/pdf/2021-esc-guidelines-for-the-diagnosis-and-treatment-of-acute-4pqhe8c49t.pdf

2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure.

Because challenges are ubiquitous, resilience is essential for success in school and in life. In this article we review research demonstrating the impact of students’ mindsets on their resilience in the face of academic and social challenges. We show that students who believe (or are taught) that intellectual abilities are qualities that can be developed (as opposed to qualities that are fixed) tend to show higher achievement across challenging school transitions and greater course completion rates in challenging math courses. New research also shows that believing (or being taught) that social attributes can be developed can lower adolescents’ aggression and stress in response to peer victimization or exclusion, and result in enhanced school performance. We conclude by discussing why psychological interventions that change students’ mindsets are effective and what educators can do to foster these mindsets and create resilience in educational settings. When students struggle with their schoolwork, what determines whether they give up or embrace the obstacle and work to overcome it? And when students feel excluded or victimized by peers, what determines whether they seek revenge through aggression or seek more productive solutions? Resilience—or whether students respond positively to challenges—is crucial for success in school and in life. Yet what causes it? And what can be done to increase it? In this article we demonstrate the impact of students’ mindsets—or implicit theories about the malleability of human characteristics—on their academic and social resilience (Dweck, 2006; Dweck, Chiu, & Hong, 1995). We show how mindsets can contribute to two of the most important issues currently facing educators: (a) academic underachievement and (b) the impact of peer exclusion and victimization. Each of these problems is of great concern, yet each has been frustratingly difficult to address. For example, many of the large-scale interventions evaluated by the Institute of

Mindsets That Promote Resilience: When Students Believe That Personal Characteristics Can Be Developed

Background
Coronary heart disease (CHD) is the most common cause of death globally. However, with falling CHD mortality rates, an increasing number of people living with CHD may need support to manage their symptoms and prognosis. Exercise‐based cardiac rehabilitation (CR) aims to improve the health and outcomes of people with CHD. This is an update of a Cochrane Review previously published in 2016.

Objectives
To assess the clinical effectiveness and cost‐effectiveness of exercise‐based CR (exercise training alone or in combination with psychosocial or educational interventions) compared with 'no exercise' control, on mortality, morbidity and health‐related quality of life (HRQoL) in people with CHD.

Search methods
We updated searches from the previous Cochrane Review, by searching CENTRAL, MEDLINE, Embase, and two other databases in September 2020. We also searched two clinical trials registers in June 2021.

Selection criteria
We included randomised controlled trials (RCTs) of exercise‐based interventions with at least six months’ follow‐up, compared with 'no exercise' control. The study population comprised adult men and women who have had a myocardial infarction (MI), coronary artery bypass graft (CABG) or percutaneous coronary intervention (PCI), or have angina pectoris, or coronary artery disease.

Data collection and analysis
We screened all identified references, extracted data and assessed risk of bias according to Cochrane methods. We stratified meta‐analysis by duration of follow‐up: short‐term (6 to 12 months); medium‐term (> 12 to 36 months); and long‐term ( > 3 years), and used meta‐regression to explore potential treatment effect modifiers. We used GRADE for primary outcomes at 6 to 12 months (the most common follow‐up time point). 

Main results
This review included 85 trials which randomised 23,430 people with CHD. This latest update identified 22 new trials (7795 participants). The population included predominantly post‐MI and post‐revascularisation patients, with a mean age ranging from 47 to 77 years.

In the last decade, the median percentage of women with CHD has increased from 11% to 17%, but females still account for a similarly small percentage of participants recruited overall ( < 15%). Twenty‐one of the included trials were performed in low‐ and middle‐income countries (LMICs). Overall trial reporting was poor, although there was evidence of an improvement in quality over the last decade. The median longest follow‐up time was 12 months (range 6 months to 19 years).

At short‐term follow‐up (6 to 12 months), exercise‐based CR likely results in a slight reduction in all‐cause mortality (risk ratio (RR) 0.87, 95% confidence interval (CI) 0.73 to 1.04; 25 trials; moderate certainty evidence), a large reduction in MI (RR 0.72, 95% CI 0.55 to 0.93; 22 trials; number needed to treat for an additional beneficial outcome (NNTB) 75, 95% CI 47 to 298; high certainty evidence), and a large reduction in all‐cause hospitalisation (RR 0.58, 95% CI 0.43 to 0.77; 14 trials; NNTB 12, 95% CI 9 to 21; moderate certainty evidence). Exercise‐based CR likely results in little to no difference in risk of cardiovascular mortality (RR 0.88, 95% CI 0.68 to 1.14; 15 trials; moderate certainty evidence), CABG (RR 0.99, 95% CI 0.78 to 1.27; 20 trials; high certainty evidence), and PCI (RR 0.86, 95% CI 0.63 to 1.19; 13 trials; moderate certainty evidence) up to 12 months' follow‐up. We are uncertain about the effects of exercise‐based CR on cardiovascular hospitalisation, with a wide confidence interval including considerable benefit as well as harm (RR 0.80, 95% CI 0.41 to 1.59; low certainty evidence). There was evidence of substantial heterogeneity across trials for cardiovascular hospitalisations (I2 = 53%), and of small study bias for all‐cause hospitalisation, but not for all other outcomes.

At medium‐term follow‐up, although there may be little to no difference in all‐cause mortality (RR 0.90, 95% CI 0.80 to 1.02; 15 trials), MI (RR 1.07, 95% CI 0.91 to 1.27; 12 trials), PCI (RR 0.96, 95% CI 0.69 to 1.35; 6 trials), CABG (RR 0.97, 95% CI 0.77 to 1.23; 9 trials), and all‐cause hospitalisation (RR 0.92, 95% CI 0.82 to 1.03; 9 trials), a large reduction in cardiovascular mortality was found (RR 0.77, 95% CI 0.63 to 0.93; 5 trials). Evidence is uncertain for difference in risk of cardiovascular hospitalisation (RR 0.92, 95% CI 0.76 to 1.12; 3 trials).

At long‐term follow‐up, although there may be little to no difference in all‐cause mortality (RR 0.91, 95% CI 0.75 to 1.10), exercise‐based CR may result in a large reduction in cardiovascular mortality (RR 0.58, 95% CI 0.43 to 0.78; 8 trials) and MI (RR 0.67, 95% CI 0.50 to 0.90; 10 trials). Evidence is uncertain for CABG (RR 0.66, 95% CI 0.34 to 1.27; 4 trials), and PCI (RR 0.76, 95% CI 0.48 to 1.20; 3 trials).

Meta‐regression showed benefits in outcomes were independent of CHD case mix, type of CR, exercise dose, follow‐up length, publication year, CR setting, study location, sample size or risk of bias.

There was evidence that exercise‐based CR may slightly increase HRQoL across several subscales (SF‐36 mental component, physical functioning, physical performance, general health, vitality, social functioning and mental health scores) up to 12 months' follow‐up; however, these may not be clinically important differences. The eight trial‐based economic evaluation studies showed exercise‐based CR to be a potentially cost‐effective use of resources in terms of gain in quality‐adjusted life years (QALYs).

Authors' conclusions
This updated Cochrane Review supports the conclusions of the previous version, that exercise‐based CR provides important benefits to people with CHD, including reduced risk of MI, a likely small reduction in all‐cause mortality, and a large reduction in all‐cause hospitalisation, along with associated healthcare costs, and improved HRQoL up to 12 months' follow‐up. Over longer‐term follow‐up, benefits may include reductions in cardiovascular mortality and MI. In the last decade, trials were more likely to include females, and be undertaken in LMICs, increasing the generalisability of findings. Well‐designed, adequately‐reported RCTs of CR in people with CHD more representative of usual clinical practice are still needed. Trials should explicitly report clinical outcomes, including mortality and hospital admissions, and include validated HRQoL outcome measures, especially over longer‐term follow‐up, and assess costs and cost‐effectiveness.

/pdf/exercise-based-cardiac-rehabilitation-for-coronary-heart-ctqt9teiud.pdf

Exercise-based cardiac rehabilitation for coronary heart disease

https://ies.ed.gov/ncee/edlabs/regions/midwest/pdf/REL_2015083.pdf

National Center for Education Evaluation and Regional Assistance

Renal osteodystrophy

https://academiccommons.columbia.edu/doi/10.7916/D8MW2R7K/download

Referral, enrollment, and completion in developmental education sequences in community colleges

After being assessed, many students entering community colleges are referred to one or more levels of developmental education. While the need to assist students with weak academic skills is well known, little research has examined student progression through multiple levels of developmental education and into entry-level college courses. The purpose of this paper is to analyze the patterns and determinants of student progression through sequences of developmental education starting from initial referral. Our results indicate that fewer than one half of the students who are referred to remediation actually complete the entire sequence to which they are referred. About 30 percent of students referred to developmental education do not enroll in any remedial course, and only about 60 percent of referred students actually enroll in the remedial course to which they were referred. The results also show that more students exit their developmental sequences because they did not enroll in the first or a subsequent course than because they failed or withdrew from a course in which they were enrolled. We also show that men, older students, African American students, part-time students, and students in vocational programs are less likely to progress through their full remedial sequences.

Referral, Enrollment, and Completion in Developmental Education Sequences in Community Colleges. CCRC Working Paper No. 15.

Using data from the Virginia Community College System and building upon prior Florida-based research, this study examines whether student success course enrollment, as well as student and instituti...

Student Success Courses in the Community College: Early Enrollment and Educational Outcomes

To support the long-term success of underprepared students, many community colleges are experimenting with accelerated developmental education models, which allow students to complete remediation and enroll in college-level math and English within a shorter time frame. This study examines three developmental acceleration programs, including two in English and one in math. Overall, students on accelerated pathways were more likely than a set of matched peers to successfully complete the relevant college-level course within 3 years. However, to help maintain strong student performance within subsequent college-level courses, accelerated pathways may need to incorporate rigorous content, systematic faculty development, and targeted student supports.

Three Accelerated Developmental Education Programs Features, Student Outcomes, and Implications

Acknowledgments: Funding for this report was provided by the Virginia Community College System (VCCS). Additional funding was provided by Lumina Foundation for Education through a grant to CCRC as part of Achieving the Dream: Community Colleges Count. The authors are grateful to the Virginia Community College System staff for sharing the data used in this study, particularly Donna Jovanovich and Susan Wood, who reviewed earlier drafts and offered insights to help us interpret our findings. We also thank the members of the VCCS Developmental Education Task Force, who provided helpful feedback on our preliminary findings and recommendations. Finally, we thank Wendy Schwartz, who edited the report. Executive Summary Overview The Virginia Community College System (VCCS) is engaged in a strategic planning process to improve performance beyond the goals in Dateline 2009, the system's current vision and plan. A key objective is to encourage colleges to improve retention and academic success for students, particularly the substantial numbers who arrive unprepared for college-level work. Specifically, the VCCS seeks to improve the rates at which underprepared students complete developmental coursework and advance to take and pass college courses, particularly the initial college-level, or \" gatekeeper, \" math and English offerings. to conduct analyses to inform its efforts to improve student outcomes. In response, CCRC designed a study to address the following question: What student characteristics, course-taking patterns, and other factors are associated with higher probabilities that students who require remediation will take and pass college-level math and English? The dataset used by CCRC, provided by the VCCS, contained information on 24,140 first-time college students who enrolled in a VCCS college in summer or fall 2004. It included information on student demographics, institutions attended, placement test scores and placement recommendations, transcript data on courses and grades, and information on educational attainment (including transfer to four-year institutions and certificates and associate degrees earned). Students were followed for four years, through the 2008 summer term. CCRC examined a range of educational outcomes, including: whether students took and passed development courses and gatekeeper English and math, the number of terms they were enrolled, the number of credits they accumulated, and whether they earned educational awards (certificates and associate degrees) or transferred to four-year institutions. This report presents the main findings from CCRC's study and outlines suggestions for steps that the VCCS and its member colleges might take to improve completion of gatekeeper courses by the many students …

/pdf/strategies-for-promoting-gatekeeper-course-success-among-1b0f2oegg2.pdf

Sung Woo Cho

Papers

Referral, enrollment, and completion in developmental education sequences in community colleges

Referral, Enrollment, and Completion in Developmental Education Sequences in Community Colleges. CCRC Working Paper No. 15.

Student Success Courses in the Community College: Early Enrollment and Educational Outcomes

Three Accelerated Developmental Education Programs Features, Student Outcomes, and Implications

Strategies for Promoting Gatekeeper Course Success Among Students Needing Remediation: Research Report for the Virginia Community College System