Air-Sea Interactions of Natural Long-Lived Greenhouse Gases (CO2, N2O, CH4)in a Changing Climate

[EN] Understanding and quantifying ocean-atmosphere exchanges of the long-lived greenhouse gases carbon dioxide (CO2), nitrous oxide (N2O) and methane (CH4) are important for understanding the global biogeochemical cycles of carbon and nitrogen in the context of ongoing global climate change. In this chapter we summarise our current state of knowledge regarding the oceanic distributions, formation and consumption pathways, and oceanic uptake and emissions of CO2, N2O and CH4, with a particular emphasis on the upper ocean. We specifically consider the role of the ocean in regulating the tropospheric content of these important radiative gases in a world in which their tropospheric content is rapidly increasing and estimate the impact of global change on their present and future oceanic uptake and/or emission. Finally, we evaluate the various uncertainties associated with the most commonly used methods for estimating uptake and emission and identify future research needs.

A revision of Askeptosaurus italicus and other thalattosaurs from the European Triassic, the interrelationships of thalattosaurs, and their phylogenetic position within diapsid reptiles (Amniota, Eureptilia)

Zusammenfassung: Thalattosaurier sind eine rein auf die Trias beschränkte Grupper mariner Diapsiden, die derzeit aus Nordamerika, Europa und China bekannt ist. Die europäischen Formen sind über längere Zeit vernachlässigt worden, was speziell für Askeptosaurus italicus aus der Mitteltrias des Monte San Giorgio gilt. Die hier durchgeführte anatomische Revision des Taxons ergibt einige Korrekturen im dorsalen Schädeldach, und ermöglicht erstmalig eine detaillierte Darstellung des ventralen Teils von Gaumen und Gehirnkapsel. Im postcranialen Skelett ergeben sich ebenfalls wichtige Korrekturen, so fehlt z. B. im Gegensatz zu bisherigen Annahmen ein Thyroidfenster im Becken. Weiterhin zeigt die Hand von Askeptosaurus eine intraspezifische Variation in der Verknöcherung. Das aquatische Reptil Endennasaurus acutirostris aus dem Nor der Lombardei wird ebenfalls neu untersucht, speziell im Hinblick auf eine potenzielle Zugehörigkeit zu Thalattosauriern. Letzteres wird bestätigt, zudem werden einige Korrekturen im Schädel durchgeführt, so ist z.B. der für Thalattosaurier typische Prämaxillare/Frontale-Kontakt vorhanden. Im Postcranium wird u.a. erstmals die vollständige Phalangenformel für die Hand ermittelt. Zwei weitere aquatische Trias-Reptilien werden ebenfalls untersucht. Zum einen ein bisher unbeschriebenes Postcranium eines relativ kleinen, hochschwänzigen Thalattosauriers aus der Obertrias von Österreich, der sehr viele Ähnlichkeiten mit dem chinesischen Xinpusaurus zeigt, und zum anderen die nur an Hand von Wirbeln bekannte Form Blezingeria ichthyospondyla aus dem Muschelkalk/Lettenkeuper der Germanischen Trias. Trotz einiger anatomischer Gemeinsamkeiten mit Thalattosauriern kann eine definitive Zugehörigkeit zu dieser Gruppe nicht bestätigt werden. Zur Klärung der verwandtschaftlichen Position der Thalattosaurier innerhalb der diapsiden Reptilien wird eine computergestützte phylogenetische Analyse basaler Diapsiden unter der Verwendung von 182 Merkmalen und 31 Taxa durchgeführt. Thalattosaurier gruppieren sich hierbei außerhalb der Sauria, und zeigen zudem ein gewisses Signal zu einer Monophylie mit Ichthyosauriern. Weitere Ergebnisse sind eine Gruppierung von Schildkröten mit Lepidosauriern, ein Schwestergruppenverhältnis von Drepanosauriern und Kuehneosauriern außerhalb der Sauria, sowie der Verlust des unteren Schläfenbogens in der frühen Evolution der Diapsiden und dessen sekundäre Aquirierung innerhalb der Archo- und Lepidosauromorpha. Eine Innengruppen-Analyse der Thalattosaurier ergibt auf der Basis von 35 Merkmalen eine basale Dichotomie, die Endennasaurus und die monophyletischen Askeptosaurus/Anshunsaurus von den übrigen Thalattosauriern abgrenzt. Die Monte San Giorgio-Taxa Hescheleria und Clarazia sind ebenfalls monophyletisch und zudem die Schwestergruppe zu Thalattosaurus. Die verbleibenden Thalattosaurier sind basal zu diesen drei Taxa positioniert, wobei der chinesische Xinpusaurus und der kalifornische Nectosaurus monophyletisch sind, und die Einbeziehung des österreichischen Thalattosauriers diesen innerhalb letzterer Taxa gruppiert. Auf der Basis dieser Ergebnisse wird ein vorläufiges biogeographisch-evolutives Szenario entworfen. Eine Kiefermuskelrekonstruktion von Askeptosaurus ergibt eine eher plesiomorphe, von posterodorsal nach anteroventral verlaufende Schläfen-Muskulatur. Zusammen mit weiteren osteologischen Merkmalen resultiert daraus eine Konfiguration, die die effektivste Beißkaft bei nur gering geöffneten Kiefern erlaubt. Die lange Schnauze, der flache Kopf und der bewegliche Hals legen eine Jagdstrategie nahe, bei der die wahrscheinlich aus kleinen bis mittelgroßen Wirbeltieren bestehende Beute durch schnelle Seitwärtsbewegungen des Kopfes gefangen wurde. Die übrige aquatische Fortbewegung des Taxons bestand aus einer subundulatorischen Lokomotion ohne Beteiligung der Extremitäten. Im Gegensatz zu Askeptosaurus bevorzugte der vollständig zahnlose Endennasaurus vermutlich nur Invertebraten und kleine Wirbeltiere als Beute, und schien seine Extremitäten im Rahmen eines paraxialen 'Pectoropelvical-Ruderns' explizit mitbenutzt zu haben.

Welfare provision in Sweden and the dominant position of the Sap

There have been almost fifty years since Harry Eckstein' s classic monograph, A Theory of Stable Democracy (Princeton, 1961), where he sketched out the basic tenets of the “congruence theory”, which was to become one of the most important and innovative contributions to understanding democratic rule. His next work, Division and Cohesion in Democracy, (Princeton University Press: 1966) is designed to serve as a plausibility probe for this 'theory' (ftn.) and is a case study of a Northern democratic system, Norway. What is more, this line of his work best exemplifies the contribution Eckstein brought to the methodology of comparative politics through his seminal article, “ “Case Study and Theory in Political Science” ” (in Greenstein and Polsby, eds., Handbook of Political Science, 1975), on the importance of the case study as an approach to empirical theory. This article demonstrates the special utility of “crucial case studies” in testing theory, thereby undermining the accepted wisdom in comparative research that the larger the number of cases the better. Although not along the same lines, but shifting the case study unit of research, I intend to take up here the challenge and build upon an equally unique political system, the Swedish one. Bearing in mind the peculiarities of the Swedish political system, my unit of analysis is going to be further restricted to the Swedish Social Democratic Party, the Svenska Arbetare Partiet. However, my research stays within the methodological framework of the case study theory inasmuch as it focuses on a single political system and party. The Swedish SAP endurance in government office and its electoral success throughout half a century (ftn. As of the 1991 election, there were about 56 years - more than half century - of interrupted social democratic "reign" in Sweden.) are undeniably a performance no other Social Democrat party has yet achieved in democratic conditions. Therefore, it is legitimate to inquire about the exceptionality of this unique political power combination. Which were the different components of this dominance power position, which made possible for SAP's governmental office stamina? I will argue here that it was the end-product of a combination of multifarious factors such as a key position in the party system, strong party leadership and organization, a carefully designed strategy regarding class politics and welfare policy. My research is divided into three main parts, the historical incursion, the 'welfare' part and the 'environment' part. The first part is a historical account of the main political events and issues, which are relevant for my case study. Chapter 2 is devoted to the historical events unfolding in the 1920-1960 period: the Saltsjoebaden Agreement, the series of workers' strikes in the 1920s and SAP's inception. It exposes SAP's ascent to power in the mid 1930s and the party's ensuing strategies for winning and keeping political office, that is its economic program and key economic goals. The following chapter - chapter 3 - explores the next period, i.e. the period from 1960s to 1990s and covers the party's troubled political times, its peak and the beginnings of the decline. The 1960s are relevant for SAP's planning of a long term economic strategy - the Rehn Meidner model, a new way of macroeconomic steering, based on the Keynesian model, but adapted to the new economic realities of welfare capitalist societies. The second and third parts of this study develop several hypotheses related to SAP's 'dominant position' (endurance in politics and in office) and test them afterwards. Mainly, the twin issues of economics and environment are raised and their political relevance for the party analyzed. On one hand, globalization and its spillover effects over the Swedish welfare system are important causal factors in explaining the transformative social-economic challenges the party had to put up with. On the other hand, Europeanization and environmental change influenced to a great deal SAP's foreign policy choices and its domestic electoral strategies. The implications of globalization on the Swedish welfare system will make the subject of two chapters - chapters four and five, respectively, whereupon the Europeanization consequences will be treated at length in the third part of this work - chapters six and seven, respectively. Apparently, at first sight, the link between foreign policy and electoral strategy is difficult to prove and uncanny, in the least. However, in the SAP's case there is a bulk of literature and public opinion statistical data able to show that governmental domestic policy and party politics are in a tight dependence to foreign policy decisions and sovereignty issues. Again, these country characteristics and peculiar causal relationships are outlined in the first chapters and explained in the second and third parts. The sixth chapter explores the presupposed relationship between Europeanization and environmental policy, on one hand, and SAP's environmental policy formulation and simultaneous agenda-setting at the international level, on the other hand. This chapter describes Swedish leadership in environmental policy formulation on two simultaneous fronts and across two different time spans. The last chapter, chapter eight - while trying to develop a conclusion, explores the alternative theories plausible in explaining the outlined hypotheses and points out the reasons why these theories do not fit as valid alternative explanation to my systemic corporatism thesis as the main causal factor determining SAP's 'dominant position'. Among the alternative theories, I would consider Traedgaardh L. and Bo Rothstein's historical exceptionalism thesis and the public opinion thesis, which alone are not able to explain the half century social democratic endurance in government in the Swedish case.

Untersuchungen zur Position der MALDI-TOF Massenspektrometrie in der Analytik von synthetischen Polymeren

Im ersten Teil dieser Arbeit wird die Anwendung der MALDI-TOF Massenspektrometrie auf annähernd monodisperse und eng verteilte Verbindungen polymerer Gestalt beschrieben. Dazu werden mit Polyphenylendendrimeren, Polybutadien-Sternpolymeren, Propionylethyleniminen und Polyethylmethylsiloxanen weniger gängige Verbindungen ausgewählt, für deren Analyse keine Standardmethodik vorliegt. Dabei wird gezeigt, dass andere Analysemethoden (wie z.B. GPC oder NMR) der MALDI-TOF Massenspektrometrie oftmals deutlich unterlegen sind - in einigen Fällen werden deren Ergebnisse gar widerlegt. In anderen Fällen wird allerdings auch festgestellt, dass diese Methoden die Massenspektrometrie unterstützen oder ergänzen können. Im darauf folgenden Teil werden durch Mischen eng verteilter Polymerstandards breite Verteilung simuliert, um so die Gründe für die Limitierung der Anwendbarkeit der MALDI-TOF Massenspektrometrie auf breite Verteilungen zu ermitteln. Die Problematik der Messung von breiten Verteilungen wird oftmals durch eine vorherige Fraktionierung mit der GPC gelöst. Auch dieses Verfahren wird in dieser Arbeit an Hand von simulierten breiten Verteilungen untersucht und bewertet. Neben qualitativen Untersuchungen mit der MALDI-TOF Massenspektrometrie wird in dieser Arbeit abgeschätzt, inwieweit diese Methode auch zur quantitativen Analyse eingesetzt werden kann. Dazu werden die Untersuchungen von Oligo(para-phenylene) (OPP) und von Cyclodehydrierungsprodukten sehr großer Dendrimere (C385, C474) beschrieben. Dabei stellt sich heraus, das neben der direkten UV-Absorption (im Falle der OPPs) auch die zunehmende Ionisierungswahrscheinlichkeit und die sinkende Desorptionswahrscheinlichkeit mit fortschreitender Cyclodehydrierung eine Quantifizierung problematisch gestalten. In einem abschließenden Kapitel wird der Versuch beschrieben, aus polyzyklischen aromatischen Kohlenwasserstoffen (PAHs) durch den Beschuss mit den UV-Strahlen des MALDI-TOF Massenspektrometers Fullerene zu erzeugen. Der Einsatz von NaCl als sogenannte Inertmatrix führt zu vielversprechenden ersten Ergebnissen.

Mediterranean-type climate in the South Aegean (Eastern Mediterranean) during the Late Miocene: Evidence from isotope and element proxies

The present-day climate in the Mediterranean region is characterized by mild, wet winters and hot, dry summers. There is contradictory evidence as to whether the present-day conditions (“Mediterranean climate”) already existed in the Late Miocene. This thesis presents seasonally-resolved isotope and element proxy data obtained from Late Miocene reef corals from Crete (Southern Aegean, Eastern Mediterranean) in order to illustrate climate conditions in the Mediterranean region during this time. There was a transition from greenhouse to icehouse conditions without a Greenland ice sheet during the Late Miocene. Since the Greenland ice sheet is predicted to melt fully within the next millennia, Late Miocene climate mechanisms can be considered as useful analogues in evaluating models of Northern Hemispheric climate conditions in the future. So far, high resolution chemical proxy data on Late Miocene environments are limited. In order to enlarge the proxy database for this time span, coral genus Tarbellastraea was evaluated as a new proxy archive, and proved reliable based on consistent oxygen isotope records of Tarbellastraea and the established paleoenvironmental archive of coral genus Porites. In combination with lithostratigraphic data, global 87Sr/86Sr seawater chronostratigraphy was used to constrain the numerical age of the coral sites, assuming the Mediterranean Sea to be equilibrated with global open ocean water. 87Sr/86Sr ratios of Tarbellastraea and Porites from eight stratigraphically different sampling sites were measured by thermal ionization mass spectrometry. The ratios range from 0.708900 to 0.708958 corresponding to ages of 10 to 7 Ma (Tortonian to Early Messinian). Spectral analyses of multi-decadal time-series yield interannual δ18O variability with periods of ~2 and ~5 years, similar to that of modern records, indicating that pressure field systems comparable to those controlling the seasonality of present-day Mediterranean climate existed, at least intermittently, already during the Late Miocene. In addition to sea surface temperature (SST), δ18O composition of coral aragonite is controlled by other parameters such as local seawater composition which as a result of precipitation and evaporation, influences sea surface salinity (SSS). The Sr/Ca ratio is considered to be independent of salinity, and was used, therefore, as an additional proxy to estimate seasonality in SST. Major and trace element concentrations in coral aragonite determined by laser ablation inductively coupled plasma mass spectrometry yield significant variations along a transect perpendicular to coral growth increments, and record varying environmental conditions. The comparison between the average SST seasonality of 7°C and 9°C, derived from average annual δ18O (1.1‰) and Sr/Ca (0.579 mmol/mol) amplitudes, respectively, indicates that the δ18O-derived SST seasonality is biased by seawater composition, reducing the δ18O amplitude by 0.3‰. This value is equivalent to a seasonal SSS variation of 1‰, as observed under present-day Aegean Sea conditions. Concentration patterns of non-lattice bound major and trace elements, related to trapped particles within the coral skeleton, reflect seasonal input of suspended load into the reef environment. δ18O, Sr/Ca and non-lattice bound element proxy records, as well as geochemical compositions of the trapped particles, provide evidence for intense precipitation in the Eastern Mediterranean during winters. Winter rain caused freshwater discharge and transport of weathering products from the hinterland into the reef environment. There is a trend in coral δ18O data to more positive mean δ18O values (–2.7‰ to –1.7‰) coupled with decreased seasonal δ18O amplitudes (1.1‰ to 0.7‰) from 10 to 7 Ma. This relationship is most easily explained in terms of more positive summer δ18O. Since coral diversity and annual growth rates indicate more or less constant average SST for the Mediterranean from the Tortonian to the Early Messinian, more positive mean and summer δ18O indicate increasing aridity during the Late Miocene, and more pronounced during summers. The analytical results implicate that winter rainfall and summer drought, the main characteristics of the present-day Mediterranean climate, were already present in the Mediterranean region during the Late Miocene. Some models have argued that the Mediterranean climate did not exist in this region prior to the Pliocene. However, the data presented here show that conditions comparable to those of the present-day existed either intermittently or permanently since at least about 10 Ma.

Molecular phylogenetic inferences on the position of the Mollusca within the Lophotrochozoa

Die phylogenetische Position der Mollusken innerhalb der Trochozoa sowie die interne Evolution der Klassen der Mollusca sind weitgehend unbekannt und wurden in meiner Arbeit anhand molekularer Merkmale untersucht. Phylogenomische Analysen zeigten in der Vergangenheit eine gute Auflösung für ursprüngliche Speziationsereignisse. Daher wurden hier drei neue EST Datensätze generiert: für Sipunculus nudus (Sipuncula), Barentsia elongata (Kamptozoa) und Lepidochitona cinerea, (Polyplacophora, Mollusca). Zusätzlich wurden gezielt Gene verschiedener Mollusken mittels RT-PCR amplifiziert. rnSowohl Kamptozoen als auch Sipunculiden wurden aufgrund morphologischer Kriterien bisher als mögliche Schwestergruppe der Mollusken gehandelt, aber die hier erzielten Ergebnisse zur Evolution der Hämerythrine, Gen-Anordnungen der mitochondrialen Genome und phylogenetische Analysen der ribosomalen und der mitochondriellen Proteine stützen diese Hypothese nicht. Die Position der Kamptozoa erwies sich hier generell als unbeständig; phylogenomische Analysen deuten eine Nähe zu den Bryozoen an, aber diese Position wird stark durch die Auswahl der Taxa beeinflusst. Dagegen weisen meine Analysen klar auf eine nähere Beziehung zwischen Annelida und Sipuncula hin. Die ribosomalen Proteine zeigen Sipuncula (und Echiura) sogar als Subtaxa der Anneliden. Wie den Mollusken fehlt den Sipunculiden jegliche Segmentierung und meine Ergebnisse legen hier die Möglichkeit des Verlusts dieses Merkmals innerhalb der Anneliden bei den Sipunculiden nahe. Innerhalb der Mollusken wurden die Solenogastren bereits als Schwestergruppe aller rezenten Mollusken vorgeschlagen. Im Rahmen meiner Arbeit wurden von drei verschiedenen Solenogastren-Arten die ersten zuverlässigen 18S rRNA-Sequenzen ermittelt, und es zeigte sich, dass alle bisher veröffentlichten 18S-Sequenzen dieser Molluskenklasse höchst unvollständig oder fehlerhaft sind. rnRibosomale Proteine sind gute phylogenetische Marker und hier wurden die Auswahl und Anzahl dieser Gene für phylogenetische Analysen optimiert. Über Sonden-basierte Detektion wurde eine sampling-Strategie getestet, die im Vergleich mit standard-phylogenomischen Ansätzen zukünftige molekulare Stammbaumrekonstruktionen mit größerem Taxonsampling ermöglicht.rn

Do domestic interests matter? – Der Einfluss nationaler Interessengruppen auf die Position von Staaten zur Umweltpolitik auf EU-Ebene

Wie kann man Ergebnisse internationaler Umweltpolitik erklären? Wie hilfreich ist dabei die liberale Theorie der Internationalen Beziehungen (IB) von Andrew Moravcsik? Die vorliegende Arbeit versucht diese Fragen anhand eines Fallbeispiels internationaler Umweltpolitik – der Position der Bundesrepublik Deutschland bezüglich der einzelnen Streitfragen der EU-Verordnung 443/2009 über den CO2-Ausstoß von Automobilen – zu beantworten. Es wird eine theoriegeleitete Außenpolitikanalyse durchgeführt, deren Hauptaugenmerk auf der spezifischen nationalen Präferenzbildung in einem bestimmten Fall liegt. Hier weist Moravcsiks Theorie eine „Lücke“ auf. Wessen Interessen sich aus welchen Gründen in einer bestimmten Situation wie durchsetzen und damit Politik beeinflussen bleibt unklar. Deshalb erweitert die Arbeit Moravcsiks liberale Theorie der IB mithilfe von Annahmen und Erkenntnissen aus der Verbändeforschung nach innen. Auf diese Weise werden die situationsspezifischen Interessen und die situationsspezifische Durchsetzungsfähigkeit der betroffenen Akteure – nationale Interessengruppen – erhoben und untersucht, inwiefern man mit ihrer Hilfe die deutsche Position zur EU-Verordnung 443/2009 erklären kann. Empirisch erweist sich dabei, dass die Position der BRD zu acht von neun Streitfragen der EU-Verordnung 443/2009 den Interessen einer Koalition aus Industriegewerkschaft (IG) Metall und Verband der Automobilindustrie (VDA) entsprach, weil diese im vorliegenden Fall mit Abstand die größte Durchsetzungsfähigkeit aufwiesen. Lediglich bezüglich einer Streitfrage wich die Position der BRD von den Interessen von IG Metall und VDA ab. Damit lässt sich festhalten: Die Position der BRD zur EU-Verordnung 443/2009 kann weitgehend mithilfe der nach innen erweiterten liberalen Theorie nach Andrew Moravcsik erklärt werden. Trotz möglicher Schwierigkeiten bei der Übertragung erscheint daher eine Anwendung des nach innen erweiterten Liberalismus auf weitere erklärungsbedürftige Phänomene der internationalen Umweltpolitik und damit eine Überprüfung der Theorie insgesamt eine interessante und sinnvolle Aufgabe zu sein.

Indoor position, localizzazione e tracciamento in ambienti chiusi

Le grandi catene di distribuzione, per sviluppare strategie commerciali sempre più efficaci, sono interessate a comprendere il percorso che ogni cliente effettua all’interno del punto vendita, che reparti visita, il tempo di permanenza in un’area specifica ecc… Quindi è stato necessario trovare un sistema per localizzare e tracciare un cliente all’interno di un ambiente chiuso (indoor position). Prima di tutto ci si è concentrati sulla ricerca e sviluppo di una nuova idea che potesse superare gli ostacoli delle soluzioni attualmente in commercio. Si è pensato di sostituire le tessere punti del punto vendita con delle tessere bluetoothLE e di creare un sistema di posizionamento al chiuso utilizzando la stessa logica di funzionamento del GPS per gli ambienti aperti. Il ricevitore è la tessera BLE posseduta dal cliente e i satelliti sono tre device Android dotati di un’app specifica per rilevare il segnale radio (RSSI) emesso dalla tessera ogni secondo. Le rilevazioni dei tre device Android sono successivamente trasferite all’interno di una web application che si occupa di elaborare i dati tramite il processo di trilaterazione. L’output sono le coordinate x,y di ciascuna tessera in ogni secondo di visita all’interno del punto vendita. Questi dati sono infine utilizzati per mostrare graficamente il percorso effettuato dal cliente, l’orario di ingresso e di uscita e il tempo di permanenza. Riepilogando, il progetto comprende una fase di ricerca e intuizione di una nuova idea, una fase di progettazione per traslare i meccanismi del funzionamento GPS all’utilizzo in un ambiente chiuso, una fase di implementazione dell’app e della web application e infine una fase di sperimentazioni sul campo che si concluderà dopo la laurea con test reali in un supermercato della zona.

Position paper on diagnosis and treatment of atopic dermatitis

The diagnosis of atopic dermatitis (AD) is made using evaluated clinical criteria. Management of AD must consider the symptomatic variability of the disease.

Communication skills training in oncology: a position paper based on a consensus meeting among European experts in 2009

Background: Communication in cancer care has become a major topic of interest. Since there is evidence that ineffective communication affects both patients and oncology clinicians (physicians and nurses), so-called communication skills trainings (CSTs) have been developed over the last decade. While these trainings have been demonstrated to be effective, there is an important heterogeneity with regard to implementation and with regard to evidence of different aspects of CST. Methods: In order to review and discuss the scientific literature on CST in oncology and to formulate recommendations, the Swiss Cancer League has organised a consensus meeting with European opinion leaders and experts in the field of CST, as well as oncology clinicians, representatives of oncology societies and patient organisations. On the basis of a systematic review and a meta-analysis, recommendations have been developed and agreed upon. Results: Recommendations address (i) the setting, objectives and participants of CST, (ii) its content and pedagogic tools, (iii) organisational aspects, (iv) outcome and (v) future directions and research. Conclusion: This consensus meeting, on the basis of European expert opinions and a systematic review and meta-analysis, defines key elements for the current provision and future development and evaluation of CST in oncology.

Secondary prevention through cardiac rehabilitation: physical activity counselling and exercise training: key components of the position paper from the Cardiac Rehabilitation Section of the European Association of Cardiovascular Prevention and Rehabilitation

Cardiac patients after an acute event and/or with chronic heart disease deserve special attention to restore their quality of life and to maintain or improve functional capacity. They require counselling to avoid recurrence through a combination of adherence to a medication plan and adoption of a healthy lifestyle. These secondary prevention targets are included in the overall goal of cardiac rehabilitation (CR). Cardiac rehabilitation can be viewed as the clinical application of preventive care by means of a professional multi-disciplinary integrated approach for comprehensive risk reduction and global long-term care of cardiac patients. The CR approach is delivered in tandem with a flexible follow-up strategy and easy access to a specialized team. To promote implementation of cardiac prevention and rehabilitation, the CR Section of the EACPR (European Association of Cardiovascular Prevention and Rehabilitation) has recently completed a Position Paper, entitled 'Secondary prevention through cardiac rehabilitation: A condition-oriented approach'. Components of multidisciplinary CR for seven clinical presentations have been addressed. Components include patient assessment, physical activity counselling, exercise training, diet/nutritional counselling, weight control management, lipid management, blood pressure monitoring, smoking cessation, and psychosocial management. Cardiac rehabilitation services are by definition multi-factorial and comprehensive, with physical activity counselling and exercise training as central components in all rehabilitation and preventive interventions. Many of the risk factor improvements occurring in CR can be mediated through exercise training programmes. This call-for-action paper presents the key components of a CR programme: physical activity counselling and exercise training. It summarizes current evidence-based best practice for the wide range of patient presentations of interest to the general cardiology community.

Secondary prevention through cardiac rehabilitation: from knowledge to implementation. A position paper from the Cardiac Rehabilitation Section of the European Association of Cardiovascular Prevention and Rehabilitation

Increasing awareness of the importance of cardiovascular prevention is not yet matched by the resources and actions within health care systems. Recent publication of the European Commission's European Heart Health Charter in 2008 prompts a review of the role of cardiac rehabilitation (CR) to cardiovascular health outcomes. Secondary prevention through exercise-based CR is the intervention with the best scientific evidence to contribute to decrease morbidity and mortality in coronary artery disease, in particular after myocardial infarction but also incorporating cardiac interventions and chronic stable heart failure. The present position paper aims to provide the practical recommendations on the core components and goals of CR intervention in different cardiovascular conditions, to assist in the design and development of the programmes, and to support healthcare providers, insurers, policy makers and consumers in the recognition of the comprehensive nature of CR. Those charged with responsibility for secondary prevention of cardiovascular disease, whether at European, national or individual centre level, need to consider where and how structured programmes of CR can be delivered to all patients eligible. Thus a novel, disease-oriented document has been generated, where all components of CR for cardiovascular conditions have been revised, presenting both well-established and controversial aspects. A general table applicable to all cardiovascular conditions and specific tables for each clinical disease have been created and commented.