Psychosocial aspects in cardiac rehabilitation: From theory to practice. A position paper from the Cardiac Rehabilitation Section of the European Association of Cardiovascular Prevention and Rehabilitation of the European Society of Cardiology

A large body of empirical research shows that psychosocial risk factors (PSRFs) such as low socio-economic status, social isolation, stress, type-D personality, depression and anxiety increase the risk of incident coronary heart disease (CHD) and also contribute to poorer health-related quality of life (HRQoL) and prognosis in patients with established CHD. PSRFs may also act as barriers to lifestyle changes and treatment adherence and may moderate the effects of cardiac rehabilitation (CR). Furthermore, there appears to be a bidirectional interaction between PSRFs and the cardiovascular system. Stress, anxiety and depression affect the cardiovascular system through immune, neuroendocrine and behavioural pathways. In turn, CHD and its associated treatments may lead to distress in patients, including anxiety and depression. In clinical practice, PSRFs can be assessed with single-item screening questions, standardised questionnaires, or structured clinical interviews. Psychotherapy and medication can be considered to alleviate any PSRF-related symptoms and to enhance HRQoL, but the evidence for a definite beneficial effect on cardiac endpoints is inconclusive. A multimodal behavioural intervention, integrating counselling for PSRFs and coping with illness should be included within comprehensive CR. Patients with clinically significant symptoms of distress should be referred for psychological counselling or psychologically focused interventions and/or psychopharmacological treatment. To conclude, the success of CR may critically depend on the interdependence of the body and mind and this interaction needs to be reflected through the assessment and management of PSRFs in line with robust scientific evidence, by trained staff, integrated within the core CR team.

Medical consensus, guidelines, and position papers: A policy for the ECFS

The terms consensus, guideline and position paper are sometimes employed as if they were interchangeable, but the purpose of such documents and the robustness of advice vary as the evidence base does not have the same depth in each. The Board of the European Cystic Fibrosis Society deemed it to be helpful to provide a short commentary on the definition of these terms, on their interconnections and on how ECFS considers them in documents endorsed by the society.

Tonnacypris glacialis (Ostracoda, Cyprididae):taxonomic position, (palaeo)ecology, and zoogeography

The freshwater ostracod Tonnacypris glaciallis (Sars, 1890) is reported from the European Pleistocene for the first time. The historical allocation of the species is discussed, and the species composition and characteristics of Tonnacypris is Diebel & Pietrzeniuk (1975) and its phylozoogeography are considered. The significance of T. glacialis is reviewed, particularly from the viewpoint of the possible implications of parthenogenesis (and occasional-male production) for the Quaternary history of the genus, and for the use of the species in palaeoenvironmental reconstruction. It is suggested that the Pleistocene fossil occurrence of I: glacialis in modern temperate latitudes is a robust indicator of mean summer temperatures of 6 degrees C.

Effect of position of near addition in an asymmetric refractive multifocal intraocular lens on quality of vision

Purpose
To evaluate the impact of the position of an asymmetric multifocal near segment on visual quality.

Setting
Cathedral Eye Clinic, Belfast, United Kingdom.

Design
Retrospective comparative case series.

Methods
Data from consecutive patients who had bilateral implantation of the Lentis Mplus LS-312 multifocal intraocular lens were divided into 2 groups. One group received inferonasal near-segment placement and the other, superotemporal near-segment placement. A +3.00 diopter (D) reading addition (add) was used in all eyes. The main outcome measures included uncorrected distance visual acuity (UDVA), uncorrected near visual acuity (UNVA), contrast sensitivity, and quality of vision. Follow-up was 3 months.

Results
Patients ranged in age from 43 to 76 years. The inferonasal group comprised 80 eyes (40 patients) and the superotemporal group, 76 eyes (38 patients). The mean 3-month spherical equivalent was −0.11 D ± 0.49 (SD) in the inferonasal group and −0.18 ± 0.46 D in the superotemporal group. The mean postoperative UDVA was 0.14 ± 0.10 logMAR and 0.18 ± 0.15 logMAR, respectively. The mean monocular UNVA was 0.21 ± 0.14 logRAD and 0.24 ± 0.13 logRAD, respectively. No significant differences were observed in the higher-order aberrations, total Strehl ratio (point-spread function), or modulation transfer function between the groups. Dysphotopic symptoms measured with a validated quality-of-vision questionnaire were not significantly different between groups.

Conclusion
Positioning of the near add did not significantly affect objective or subjective visual function parameters.

Physical activity assessment in cystic fibrosis: A position statement

Background

The aim of this position statement was to inform the choice of physical activity tools for use within CF research and clinical settings.

Methods

A systematic review of physical activity tools to explore evidence for reliability, validity, and responsiveness. Narrative answers to “four key questions” on motion sensors, questionnaires and diaries were drafted by the core writing team and then discussed at the Exercise Working Group in ECFS Lisbon 2013.

Results and summary

Our current position is that activity monitors such as SenseWear or ActiGraph offer informed choices to facilitate a comprehensive assessment of physical activity, and should as a minimum report on dimensions of physical activity including energy expenditure, step count and time spent in different intensities and sedentary time. The DigiWalker pedometer offers an informed choice of a comparatively inexpensive method of obtaining some measurement of physical activity. The HAES represents an informed choice of questionnaire to assess physical activity. There is insufficient data to recommend the use of one diary over another. Future research should focus on providing additional evidence of clinimetric properties of these and new physical activity assessment tools, as well as further exploring the added value of physical activity assessment in CF.

Galvanic Vestibular Stimulation Induces a Spatial Bias in Whole-body Position Estimates

Letter to the Editor

Core and patch position optimizations for vibration control of piezolaminated structures

This paper deals with a finite formulation baserd on the classical laminated plate tehory, for active control of thin late laminated structures with integrated piezoelectric layers, acting as sensors and actuators. The control is initialized through a previuos optimization of the core of the laminated structure, in order to minimize the vibration amplitude. Also the optimization of the patches position in performed to maximize the piezoelectric actuator efficiency. the simulating annealing mthod is used for these purposes. The finite element model is a single layer triangular nonconforming plate/shell element with 18 degrees of fredom for the generalized displacements, and one electrical potential degree of freedom for each piezoelectric element layer, wich can be surface bonded or imbedded on the laminate. To achieve a mechanism of active control of the structure dynamic response, a feedback control algorirhm is used, coupling the sensor and active piezoelectric layers. To calculate the dynamic response of the laminated structures the Newmark method is considered. The model is applied in the solution of an illustrative case and the results are presented and discussed.

Position-specific Performance Indicators that Discriminate between Successful and Unsuccessful Teams in Elite Women’s Indoor Field Hockey: Implications for Coaching

The aim of this investigation was to establish median performance profiles for the six playing positions in elite women’s indoor hockey and then identify whether these position-specific profiles could discriminate between qualifying (top four), mid-table and relegated teams in the 2011-12 England Hockey premier league. Successful passing in relegated teams was significantly lower (p<0.008) than in mid-table and qualifying teams in four of the five outfield positions. Furthermore, the right backs of qualifying teams demonstrated significantly fewer (p<0.008) unsuccessful passes (x̃=15.5 ±CLs 15.0 and 10.0 respectively) and interceptions (x̃=4.0 ±CLs 4.0 and 3.0 respectively) than relegated teams (x̃=19.5 ±CLs 21.0 and 17.0; x̃=7.5 ±CLs 8.0 and 6.0 respectively). Finally, the right forwards of relegated teams demonstrated significantly fewer (p<0.008) successful interceptions (x̃=4.0 ±CLs 5.0 and 4.0 respectively) than qualifying teams (x̃=5.0 ±CLs 6.0 and 3.0 respectively) and significantly more (p<0.008) unsuccessful interceptions (x̃=5.5 ±CLs 6.0 and 4.0 respectively) than mid-table teams (x̃=3.0 ±CLs 3.0 and 2.0 respectively). Based on these findings, coaches should adapt tactical strategies and personnel deployment accordingly to enhance the likelihood of preparing a qualifying team. Research should build from these data to examine dribbling, pressing and patterns of play when outletting.