989 resultados para test de ratio des variances


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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

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There is no accepted way of measuring prothrombin time without time loss for patients undergoing major surgery who are at risk of intraoperative dilution and consumption coagulopathy due to bleeding and volume replacement with crystalloids or colloids. Decisions to transfuse fresh frozen plasma and procoagulatory drugs have to rely on clinical judgment in these situations. Point-of-care devices are considerably faster than the standard laboratory methods. In this study we assessed the accuracy of a Point-of-care (PoC) device measuring prothrombin time compared to the standard laboratory method. Patients undergoing major surgery and intensive care unit patients were included. PoC prothrombin time was measured by CoaguChek XS Plus (Roche Diagnostics, Switzerland). PoC and reference tests were performed independently and interpreted under blinded conditions. Using a cut-off prothrombin time of 50%, we calculated diagnostic accuracy measures, plotted a receiver operating characteristic (ROC) curve and tested for equivalence between the two methods. PoC sensitivity and specificity were 95% (95% CI 77%, 100%) and 95% (95% CI 91%, 98%) respectively. The negative likelihood ratio was 0.05 (95% CI 0.01, 0.32). The positive likelihood ratio was 19.57 (95% CI 10.62, 36.06). The area under the ROC curve was 0.988. Equivalence between the two methods was confirmed. CoaguChek XS Plus is a rapid and highly accurate test compared with the reference test. These findings suggest that PoC testing will be useful for monitoring intraoperative prothrombin time when coagulopathy is suspected. It could lead to a more rational use of expensive and limited blood bank resources.

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Das generative Fertigungsverfahren Selective Laser Melting (SLM) wird zur direkten Herstellung von metallischen Funktionsbauteilen verwendet. Während des Bauprozesses entstehen durch den schichtweisen Aufbau und die lokale Energieeinbringung mittels eines fokussierten Laserstrahls thermisch induzierte Eigenspannungen, die zu Verzug des Bauteils oder von Bauteilbereichen führen können. Üblicherweise werden die Verzüge durch Stützstrukturen zwischen Bauteil und Substratplatte verhindert. Jedoch ist es nicht immer möglich alle Bereiche eines Bauteils, je nach Komplexität der Geometrie oder Zugänglichkeit, mit Stützstrukturen zu versehen bzw. diese wieder zu entfernen. Durch eine Vorwärmung der Substratplatte während des Bauprozesses können die Verzüge reduziert oder ganz vermieden werden. Jedoch ist bisher keine systematische Untersuchung des Einflusses der Vorwärmung auf Verzüge von Aluminium Bauteilen durchgeführt worden. Ziel dieser Arbeiten ist daher die systematische Untersuchung der Auswirkung einer Vorwärmung beim SLM von Aluminiumbauteilen und die Ermittlung der geeigneten Vorwärmtemperatur, bei der nahezu keine Verzüge mehr entstehen. Eine signifikante Verzugsreduzierung im Vergleich zu den Verzügen ohne Vorwärmung zeigt sich ab einer Vorwärmtemperatur von 150°C. Bei einer Vorwärmtemperatur von 250°C sind im Rahmen der Messgenauigkeit unabhängig von der untersuchten Twincantilever Testgeometrie keine Verzüge mehr feststellbar. Neben der Reduzierung der Verzüge verhindert die Vorwärmung außerdem spannungsbedingte Risse im Bauteil, die ohne Vorwärmung zum Abreißen von Teilen der Testgeometrie führen können. Mit 90 HV 0,1 bei 250°C Vorwärmtemperatur ist die Härte größer als die geforderte Mindesthärte nach DIN EN 1706 von Druckgussbauteilen aus dem Werkstoff AlSi10Mg. Aus diesem Ergebnis kann abgeleitet werden, dass eine Vorwärmtemperatur von 250°C geeignet ist, Bauteile aus dem Werkstoff AlSi10Mg mit SLM defektfrei und prozesssicher herzustellen und Verzüge vollständig zu vermeiden.

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Generative Fertigungsverfahren haben sich in den letzten Jahren als effektive Werkzeuge für die schnelle Entwicklung von Produkten nahezu beliebiger Komplexität entwickelt. Gleichzeitig wird gefordert, die Reproduzierbarkeit der Bauteile und auch seriennahe bzw. seriengleiche Eigenschaften zu gewährleisten. Die Vielfalt und der Umfang der Anwendungen sowie die große Anzahl verschiedener generativer Fertigungsverfahren verlangen adäquate Qualitätsüberwachungs- und Qualitätskontrollsysteme. Ein Lösungsansatz für die Qualitätsbewertung von generativen Fertigungsverfahren besteht in der Einführung eines Kennzahlensystems. Hierzu müssen zunächst Anforderungsprofile und Qualitätsmerkmale für generativ hergestellte Bauteile definiert werden, welche durch Prüfkörpergeometrien abgebildet und mit Hilfe von Einzelkennzahlen klassifiziert werden. In Rahmen der durchgeführten Untersuchungen wurde die Qualitätsbewertung anhand von Prüfkörpergeometrien am Beispiel des Laser-Sinterprozesses qualifiziert. Durch Beeinflussung der Prozessparameter, d.h. der gezielten Einbringung von Störgrößen, welche einzeln oder in Kombination zu unzulässigen Qualitätsschwankungen führen können, ist es möglich, die Qualität des Produktes zu beurteilen. Die Definition von Einzelkennzahlen, die eine Steuerung und Kontrolle sowie eine Vorhersage potentieller Fehler ermöglicht, bietet hierbei essentielle Möglichkeiten zur Qualitätsbewertung. Eine Zusammenführung zu einem gesamtheitlichen Kennzahlensystem soll zum einen den Prozess auf Grundlage der definierten Anforderungsprofile bewerten und zum anderen einen direkten Zusammenhang der ausgewählten Störgrößen und Prozessgrößen herleiten, um vorab eine Aussage über die Bauteilqualität treffen zu können.

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Flurförderzeuge sind aufgrund ihrer Einsatzbedingungen und konstruktiven Merkmale besonderen Beanspruchungen ausgesetzt. Diese elektrischen, mechanischen und thermischen Beanspruchungen unterscheiden sich teilweise deutlich von denen anderer Fahrzeuge wie Personenwagen oder mobilen Baumaschinen. Um Auslegungs- und Dimensionierungsrichtlinien für die im Flurförderzeug verbauten elektronischen Komponenten zu erarbeiten, wurden an einem Schubmaststapler die auf ausgewählte Komponenten einwirkenden Beanspruchungen aufgezeichnet und umfangreich ausgewertet. In verschiedenen Prüfstandsuntersuchungen wurden die angenommenen Beanspruchungen unter Laborbedingungen nachgestellt, um das Verhalten der Elektronikkomponenten näher zu betrachten und Ausfallcharakteristiken, wie beispielsweise die Zusammenhänge zwischen Belastungshöhe und Belastungshäufigkeit bis zum Ausfall, abzuleiten.

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To test a system with milk flow-controlled pulsation, milk flow was recorded in 29 Holstein cows during machine milking. The three different treatments were routine milking (including a pre-stimulation of 50-70 s), milking with a minimum of teat preparation and milking with milk flow-controlled b-phase, i.e. with a gradually elongated b-phase of the pulsation cycle with increasing milk flow rate and shortening again during decreasing milk flow. For data evaluation the herd was divided into three groups based on the peak flow rate at routine milking (group 1: <3.2 kg/min; group 2: 3.2-4.5 kg/min; group 3: >4.5 kg/min). Compared with routine milking, milking with milk flow-controlled b-phase caused a significant elevation of the peak flow rate and the duration of incline lasted longer especially in cows with a peak flow rate of >3.2 kg/min in routine milking. In milking with a minimum of teat preparation the duration of incline lasted longer compared with the two other treatments. Bimodality of milk flow, i.e. delayed milk ejection at the start of milking, was most frequent at milking with a minimum of teat preparation. No significant differences between routine milking and milking with milk flow-controlled b-phase were detected for all other milking characteristics. In summary, milking with milk flow-controlled b-phase changes the course of milk removal, however mainly in cows with high peak flow rates.

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BACKGROUND There is ongoing debate on the optimal drug-eluting stent (DES) in diabetic patients with coronary artery disease. Biodegradable polymer drug-eluting stents (BP-DES) may potentially improve clinical outcomes in these high-risk patients. We sought to compare long-term outcomes in patients with diabetes treated with biodegradable polymer DES vs. durable polymer sirolimus-eluting stents (SES). METHODS We pooled individual patient-level data from 3 randomized clinical trials (ISAR-TEST 3, ISAR-TEST 4 and LEADERS) comparing biodegradable polymer DES with durable polymer SES. Clinical outcomes out to 4years were assessed. The primary end point was the composite of cardiac death, myocardial infarction and target-lesion revascularization. Secondary end points were target lesion revascularization and definite or probable stent thrombosis. RESULTS Of 1094 patients with diabetes included in the present analysis, 657 received biodegradable polymer DES and 437 durable polymer SES. At 4years, the incidence of the primary end point was similar with BP-DES versus SES (hazard ratio=0.95, 95% CI=0.74-1.21, P=0.67). Target lesion revascularization was also comparable between the groups (hazard ratio=0.89, 95% CI=0.65-1.22, P=0.47). Definite or probable stent thrombosis was significantly reduced among patients treated with BP-DES (hazard ratio=0.52, 95% CI=0.28-0.96, P=0.04), a difference driven by significantly lower stent thrombosis rates with BP-DES between 1 and 4years (hazard ratio=0.15, 95% CI=0.03-0.70, P=0.02). CONCLUSIONS In patients with diabetes, biodegradable polymer DES, compared to durable polymer SES, were associated with comparable overall clinical outcomes during follow-up to 4years. Rates of stent thrombosis were significantly lower with BP-DES.

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Aims: Arterial plaque rupture and thrombus characterise ST-elevation myocardial infarction (STEMI) and may aggravate delayed arterial healing following durable polymer drug-eluting stent (DP-DES) implantation. Biodegradable polymer (BP) may improve biocompatibility. We compared long-term outcomes in STEMI patients receiving BP-DES vs. durable polymer sirolimus-eluting stents (DP-SES). Methods and results: We pooled individual patient-level data from three randomised clinical trials (ISAR-TEST-3, ISAR-TEST-4 and LEADERS) comparing outcomes from BP-DES with DP-SES at four years. The primary endpoint (MACE) comprised cardiac death, MI, or target lesion revascularisation (TLR). Secondary endpoints were TLR, cardiac death or MI, and definite or probable stent thrombosis. Of 497 patients with STEMI, 291 received BP-DES and 206 DP-SES. At four years, MACE was significantly reduced following treatment with BP-DES (hazard ratio [HR] 0.59, 95% CI: 0.39-0.90; p=0.01) driven by reduced TLR (HR 0.54, 95% CI: 0.30-0.98; p=0.04). Trends towards reduction were seen for cardiac death or MI (HR 0.63, 95% CI: 0.37-1.05; p=0.07) and definite or probable stent thrombosis (3.6% vs. 7.1%; HR 0.49, 95% CI: 0.22-1.11; p=0.09). Conclusions: In STEMI, BP-DES demonstrated superior clinical outcomes to DP-SES at four years. Trends towards reduced cardiac death or myocardial infarction and reduced stent thrombosis require corroboration in specifically powered trials.

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BACKGROUND: Follow-up of abnormal outpatient laboratory test results is a major patient safety concern. Electronic medical records can potentially address this concern through automated notification. We examined whether automated notifications of abnormal laboratory results (alerts) in an integrated electronic medical record resulted in timely follow-up actions. METHODS: We studied 4 alerts: hemoglobin A1c > or =15%, positive hepatitis C antibody, prostate-specific antigen > or =15 ng/mL, and thyroid-stimulating hormone > or =15 mIU/L. An alert tracking system determined whether the alert was acknowledged (ie, provider clicked on and opened the message) within 2 weeks of transmission; acknowledged alerts were considered read. Within 30 days of result transmission, record review and provider contact determined follow-up actions (eg, patient contact, treatment). Multivariable logistic regression models analyzed predictors for lack of timely follow-up. RESULTS: Between May and December 2008, 78,158 tests (hemoglobin A1c, hepatitis C antibody, thyroid-stimulating hormone, and prostate-specific antigen) were performed, of which 1163 (1.48%) were transmitted as alerts; 10.2% of these (119/1163) were unacknowledged. Timely follow-up was lacking in 79 (6.8%), and was statistically not different for acknowledged and unacknowledged alerts (6.4% vs 10.1%; P =.13). Of 1163 alerts, 202 (17.4%) arose from unnecessarily ordered (redundant) tests. Alerts for a new versus known diagnosis were more likely to lack timely follow-up (odds ratio 7.35; 95% confidence interval, 4.16-12.97), whereas alerts related to redundant tests were less likely to lack timely follow-up (odds ratio 0.24; 95% confidence interval, 0.07-0.84). CONCLUSIONS: Safety concerns related to timely patient follow-up remain despite automated notification of non-life-threatening abnormal laboratory results in the outpatient setting.

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BACKGROUND: Given the fragmentation of outpatient care, timely follow-up of abnormal diagnostic imaging results remains a challenge. We hypothesized that an electronic medical record (EMR) that facilitates the transmission and availability of critical imaging results through either automated notification (alerting) or direct access to the primary report would eliminate this problem. METHODS: We studied critical imaging alert notifications in the outpatient setting of a tertiary care Department of Veterans Affairs facility from November 2007 to June 2008. Tracking software determined whether the alert was acknowledged (ie, health care practitioner/provider [HCP] opened the message for viewing) within 2 weeks of transmission; acknowledged alerts were considered read. We reviewed medical records and contacted HCPs to determine timely follow-up actions (eg, ordering a follow-up test or consultation) within 4 weeks of transmission. Multivariable logistic regression models accounting for clustering effect by HCPs analyzed predictors for 2 outcomes: lack of acknowledgment and lack of timely follow-up. RESULTS: Of 123 638 studies (including radiographs, computed tomographic scans, ultrasonograms, magnetic resonance images, and mammograms), 1196 images (0.97%) generated alerts; 217 (18.1%) of these were unacknowledged. Alerts had a higher risk of being unacknowledged when the ordering HCPs were trainees (odds ratio [OR], 5.58; 95% confidence interval [CI], 2.86-10.89) and when dual-alert (>1 HCP alerted) as opposed to single-alert communication was used (OR, 2.02; 95% CI, 1.22-3.36). Timely follow-up was lacking in 92 (7.7% of all alerts) and was similar for acknowledged and unacknowledged alerts (7.3% vs 9.7%; P = .22). Risk for lack of timely follow-up was higher with dual-alert communication (OR, 1.99; 95% CI, 1.06-3.48) but lower when additional verbal communication was used by the radiologist (OR, 0.12; 95% CI, 0.04-0.38). Nearly all abnormal results lacking timely follow-up at 4 weeks were eventually found to have measurable clinical impact in terms of further diagnostic testing or treatment. CONCLUSIONS: Critical imaging results may not receive timely follow-up actions even when HCPs receive and read results in an advanced, integrated electronic medical record system. A multidisciplinary approach is needed to improve patient safety in this area.

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Nuclear morphometry (NM) uses image analysis to measure features of the cell nucleus which are classified as: bulk properties, shape or form, and DNA distribution. Studies have used these measurements as diagnostic and prognostic indicators of disease with inconclusive results. The distributional properties of these variables have not been systematically investigated although much of the medical data exhibit nonnormal distributions. Measurements are done on several hundred cells per patient so summary measurements reflecting the underlying distribution are needed.^ Distributional characteristics of 34 NM variables from prostate cancer cells were investigated using graphical and analytical techniques. Cells per sample ranged from 52 to 458. A small sample of patients with benign prostatic hyperplasia (BPH), representing non-cancer cells, was used for general comparison with the cancer cells.^ Data transformations such as log, square root and 1/x did not yield normality as measured by the Shapiro-Wilks test for normality. A modulus transformation, used for distributions having abnormal kurtosis values, also did not produce normality.^ Kernel density histograms of the 34 variables exhibited non-normality and 18 variables also exhibited bimodality. A bimodality coefficient was calculated and 3 variables: DNA concentration, shape and elongation, showed the strongest evidence of bimodality and were studied further.^ Two analytical approaches were used to obtain a summary measure for each variable for each patient: cluster analysis to determine significant clusters and a mixture model analysis using a two component model having a Gaussian distribution with equal variances. The mixture component parameters were used to bootstrap the log likelihood ratio to determine the significant number of components, 1 or 2. These summary measures were used as predictors of disease severity in several proportional odds logistic regression models. The disease severity scale had 5 levels and was constructed of 3 components: extracapsulary penetration (ECP), lymph node involvement (LN+) and seminal vesicle involvement (SV+) which represent surrogate measures of prognosis. The summary measures were not strong predictors of disease severity. There was some indication from the mixture model results that there were changes in mean levels and proportions of the components in the lower severity levels. ^

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Zur Versachlichung der Diskussion über die TK-Studie zum Effekt eines Qualitätsmonitorings in der ambulanten Psychotherapie hat der wissenschaftliche Beirat die Ergebnisse aus seiner Sichtweise dargestellt. Zur Hauptfragestellung wird der Abschlussbericht zitiert, der bestätigt, dass es sich um eine konfirmatorische Untersuchung handelte. Im Kern sollte sie die Hypothesen zur Überlegenheit des TK-Modells gegenüber dem Verfahren der Gutachterverfahren überprüfen. Beim TK-Modell handelt es sich um eine „Komplexintervention“, die aus mehreren Bausteinen bestand. Die Studienergebnisse lassen somit nur die Aussage zu, dass diese Komplexintervention in ihrer Kombination keine Überlegenheit gezeigt hat. Ob einzelne Bausteine Wirksamkeit hatten, bedarf weiterer Forschung. Schließlich werden das Repräsentativitäts- und das Selektivitätsproblem der Studie bzw. der verwertbaren Stichproben erläutert und mit Verweis auf die Literatur wird deren Relevanz dargelegt.

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The value of cerebrospinal fluid (CSF) lactate level and CSF/blood glucose ratio for the identification of bacterial meningitis following neurosurgery was assessed in a retrospective study. During a 3-year period, 73 patients fulfilled the inclusion criteria and could be grouped by preset criteria in one of three categories: proven bacterial meningitis (n = 12), presumed bacterial meningitis (n = 14), and nonbacterial meningeal syndrome (n = 47). Of 73 patients analyzed, 45% were treated with antibiotics and 33% with steroids at the time of first lumbar puncture. CSF lactate values (cutoff, 4 mmol/L), in comparison with CSF/blood glucose ratios (cutoff, 0.4), were associated with higher sensitivity (0.88 vs. 0.77), specificity (0.98 vs. 0.87), and positive (0.96 vs. 0.77) and negative (0.94 vs. 0.87) predictive values. In conclusion, determination of the CSF lactate value is a quick, sensitive, and specific test to identify patients with bacterial meningitis after neurosurgery.

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Einleitung und Fragestellung In der Forschung zum Selbstgespräch im Sport dominiert die Frage nach dessen Wir-kung auf die Leistung. Der Einfluss des während der Leistungserbringung geäußerten Selbstgesprächs auf (un-)beteiligte Personen (z.B. Zuschauer, Gegenspieler oder Dop-pelpartner) wurde bislang kaum untersucht. Van Raalte, Brewer, Cornelius und Petitpas (2006) konnten immerhin zeigen, dass Zuschauer einen Tennisspieler als kompetenter einschätzen, wenn er in einem Laborexperiment mit positivem statt mit negativem Selbst-gespräch gezeigt wurde. In unserer Studie stehen Dyaden im Zentrum, in der eine Person eine andere beobach-tet, die mit sich selbst spricht. Untersucht wird, ob bei einer additiven Teamaufgabe sol-che Beobachtungen einen Effekt auf die Kompetenzeinschätzung und die Anstren-gungsbereitschaft haben. Es wird vermutet, dass die beobachtende Person dann eine höhere Anstrengungsbereitschaft (AV) zeigt, wenn sie einen Teampartner mit positivem Selbstgespräch (UV) beobachtet, da sie ihren Partner als kompetenter einschätzt und diese Einschätzung als Mediator wirkt. Methode Es wurde ein randomisierter Zweigruppen-Versuchsplan mit zwei Experimentalgruppen (je n=20) durchgeführt. Das Treatment bestand aus einem Video, das den (jeweils identi-schen) Teampartner bei der Bewältigung der zu absolvierenden visuomotorisch-koordinativen Testaufgabe zeigt (Test 2HAND des Wiener Testsystems). Das Video wur-de abhängig von der Gruppenzugehörigkeit mit negativen respektive positiven Selbstge-sprächsaussagen unterlegt. Die Mediatorvariable wahrgenommene Kompetenz wurde mittels eines Fragebogens erhoben, der in Anlehnung an Van Raalte et al. (2006) entwi-ckelt wurde. Das Vorgehen zur Erhebung der abhängigen Variable Anstrengungsbereit-schaft wurde von Ohlert (2009) übernommen: Die Probanden erhielten die Möglichkeit, sich auf die spätere Testphase vorzubereiten. Erfasst wurde dabei die Zeit, die sie für die Vorbereitung in Anspruch nahmen, und die Genauigkeit, mit der sie eine Reihe von Aufwärmaufgaben absolvierten. Ergebnisse Die Datenerhebung wurde soeben abgeschlossen. Die Ergebnisse der noch ausstehen-den regressionsanalytischen Auswertung werden auf der Tagung präsentiert. Literatur Ohlert, J. (2009). Teamleistung. Social Loafing in der Vorbereitung auf eine Gruppenaufgabe. Hamburg: Dr. Kovac. Van Raalte, J. L., Brewer, B. W., Cornelius, A. E. & Petitpas, A. J. (2006). Self-presentational effects of self-talk on perceptions of tennis players. Hellenic Journal of Psychology, 3, 134-149.