Cascade Training Research Articles

The Development of a Train-the-Trainer Approach in Reciprocal Reading Instruction in England’s Primary Schools

There is good evidence that targeted reciprocal reading instruction for struggling readers can lead to attainment gains in reading for children aged 9–12 years in England using the FFT Reciprocal Reading instruction programme when training is delivered by the programme developer. However, for programme scale-up, a train-the-trainer delivery approach is required. This study reports the development of a train-the-trainer delivery approach during a Phase-1 pilot to enable the programme’s delivery at greater scale. During the pilot, five trainers were trained to cascade training to 16 English primary schools, which implemented the programme with 217 children. The train-the-trainer approach developed used a workshop and cascade model recommended by both health and education sectors. Trainer and school staff perception feedback was collected during the development process, and independently designed standardised reading tests were used to explore children’s progress during the pilot. Feedback suggests that the train-the-trainer approach developed is implementable in schools, including observable pupil progress in reading. This train-the-trainer delivery approach should now be tested using RCT methodology.

A multi-phase structured cascade model for mass training of community healthcare workers in performing clinical breast exams in remote regions.

Clinical breast exam (CBE) by outreach healthcare workers (HCW) may help downstage breast cancer in resource-limited areas where mammography may not be feasible. We evaluated the effectiveness of a pilot cascade-model training programme for HCWs in remote areas of Pakistan. The training programme comprised three phases. In phase one, fellowship-trained breast surgeons at a metropolitan academic centre trained six HCWs to perform CBEs. In phase two, these six HCWs (master trainers) trained 15 additional HCWs, implementing cascade training. In phase three, the consultant breast surgeon conducted a re-evaluation and refresher course for all 21 HCWs at least one year after the original training session. We assessed CBE ability and skills through pre- and post-changes through self-reported confidence and direct observation of procedural skills. Significant improvements in learners' self-reported confidence and CBE skills were observed in both phases one and two. The median scores in the learners' post-training self-reported confidence and CBE skills (inspection, palpation, and lymph node examination) improved by 20% and 46.2%, respectively, indicating excellent learning outcomes of the cascade training sessions. Phase three showed sustained high scores in self-reported confidence and CBE skills more than one year later. Mass training of outreach HCWs in remote regions in performing CBE may be possible with a structured multiphase cascade-training model and may be an important step in downstaging symptomatic breast cancer in low-resource settings.

Assessing fidelity of design and training of Making Every Contact Count (MECC) in a mental health inpatient setting

BackgroundMaking Every Contact Count (MECC) is a public health strategy which strives to enable brief interventions to be implemented through opportunistic healthy lifestyle conversations. In a mental health inpatient setting a bespoke MECC training package has been developed to encourage cascade training through a train the trainer model and to incorporate an additional regional health strategy A Weight Off Your Mind into Core MECC training to provide a focus on healthy weight management. This study evaluated the fidelity of design of MECC in the mental health inpatient setting and fidelity of the training package currently being cascaded across the region.MethodsInitially a documentary analysis of six documents shared through the mental health inpatient setting including MECC implementation guide, logic model, checklist and evaluation framework. Documents were analysed using the Template for Intervention Description and Replication (TIDieR) checklist and coded using the Behaviour Change Technique (BCT) Taxonomy version one (BCTTv1) and the Expert Recommendations for Implementing Change (ERIC) Taxonomy. Coding was compared against MECC guidance documents to complete the fidelity assessment. A training delivery guide, training slides and two recordings of both train the trainer and Core MECC + A Weight Off Your Mind training were analysed for behaviour change techniques (BCTs) and compared to conduct a fidelity training assessment.ResultsOverall the implementation of MECC in the mental health inpatient setting had moderate fidelity to the MECC guidance, with a total of 31 BCTs identified across guidance and provider documents and a 77% adherence of provider documents to guidance. The highest level of fidelity applied to the MECC implementation guide where 86% of identified BCTs were also present. The training package showed high fidelity that both training programmes were being delivered as intended with 100% of BCT matched from training materials to training transcripts. Potential loss of fidelity through additional BCTs was present across provider documents and training transcripts.ConclusionThe implementation of MECC across the mental health inpatient setting and the training package appear to be delivered as intended therefore demonstrating good fidelity and potential benefits to public health. Future research would benefit from assessing cascade training sessions from those who have completed train the trainer to evaluate ongoing fidelity of training across the trust.

Participatory research at scale: A comparative analysis of four approaches to large-scale agricultural technology testing with farmers

Tailoring agricultural technology options to the diverse conditions of smallholder farmers requires innovative approaches for testing these technologies with farmers across varied contexts, while incorporating their feedback into learning and decision-making processes. This study compares four such approaches: the Farmer Field School on Participatory Plant Breeding (FFS-PPB), Farmer Research Network (FRN), Crowdsourcing–Triadic comparisons of technologies (Tricot), and adapted Mother–Baby Trial (MBT) as implemented by four concrete projects. The objectives are to provide detailed descriptions of these approaches and their project-specific implementations, identify and analyze common aspects and differences, and derive insights to guide future farmer-inclusive projects aiming at contextual scaling of agricultural technologies. A literature review, key informant interviews, and a systematic content analysis were conducted for the analysis. Common features include cascade training models, simple farmer-managed experiments, and the use of digital tools for data collection. Major differences lie in the extent of farmer–researcher collaboration and decision-making, as well as how technology option-by-context interactions are addressed. The FRN, FFS-PPB, and adapted MBT approaches involve farmers in decision-making throughout most stages of research, including co-learning cycles that adapt the research design and technology options to farmers’ needs. Although these approaches require more training and expertise, they increase the likelihood of achieving relevant results that farmers can implement in practice. In contrast, more standardized approaches like the Crowdsourcing–Tricot streamline the implementation, data management and analysis of large-scale trials, but have limitations in capturing the underlying reasons for farmers’ preferences. Among the studied approaches, the FRN as implemented by the Women's Fields project in Niger is particularly effective in identifying which options best suit specific farming contexts.

The implementation of a "safety officer" program: an innovative approach to improve infection prevention and control practices in Ethiopia.

Effective infection prevention and control (IPC) was central to keeping healthcare workers (HCWs) safe during the COVID-19 pandemic. However, as the pandemic continued, the maintenance of high-quality IPC practices waned, placing HCWs at increased risk of infection. A COVID-19 Safety Officer (SO) program was piloted by the United States Agency for International Development (USAID)-funded Reaching Impact, Saturation and Epidemic Control (RISE) project across two health facilities in Ethiopia, which trained clinical and non-clinical HCWs on IPC protocols to promote safe practices in patient care areas. We sought to evaluate the implementation and effectiveness of the SO program in improving IPC practices within the clinical setting. This is a post-implementation evaluation of the SO program, implemented in two hospitals in Ethiopia between May 2022 and December 2022. Participants completed a 4-day course on COVID-19 epidemiology, IPC, safety communication, and learning theory as a part of the Training of Trainers component (n = 23), and were posted in clinical wards to provide staff training and support to maintain IPC protocols. The program was evaluated at 6 months using the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework. Effectiveness was measured using direct observation of IPC practices across intervention sites. Implementation outcomes were measured using surveys and qualitative interviews to capture training cascade, knowledge, comfort, acceptability, and maintenance. Participants were able to cascade training to an additional 167 clinical (67.6%) and 80 non-clinical (32.3%) staff across both sites. Direct observation of clinical staff at 6 months showed that 95% (59/62) wore at least a surgical mask with patients and were compliant with masking and/or distancing protocol. Clinical interviews revealed that SOs contributed to increased perceived comfort with screening and isolation procedures and environmental cleaning procedures. The SO training program was widely adopted, and effective in improving the implementation and comfort of maintaining IPC practices in clinical settings.

Empowering Midwives in Humanitarian Settings: Integrating Heat-Stable Carbetocin and Tranexamic Acid into Postpartum Hemorrhage Training.

Maternal mortality remains extremely high in fragile settings, with hemorrhage as the leading cause. This study describes a new model for more effective training on postpartum hemorrhage (PPH) prevention and treatment. Using a low-dose (of information) and high-frequency (of repetitions) approach (LDHF), the strategy comprised an introductory webinar, self-paced study, 2-day in-person workshops, cascade training, continuous facility-based skills drills, and a WhatsApp community of practice and supervision (CoP). Innovations consisted of the practical, midwifery-centered, and short-duration training, and the integration of tranexamic acid (TXA) and heat-stable carbetocin (HSC) into existing modules from the "Bleeding-After-Birth-Complete" toolkit. Effects were assessed through mixed-methods evaluation. Confidentiality and "do-not-harm" principles were respected. Nine training sessions were conducted in South Sudan and Uganda combined, engaging 126 participants. Average knowledge increases of 21% in South Sudan and 18% in Uganda were recorded. Feedback also indicated changes in practices and attitudes: enhanced competency, teamwork, clinical protocols adherence, appreciation for midwife-led practical sessions, the LDHF method, and continuous support through the WhatsApp CoP. In post-workshop action plans, facility teams outlined steps to apply acquired knowledge and skills. These included training colleagues, establishing quality improvement projects, conducting skill drills, ensuring job aid visibility, and systematically reporting on PPH in the data collection templates of the facilities. This case study highlights the value of a practical, LDHF refresher training strategy. This strategy bolstered providers' skills, knowledge, and confidence in using HSC and TXA for PPH prevention and treatment. Findings can guide future training in similar fragile, low-resource, and humanitarian settings. Strengthening midwifery leadership, fostering interdisciplinary collaboration, and using the LDHF training approach can contribute to resilient health systems and taskforce, aligning with global efforts to reduce maternal mortality.

Journey From a Digital Innovation to a Sustainable Health Worker Capacity-Building App in India: Experiences, Challenges, and Lessons Learned.

Health workers, especially auxiliary nurse midwives (ANMs), are among the most critical resources in improving the quality of immunization services and reducing vaccine hesitancy under the Universal Immunization Programme (UIP) in India. To improve health worker immunization skills, UIP trainings in India are primarily conducted through instructor-led classroom, cascade trainings. However, a 2018 capacity-building need assessment revealed several challenges involved in traditional classroom training, such as a single-time exposure to new guidelines, complicated logistics arrangements, a lack of refresher training, and varying quality of training. These complexities make it difficult to meet the timely knowledge and skill needs of every health worker effectively and uniformly in a rapidly changing scenario of UIP. To meet health worker capacity-building needs and address these challenges, Rapid Immunization Skill Enhancement (RISE), a learning management system (LMS) application, was conceptualized. The RISE LMS application was developed as a human-centered, interactive, continuous, and adaptable knowledge and skill-building platform for health workers engaged in the UIP. RISE complements existing classroom-based cascade training for health workers by leveraging digital technologies for faster, easier, and more effective knowledge transfer to accommodate the fast-changing needs of a dynamic health program like UIP. In this article, we share the challenges and strategic solutions to digital training applications, lessons learned, sustainability of the application, and the impact RISE has made in India, all of which stemmed from leadership, coordinated efforts from a team of skilled professionals, government acceptance, detailed planning, and continued stakeholder engagement.

EYE-BLINK DETECTION ASSISTIVE SYSTEM FOR PARALYZED PATIENT

Paralysis is defined as the complete loss of muscle function in any part of the body. It occurs when there is a problem with the passage of messages between the muscles and the brain. Some paralyzed people cannot move even a single part of the body other than their eyes. Hence, the main aim of this project is to design a real time interactive system that can assist the paralyzed to control appliances such as lights, fans or by playing pre-recorded audio messages, through a predefined number of eye blinks. Image processing techniques have been implemented in order to detect the eye blinks. In our system, the face tracking is accomplished by using a set of trained Haar cascade classifier, and a template matching technique is employed to track the eye. Initially, the involuntary blinks of the paralyzed person are used to locate the patients eyes by finding the number of connected components in a frame.

A national mental health cascade training programme for practitioners supporting unaccompanied minors in Greece.

Practitioners who support unaccompanied minors (UAMs) come from different professional backgrounds and often are not appropriately trained to address children's complex mental health needs. This gap informed a training programme across all accommodation centres in Greece. The aim of the Train-of-Trainer (ToT) national programme was to upskill trainers from 17 organisations to cascade knowledge. Training was interprofessional, trauma-informed and culturally sensitive. A pilot implementation involved 199 practitioners from all disciplines. A sub-sample of 33 practitioners, nine managers and six trainers shared their experiences in focus group discussions, which were analysed through a thematic framework. Participants found that the programme was useful in generating knowledge relevant to children's needs and their roles, addressing the emotional impact of trauma on staff, sharing learning across professional disciplines and being interactive, but systemic support should be put in place for benefits to be sustained. Train-of-Trainer is a resource-effective approach to upskill mixed staff groups across many organisations. This should involve caregivers and staff with limited educational opportunities, while accommodating for different professional needs. Training should be integrated to service budgets, specifications and structures.

Comparing different lymphatic filariasis patient estimate approaches and results in Ethiopia

BackgroundThe World Health Organization (WHO) recommends that countries ensure morbidity management and disability prevention (MMDP) services are available to all lymphedema and hydrocele patients in lymphatic filariasis (LF)-endemic areas. The first step in ensuring the availability of MMDP services is to understand the number and distribution of people with lymphedema and hydrocele. We examined the burden of lymphoedema and hydrocoele using different patient estimation approaches employed in endemic districts of the Beneshangul-Gumuz and Tigray regions of Ethiopia.Methodology/principal findingsIn Approach I, trained health extension workers (HEWs) conducted the patient estimates during a door-to-door pre-mass drug administration (MDA) census. Validation of a sample of the data collected was integrated with a post-MDA coverage survey. In Approach II, trained HEWs conducted a stand-alone patient estimation, and clinical officers validated all suspected patients. In 15 districts, 753,557 individuals were surveyed. A total of 1,645 lymphedema (1:1.6 male-to-female ratio) and 517 hydrocele cases were identified. The prevalence of lymphedema and hydrocele was 40 per 10,000 in the adult population and 25 per 10,000 in the adult male population, with wide variation across districts. Validation in Approach I showed that 94% of the lymphedema cases and 77% of hydrocele cases were correctly identified by the HEWs, while 60% and 53% were correctly identified in Approach II.Conclusion/significancePatient estimation is important for planning, prioritization, targeting interventions, and monitoring progress in LF-endemic areas. Trained HEWs can correctly identify most cases using a standardized patient estimate job aid and questionnaire, even when cascade training is used. For the purposes of LF elimination, these results are sufficient and at a low cost per district. Ethiopia’s LF program could integrate patient estimations into MDA activities in the remaining LF-endemic districts with minimal cost and effort.

Teaching Recovery Techniques (TRT) to Ukrainian children and adolescents to self-manage post-traumatic stress disorder (PTSD) symptoms following the Russian invasion of Ukraine in 2022 – The first 7 months

BackgroundThe Russian invasion of Ukraine in February 2022 prompted many to provide mental health input, especially trauma management, to Ukrainian children and adolescents (C/A) exposed to it. MethodsRapid cascade training of 200 Ukrainian psychologists during 2022 to provide, in pairs, free of charge and without selection, TRT courses of 4–6, 90 min sessions online or face to face to C/A 7 to 23 years in Ukraine and those migrating abroad. CRIES–8 PTSD questionnaires were administered at the beginning and end of the courses during May–December 2022. Age, gender, their geographical war risk, and whether C/A had stayed or migrated elsewhere were collected. A CRIES-8 score of ≥17/40 defined likely PTSD. Results3123 C/A completed an initial CRIES-8 questionnaire with matching demographics, 2737 a questionnaire at the end and 1798 both. At entry to TRT, likely PTSD was greater in females (65 %) than males (52 %, p < 0.001) declining with increasing age, particularly in males (p < 0.001). Migration had mixed effects and moving to lower war risk areas or abroad did not reduce PTSD risk. TRT benefited 68 % of C/A overall by reducing CRIES-8 from ≥17 to <17, the rate increasing the more experienced the TRT facilitators became (p < 0.0001). Online and face to face outcomes were the same. LimitationsThe chaos of war prevented capture of all potential C/A questionnaires and long-term repeat testing not yet undertaken. ConclusionsEven in the chaos of war, effective mental health input can be rapidly and cheaply (c.50 USD/child) provided and should be encouraged.

A cascade training protocol for schoolteachers on oral health: Investigating the influence of primary and secondary mentors.

Oral health holds paramount importance for overall well-being, particularly among school-aged children, where inadequate oral health can cause significant discomfort and impede educational performance. Despite its critical nature, oral health awareness and practices within Indian school communities remain suboptimal. There exists an urgent necessity for efficacious educational initiatives to bridge this gap and foster oral health awareness among both schoolteachers and students. This monitored training introduces a pioneering cascade model training initiative aimed at evaluating its impact on enhancing oral health knowledge among schoolteachers and students in Indian schools. A total of 100 school teachers from 50 Centre government schools will undergo training in two distinct sessions. Following this, two teachers from each school will be selected to further train 24 class monitors from grades 6-9, who will subsequently impart knowledge to approximately 40 students per class. This phase of the training will be ongoing, ensuring training consistency through online supervision and active participation of the expert team in training activities with newly designated master trainers. Pre- and post-training assessments will be conducted at each level to gauge the monitored training's effectiveness. The entire training is projected to conclude within a year. This cascade model monitored training initiative represents a novel approach in promoting oral health awareness in Indian schools, marking a pioneering endeavor in this domain. Through this program, we aim to empower 1200 class monitors as master trainers and reach approximately 24,000 school students across 480 supervised training sessions. The establishment of master trainers through a cascade process, coupled with the engagement of the CDER expert team, ensures accurate dissemination of information at every stage. The comprehensive evaluation facilitated by pre- and post-training assessments at each level further enhances the program's effectiveness, laying a solid foundation for future oral health initiatives within school communities.

Investigating Infection Prevention and Control Practices among Healthcare Workers in Kasese District, Uganda: Factors and Implications for Ebola Preparedness

The World Health Organization (WHO) African region often faces numerous public health emergencies, with a significant proportion caused by infectious diseases. Ebola virus disease (EVD) is a high-consequence pathogen of particular concern due to its high mortality rate and potential for global transmission. The study aimed to investigate infection prevention and control (IPC) practices with factors associated with the practice among health care workers (HCWs) in Kasese district, Uganda. The study design was cross-sectional, utilizing both qualitative and quantitative methods. The study population consisted of HCWs working in six selected Health Centre III facilities in sub-counties bordering the Democratic Republic of Congo (DRC). A sample of 106 HCWs was purposively selected and data collection involved structured questionnaires, and then data analysis was done using descriptive statistics and logistic regression. The study reveals that a majority of HCWs were female (55.7%), worked in outpatient departments (49.1%), had 6-10 years of service (43.4%), held certificates as their highest education level (48.1%), and were predominantly nurses (53.8%). IPC practices were found to be low, with 72.6% of participants exhibiting inappropriate IPC practices. Individual factors influencing low IPC practices included the duration of IPC training, knowledge, attitude towards IPC, and education level, all statistically significant (P &lt; 0.05). Similarly, health facility factors such as the accessibility of IPC guidelines and personal protective equipment (PPE), availability of sanitizer/soap, and proper and continuous IPC training/continuing medical education (CME) were associated with low IPC practice (P &lt; 0.05). In conclusion, the study highlights a low level of IPC practice among HCWs in Health Centre Threes in Kasese District, with both individual and health facility factors contributing to this issue. Recommendations include training HCWs in IPC and organizing regular cascade training, providing IPC knowledge as part of their daily duties, ensuring confidence in managing Ebola during outbreaks, maintaining IPC strategies implemented during EVD outbreaks, and supplying IPC materials to healthcare facilities. These efforts, coupled with increased staffing, can significantly enhance protection and performance in public healthcare services.

Cascade training for scaling up care for perinatal depression in primary care in Nigeria

BackgroundTask-shared care is a demonstrated approach for integrating mental health into maternal and child healthcare (MCH) services. Training and continued support for frontline providers is key to the success of task sharing initiatives. In most settings this is provided by mental health specialists. However, in resource constrained settings where specialists are in short supply, there is a need to explore alternative models for providing training and supportive supervision to frontline maternal care providers. This paper reports on the impact of a cascade training (train-the-trainers) approach in improving the knowledge and attitudes of primary healthcare workers (PHCW) to perinatal depression.MethodsSenior primary health care providers selected from across participating local government areas were trained to provide training to other PHCWs. The training sessions facilitated by these trainers were observed and rated for fidelity by specialist trainers, while the trainees provided their impression of and satisfaction with the training sessions using predesigned assessment forms. Training outcomes assessed included knowledge of depression (using mhGAP training questions and knowledge of depression questionnaire) and attitude towards providing care for depression (revised depression attitude questionnaire (R-DAQ)) measured pre and post training as well as six months after training.ResultsTrainees were 198 PHCWs (94.4% female), who routinely provide MCH services in 28 selected primary care clinics and had between 6- and 34-years’ experience. Training was provided by 11 trained trainers who were general physicians or senior nurses. Training sessions were rated high in fidelity and on training style. Sessions were rated excellent by 77.8% of the trainees with the trainers described as knowledgeable, effective and engaging. Knowledge of depression mean score improved from a pre-training level of 12.3 ± 3.5 to 15.4 ± 3.7, immediately post-training and 14.7 ± 3.2, six months post-training (both comparisons: p < 0.001). The proportion of PHCW workers endorsing statements indicative of positive attitudes on the professional confidence and the generalist perspective modules of the R-DAQ also increased with training.ConclusionOur findings suggest that cascade training can be an effective model for rapidly providing training and upskilling frontline PHCWs to deliver care for women with perinatal depression in resource limited settings.Trial registrationThis study was retrospectively registered 03 December 2019. https://doi.org/10.1186/ISRCTN 94,230,307.

Continuous professional development: Assessing teachers' experiences with the cascading training model

Continuous professional development (CPD) is integral in educational reform; developing and enhancing teachers’ pedagogical skills and knowledge. In Malaysia, the cascade training model is often preferred for CPD programmes in public secondary schools. This may be due to cost effectiveness and reach, where many teachers can be trained in a short timeframe. Critics of the cascade model of training tend however, point to a risk of knowledge being diluted as it is transferred from the trainers to the attendees and then to teachers in schools. This paper focuses on documenting the experiences of Malaysian secondary school English teachers attending school-based assessment (SBA) CPD training courses using the cascade training model. Adopting a qualitative research approach, through the use of in-depth semi-structured interviews, data was collected from 14 English teachers from 14 public secondary schools. The findings indicate that there were mixed experiences of teachers attending cascade training programs and that of subsequent trainings that were conducted by attendees of the programmes. These experiences were affected largely by the quality of the training programme (i.e. design of program curriculum and materials), trainer quality, participants selected, and follow up support afforded to participants. This paper culminates with recommendations for further CPD improvements.

On the effectiveness of a contrastive cascade graph learning framework: The power of synthetic cascade data.

Analyzing the dynamics of information diffusion cascades and accurately predicting their behavior holds significant importance in various applications. In this paper, we concentrate specifically on a recently introduced contrastive cascade graph learning framework, for the task of predicting cascade popularity. This framework follows a pre-training and fine-tuning paradigm to address cascade prediction tasks. In a previous study, the transferability of pre-trained models within the contrastive cascade graph learning framework was examined solely between two social media datasets. However, in our present study, we comprehensively evaluate the transferability of pre-trained models across 13 real datasets and six synthetic datasets. We construct several pre-trained models using real cascades and synthetic cascades generated by the independent cascade model and the Profile model. Then, we fine-tune these pre-trained models on real cascade datasets and evaluate their prediction accuracy based on the mean squared logarithmic error. The main findings derived from our results are as follows. (1) The pre-trained models exhibit transferability across diverse types of real datasets in different domains, encompassing different languages, social media platforms, and diffusion time scales. (2) Synthetic cascade data prove effective for pre-training purposes. The pre-trained models constructed with synthetic cascade data demonstrate comparable effectiveness to those constructed using real data. (3) Synthetic cascade data prove beneficial for fine-tuning the contrastive cascade graph learning models and training other state-of-the-art popularity prediction models. Models trained using a combination of real and synthetic cascades yield significantly lower mean squared logarithmic error compared to those trained solely on real cascades. Our findings affirm the effectiveness of synthetic cascade data in enhancing the accuracy of cascade popularity prediction.

Deep hierarchical distillation proxy-oil modeling for heterogeneous carbonate reservoirs

This paper presents a novel few-shot proxy modeling approach for the oil and gas industry to reduce reliance on numerical simulators for reservoir analysis. The strategy introduces a regression framework leveraging deep hierarchical self-distillation to construct a meta-model based on ensemble learning. The proposed method employs a cascade training scheme, which uses predictions derived from a superior hierarchical level to distill knowledge into the next predictor. The pivotal idea of self-distillation is to generate “soft targets” rather than hard ones. Soft targets represent probability distributions over potential output curves rather than a correct answer. This smoothing information provides additional guidance to the model during training, helping it generalize better. This architecture utilizes three-dimensional (3D) maps in proxy modeling to forecast cumulative fluid production and generate risk curves indispensable for effective field decisions. The study employed data acquired from a complex oil field characterized by a substantial degree of uncertainty. The hierarchical self-distillation technique outperforms alternative methods, achieving a symmetric mean absolute percentage error (SMAPE) below 2%. It reduces computational overhead by 84% for a probabilistic model with 900 simulations and 62% for a model with 200 simulations. The developed proxy model delivers valuable insights for decision-making in oil field management, offering the potential to decrease expenses and enhance efficiency in field exploration endeavors.

Embedding Physical Activity Guidance During Pregnancy and in Postpartum Care: 'This Mum Moves' Enhances Professional Practice of Midwives and Health Visitors.

The benefits of physical activity during pregnancy and after childbirth are well established, yet many health care professionals do not feel well equipped to provide physical activity guidance to these populations. As such, the objectives of this study were to explore the immediate and longer term effects of training on health care professionals' ability to provide physical activity guidance to pregnant women and new mothers (mums). Midwives and health visitors from 5 locations in the United Kingdom were provided with training on the Chief Medical Officers' physical activity guidelines for pregnancy and after childbirth (n = 393). Midwives and health visitors attended training to become This Mum Moves Ambassadors, then disseminated education to colleagues through a cascade training model. Changes in knowledge, confidence, and professional practice were assessed by survey before and immediately after training (n = 247), and follow-up surveys were completed 3 (n = 35) and 6 (n = 34) months posttraining. At all posttraining time points, health care professionals reported a significant increase in their confidence to communicate about physical activity (P < .001). The reported frequency of having conversations about physical activity increased significantly 3 and 6 months following training compared with baseline (pregnant women, P = .017; new mums, P = .005). There were changes in the types of advice and resources offered by health care professionals and an overall increase in health care professionals' own reported physical activity levels. The This Mum Moves cascade approach to delivering training in physical activity guidelines improved reported knowledge, confidence and professional practice of midwives and health visitors, both immediately following and 3 and 6 months after training.

Facilitators and barriers to seasonal malaria chemoprevention (SMC) uptake in Nigeria: a qualitative approach

BackgroundSMC was adopted in Nigeria in 2014 and by 2021 was being implemented in 18 states, over four months between June and October by 143000 community drug distributors (CDDs) to a target population of 23million children. Further expansion of SMC is planned, extending to 21 states with four or five monthly cycles. In view of this massive scale-up, the National Malaria Elimination Programme undertook qualitative research in five states shortly after the 2021 campaign to understand community attitudes to SMC so that these perspectives inform future planning of SMC delivery in Nigeria.MethodsIn 20 wards representing urban and rural areas with low and high SMC coverage in five states, focus group discussions were held with caregivers, and in-depth interviews conducted with community leaders and community drug distributors. Interviews were also held with local government area and State malaria focal persons and at national level with the NMEP coordinator, and representatives of partners working on SMC in Nigeria. Interviews were recorded and transcribed, those in local languages translated into English, and transcripts analysed using NVivo software.ResultsIn total, 84 focus groups and 106 interviews were completed. Malaria was seen as a major health concern, SMC was widely accepted as a key preventive measure, and community drug distributors (CDDs) were generally trusted. Caregivers preferred SMC delivered door-to-door to the fixed-point approach, because it allowed them to continue daily tasks, and allowed time for the CDD to answer questions. Barriers to SMC uptake included perceived side-effects of SMC drugs, a lack of understanding of the purpose of SMC, mistrust and suspicions that medicines provided free may be unsafe or ineffective, and local shortages of drugs.ConclusionsRecommendations from this study were shared with all community drug distributors and others involved in SMC campaigns during cascade training in 2022, including the need to strengthen communication about the safety and effectiveness of SMC, recruiting distributors from the local community, greater involvement of state and national level pharmacovigilance coordinators, and stricter adherence to the planned medicine allocations to avoid local shortages. The findings reinforce the importance of retaining door-to-door delivery of SMC.

Working Mode Recognition of Non-Specific Radar Based on ResNet-SVM Learning Framework.

Mode recognition is a basic task to interpret the behavior of multi-functional radar. The existing methods need to train complex and huge neural networks to improve the recognition ability, and it is difficult to deal with the mismatch between the training set and the test set. In this paper, a learning framework based on residual neural network (ResNet) and support vector machine (SVM) is designed, to solve the problem of mode recognition for non-specific radar, called multi-source joint recognition framework (MSJR). The key idea of the framework is to embed the prior knowledge of radar mode into the machine learning model, and combine the manual intervention and automatic extraction of features. The model can purposefully learn the feature representation of the signal on the working mode, which weakens the impact brought by the mismatch between training and test data. In order to solve the problem of difficult recognition under signal defect conditions, a two-stage cascade training method is designed, to give full play to the data representation ability of ResNet and the high-dimensional feature classification ability of SVM. Experiments show that the average recognition rate of the proposed model, with embedded radar knowledge, is improved by 33.7% compared with the purely data-driven model. Compared with other similar state-of-the-art reported models, such as AlexNet, VGGNet, LeNet, ResNet, and ConvNet, the recognition rate is increased by 12%. Under the condition of 0-35% leaky pulses in the independent test set, MSJR still has a recognition rate of more than 90%, which also proves its effectiveness and robustness in the recognition of unknown signals with similar semantic characteristics.