects likely to be complicated by telomerase mutations. RESULTS: The median age of subjects was 60.5 years (interquartile range = 52.0-62.0), 64.3% were male, and the mean post-transplant observation time was 3.2 years (SD ± 2.9). A mutation in telomerase reverse transcriptase was present in 11 subjects, a telomerase RNA component mutation was present in 2 subjects, and an uncharacterized mutation was present in 1 subject. After lung transplantation, 10 subjects were leukopenic and 5 did not tolerate lymphocyte anti-proliferative agents. Six subjects developed recurrent lower respiratory tract infections, 7 developed acute cellular rejection (A1), and 4 developed chronic lung allograft dysfunction. Eight subjects developed at least 1 episode of acute renal failure and 10 developed chronic renal insufficiency. In addition, 3 subjects developed cancer. No subjects had cirrhosis. At data censorship, 13 subjects were alive. CONCLUSIONS: The clinical course for lung transplant recipients with telomerase mutations is complicated by renal disease, leukopenia with intolerance of lymphocyte anti-proliferative agents, and recurrent lower respiratory tract infections. In contrast, cirrhosis was absent, acute cellular rejection was mild, and development of chronic lung allograft dysfunction was comparable to other lung transplant recipients. Although it poses challenges, lung transplantation may be feasible for patients with pulmonary fibrosis from telomerase mutations.
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AIMS: The well-known limitations of vitamin K antagonists (VKA) led to development of new oral anticoagulants (NOAC) in non-valvular atrial fibrillation (NVAF). The aim of this meta-analysis was to determine the consistency of treatment effects of NOAC irrespective of age, comorbidities, or prior VKA exposure. METHODS AND RESULTS: All randomized, controlled phase III trials comparing NOAC to VKA up to October 2012 were eligible provided their results (stroke/systemic embolism (SSE) and major bleeding (MB)) were reported according to age (≤ or >75 years), renal function, CHADS2 score, presence of diabetes mellitus or heart failure, prior VKA use or previous cerebrovascular events. Interactions were considered significant at p <0.05. Three studies (50,578 patients) were included, respectively evaluating apixaban, rivaroxaban, and dabigatran versus warfarin. A trend towards interaction with heart failure (p = 0.08) was observed with respect to SSE reduction, this being greater in patients not presenting heart failure (RR = 0.76 [0.67-0.86]) than in those with heart failure (RR = 0.90 [0.78-1.04]); Significant interaction (p = 0.01) with CHADS2 score was observed, NOAC achieving a greater reduction in bleeding risk in patients with a score of 0-1 (RR 0.67 CI 0.57-0.79) than in those with a score ≥2 (RR 0.85 CI 0.74-0.98). Comparison of MB in patients with (RR 0.97 CI 0.79-1.18) and without (RR 0.76 CI 0.65-0.88) diabetes mellitus showed a similar trend (p = 0.06). No other interactions were found. All subgroups derived benefit from NOA in terms of SSE or MB reduction. CONCLUSIONS: NOAC appeared to be more effective and safer than VKA in reducing SSE or MB irrespective of patient comorbidities. Thromboembolism risk, evaluated by CHADS2 score and, to a lesser extent, diabetes mellitus modified the treatment effects of NOAC without complete loss of benefit with respect to MB reduction.
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Chronic graft-versus-host disease (cGvHD) is the leading cause of late nonrelapse mortality (transplant-related mortality) after hematopoietic stem cell transplant. Given that there are a wide range of treatment options for cGvHD, assessment of the associated costs and efficacy can help clinicians and health care providers allocate health care resources more efficiently. OBJECTIVE: The purpose of this study was to assess the cost-effectiveness of extracorporeal photopheresis (ECP) compared with rituximab (Rmb) and with imatinib (Imt) in patients with cGvHD at 5 years from the perspective of the Spanish National Health System. METHODS: The model assessed the incremental cost-effectiveness/utility ratio of ECP versus Rmb or Imt for 1000 hypothetical patients by using microsimulation cost-effectiveness techniques. Model probabilities were obtained from the literature. Treatment pathways and adverse events were evaluated taking clinical opinion and published reports into consideration. Local data on costs (2010 Euros) and health care resources utilization were validated by the clinical authors. Probabilistic sensitivity analyses were used to assess the robustness of the model. RESULTS: The greater efficacy of ECP resulted in a gain of 0.011 to 0.024 quality-adjusted life-year in the first year and 0.062 to 0.094 at year 5 compared with Rmb or Imt. The results showed that the higher acquisition cost of ECP versus Imt was compensated for at 9 months by greater efficacy; this higher cost was partially compensated for ( 517) by year 5 versus Rmb. After 9 months, ECP was dominant (cheaper and more effective) compared with Imt. The incremental cost-effectiveness ratio of ECP versus Rmb was 29,646 per life-year gained and 24,442 per quality-adjusted life-year gained at year 2.5. Probabilistic sensitivity analysis confirmed the results. The main study limitation was that to assess relative treatment effects, only small studies were available for indirect comparison. CONCLUSION: ECP as a third-line therapy for cGvHD is a more cost-effective strategy than Rmb or Imt.
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This study compared the relative effectiveness of two computerized remedial reading programs in improving the reading word recognition, rate, and comprehension of adolescent readers demonstrating significant and longstanding reading difficulties. One of the programs involved was Autoskill Component Reading Subskills Program, which provides instruction in isolated letters, syllables, and words, to a point of rapid automatic responding. This program also incorporates reading disability subtypes in its approach. The second program, Read It Again. Sam, delivers a repeated reading strategy. The study also examined the feasibility of using peer tutors in association with these two programs. Grade 9 students at a secondary vocational school who satisfied specific criteria with respect to cognitive and reading ability participated. Eighteen students were randomly assigned to three matched groups, based on prior screening on a battery of reading achievement tests. Two I I groups received training with one of the computer programs; the third group acted as a control and received the remedial reading program offered within the regular classroom. The groups met daily with a trained tutor for approximately 35 minutes, and were required to accumulate twenty hours of instruction. At the conclusion of the program, the pretest battery was repeated. No significant differences were found in the treatment effects of the two computer groups. Each of the two treatment groups was able to effect significantly improved reading word recognition and rate, relative to the control group. Comprehension gains were modest. The treatment groups demonstrated a significant gain, relative to the control group, on one of the three comprehension measures; only trends toward a gain were noted on the remaining two measures. The tutoring partnership appeared to be a viable alternative for the teacher seeking to provide individualized computerized remedial programs for adolescent unskilled readers. Both programs took advantage of computer technology in providing individualized drill and practice, instant feedback, and ongoing recordkeeping. With limited cautions, each of these programs was considered effective and practical for use with adolescent unskilled readers.
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Bien que la douleur soit une expérience subjective universelle, la façon de la percevoir et de l’interpréter est modulée par une multitude de facteurs. Plusieurs interventions cognitives se sont montrées efficaces pour réduire la douleur dans des conditions cliniques et expérimentales. Cette thèse s’intéressera particulièrement aux mécanismes psychophysiologiques impliqués dans les stratégies de modulation volontaire de la douleur. Ces stratégies sont intéressantes puisqu’elles encouragent une prise en charge par l’individu, lui permettant de jouer un rôle actif dans la régulation de sa douleur. La première étude s’intéresse à l’efficacité du biofeedback comme moyen de modulation volontaire de la douleur. Il s’agissait de déterminer si le fait de présenter une rétroaction de l’amplitude du réflex RIII (évoqué par une stimulation électrique du nerf sural) au cours d’un entraînement de plusieurs essais permettrait au participant d’adopter des stratégies de modulation de la douleur et d’activer volontairement des mécanismes de contrôle descendant de la douleur. De façon à évaluer spécifiquement les changements induits par le biofeedback, la modulation du réflexe RIII et de la douleur était comparée dans trois groupes (biofeedback valide, faux biofeedback et groupe contrôle sans rétroaction). Dans les trois groupes, il était suggéré aux participants d’utiliser des stratégies cognitives de modulation de la douleur (attention, modulation de la respiration, réévaluation cognitive et imagerie mentale) afin d’augmenter ou de diminuer leur réflexe RIII comparativement à leur niveau de base. Les résultats de notre étude indiquent que les participants des 3 groupes ont réussi à moduler leur réflexe RIII (p<0,001) ainsi que leurs évaluations de douleur (p<0,001) (intensité et désagrément). Les résultats de notre étude montrent que l’entraînement au biofeedback n’était pas nécessaire pour obtenir une modulation du réflexe RIII et de la douleur, ce qui suggère que l’utilisation de stratégies cognitives pourrait être suffisante pour déclencher des mécanismes de contrôle de la douleur. La deuxième étude découle de la première et s’intéressait à l’influence de la fréquence et de la phase respiratoire sur la nociception spinale, l’activité cérébrale et la perception de douleur. Le contrôle volontaire de la respiration est un moyen commun de régulation des émotions et est fréquemment utilisé en combinaison avec d’autres techniques (ex. : relaxation, méditation) dans le but de réguler la douleur. Les participants étaient invités à synchroniser leur respiration à des indices sonores indiquant le moment de l’inspiration et de l’expiration. Trois patrons de respiration étaient proposés (respiration à 0,1Hz avec une inspiration de 4 secondes, respiration à 0,1Hz avec une inspiration de 2 secondes et respiration à 0,2Hz avec une inspiration de 2 secondes. La moitié des stimulations étaient données durant l’inspiration et l’autre moitié durant l’expiration. Afin d’évaluer l’effet de ces manipulations, l’amplitude du RIII, l’évaluation subjective d’intensité de la douleur et de l’anxiété suscitée par le choc en plus des potentiels évoqués étaient mesurés. Les résultats de cette étude démontrent que les évaluations d’intensité de la douleur n’étaient pas affectées par le patron respiratoire (p=0,3), mais étaient statistiquement plus basses durant l’inspiration comparativement à l’expiration (p=0,02). Un effet de phase (p=0,03) était également observé sur les potentiels évoqués durant la condition de respiration à 0,1hHz avec une inspiration de 2 secondes comparativement au patron de respiration de 0,2Hz. Paradoxalement, l’amplitude du réflexe RIII était augmenté durant l’inspiration (p=0,02) comparativement à l’expiration. Ces résultats montrent que la manipulation de la fréquence et de la phase respiratoires (par une synchronisation imposée) a un effet marginal sur les évaluations de douleur et sur l’activité cérébrale et spinale évoquée par une stimulation électrique (douleur aigüe). Cela suggère que d’autres mécanismes contribuent aux effets analgésiques observés dans la relaxation et la méditation. Plus largement, nos résultats font état de la nécessité d’études plus approfondies avec une méthodologie plus rigoureuse afin de contrôler les effets non spécifiques aux traitements évalués. Une meilleure connaissance des mécanismes sous-tendant chaque stratégie permettrait de mieux cibler les clientèles susceptibles d’y répondre et de mieux considérer le ratio coût bénéfice de chaque traitement.
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Anliegen dieser Dissertation ist die Untersuchung des Einflusses eines Lesestrategietrainings auf die Entwicklung des Leseverständnisses in den Klassen 2 und 4. In einer experimentellen Studie mit Prä-Post-Test-Design wurde die Wirksamkeit eines 25 Sitzungen umfassenden Trainings der Strategien Vorhersagen, kleinschrittiges Wiederholen und Zusammenfassen den Effekten einer lesefernen Kontrollbedingung gegenübergestellt. Die Lesestrategien wurden peergestützt vermittelt, d. h. in Dyaden aus einem leseschwächeren und einem lesestärkeren Kind. In drei Teilstudien wurden Fragestellungen zur differenzierten Analyse der Trainingswirksamkeit untersucht: (1) Wird die Trainingswirksamkeit durch die Effizienz der Worterkennungsprozesse beeinflusst?, (2) Kann die Entwicklung der Leseflüssigkeit durch das Lesestrategietraining gefördert werden? und (3) Können leseschwache Kinder von der Zusammenarbeit mit lesestärkeren Tutor(inn)en hinsichtlich der Verbesserung ihres Leseverständnisses profitieren?. Die Ergebnisse dieser Dissertation sprechen dafür, dass das eingesetzte peergestützte Lesestrategietraining das Leseverständnis und die Leseflüssigkeit von Zweit- und Viertklässler(inne)n unter bestimmten Voraussetzungen positiv beeinflussen konnte. Die Leseleistungen vor dem Training, die Effizienz der Worterkennungsprozesse und die Rolle im dyadischen Lernen erwiesen sich als relevante Einflussfaktoren für die Wirksamkeit des Strategietrainings. Zweitklässler(innen), die aufgrund guter Prä-Test Leseleistungen die Tutor(inn)enrolle erhielten, konnten ihr Leseverständnis gegenüber Kindern mit gleichen Leseleistungen in der Kontrollbedingung signifikant steigern. Leseschwache Zweitklässler(innen) hingegen schienen nur bei (relativ) effizienten Worterkennungsprozessen die Lesestrategien zur Steigerung ihres globalen Leseverständnisses nutzen zu können, wobei sie keinen Zugewinn aus der dyadischen Zusammenarbeit ziehen konnten. Bei ineffizienten Worterkennungsprozessen hatte das Strategietraining negative Auswirkungen auf das allgemeine Leseverständnis. Anders in Klasse 4: Kinder, die aufgrund unterdurchschnittlicher Leseleistungen im Prä-Test als Tutand(inn)en am Training teilnahmen, verbesserten ihr Leseverständnis und konnten dabei von der Zusammenarbeit mit lesestarken Tutor(inn)en profitieren. Für die Tutor(inn)en in Klasse 4 zeigte sich kein Effekt des Strategietrainings gegenüber der Kontrollgruppe. In beiden Klassenstufen stellte sich im Verlauf des Strategietrainings eine schnellere Entwicklung der Leseflüssigkeit der schwachen Leser(innen) ein. Zusammengefasst erzielte das Training die größten Effekte für gute Leser(innen) in Klasse 2 und schwache Leser(innen) in Klasse 4 – beide Gruppen konnten ihr Leseverständnis praktisch bedeutsam gegenüber Kindern mit gleichen Leseleistungen in der Kontrollbedingung steigern.