Minimally Trained Research Articles

Resurgence of goal-directed actions and habits.

This study investigated how goal-directed and habitual behaviors recover after extinction within the context of the resurgence effect, a form of relapse induced by the removal or worsening of alternative reinforcement. Rats were trained to press a target lever with one reinforcer (O1) for either minimal (4) or extended (16) sessions. An extinction test after the completion of O1 devaluation confirmed that minimal and extended training formed goal-directed and habitual behaviors, respectively. Then, pressing an alternative lever was reinforced with a second reinforcer (O2) while the target response was placed on extinction. When O2 was discontinued, the minimally trained target response resurged with goal-directed status as in the extinction test. However, the extinguished habitual behavior in the extensively trained rats did not recover as a habit but instead with goal-directed status, possibly due to the context specificity of habits or the introduction of a new response-reinforcer contingency. The critical finding that reinforcer devaluation consistently led to less resurgence regardless of the amount of acquisition training provides a clinical implication that coupling differential-reinforcement-of-alternative-behavior (DRA) treatments with the devaluation of the associated reinforcer of problematic behavior could effectively diminish its recurrence.

Remote self-measurement of wrist range of motion performed on normal wrists by a minimally trained individual using the iPhone level application only demonstrated good reliability in measuring wrist flexion and extension

Study DesignThis is a reliability study using the intraclass correlation coefficient. PurposeThe purpose of this study was to determine whether an individual with minimal training could use the iPhone Level application to self-measure the range of motion of the forearm and wrist from a remote location. MethodsForty healthy participants (80 wrists) were measured twice by two examiners using a universal goniometer and the iPhone Level application. After measurement, each participant received a training session in the self-measurement method. They were then asked to perform remote self-measurements two to three days later and report their findings to the examiners using Skype or FaceTime. ResultsSPSS, version 26, was used to run intraclass correlation coefficients using a two-way random analysis at a 95% confidence interval with absolute agreement. Comparisons of single measurements were used to determine reliability. Good inter-rater reliability was found between wrist flexion and extension in all testing conditions. Measurement of active motion in supination, pronation, radial, and ulnar deviation demonstrated moderate reliability compared with the universal goniometer where the measurements were performed by the investigators. Self-measurement of the participant resulted in moderate reliability for supination and poor reliability in pronation, radial, and ulnar deviation. DiscussionSome participants found the procedures technologically and perceptually challenging. Anatomical variances, positional requirements, and substitution patterns complicated the process. ConclusionsThe iPhone Level application may be used to perform reliable self-measurements of wrist flexion and extension from a remote location. Further research exploring methods for remote selfmeasurement is indicated.

Abstract P1-01-01: Clinical efficacy evaluation of a novel palpation imaging device for early detection of breast cancer in the developing world

Abstract Background & Objectives: Breast cancer is the most common cancer in women worldwide, disproportionately affecting low- and-middle income countries (LMICs). 52.6% of new breast cancer cases occur in LMICs, and this is expected to grow to 70% by year 2020. Two-thirds of the estimated 15,000,000 healthy-life years lost annually to breast cancer globally are from LMICs. The 5-year survival rate is 40-60% in most LMICs as compared to 80-90% in High Income Countries (HICs). Low-cost, user-friendly technology can help equip minimally trained community health workers to administer standardized breast exams without any special infrastructure, with the goal to down-stage breast cancer. Methods: IRB cleared prospective trial enrolled women as part of a community screening program or women seeking medical advice for breast related symptoms. Consenting women above age 30 were eligible to enroll. Subjects received an iBreastExam evaluation and a Clinical Breast Examination (CBE), each by a different health-worker, blinded to the other test. Subjects positive on iBE and/or CBE, received follow-up diagnostic imaging (mammogram for women above age 40 years or breast ultrasound for women age 40 years or younger). Standard of truth was established as a positive mammogram BIRADS 3-6 or a positive ultrasound as BIRADS 3-6. To assess accuracy of iBE and CBE to detect lesions, the sensitivity and specificity were calculated compared to diagnostic imaging. For the purposes of analysis, each breast was considered as an independent result. Instead of detection of cancer, standardized diagnostic imaging modalities (mammogram and ultrasound) were used as comparators because the palpation device was evaluated as a tool in LMIC settings to enable early detection of suspicious breast lumps requiring clinical follow-up. Results: 1,200 women (2,400 breasts) with median age of 43 years were examined under this study with both, iBE and CBE. From 2,400 breasts, 96 were identified by iBreastExam, CBE or both to have at least one breast lesion. An additional 63 women (126 breasts) enrolled in the study due to a breast related symptom and were examined with iBE, CBE and age-appropriate diagnostic imaging. Combining both groups, 222 breasts were examined with age-appropriate diagnostic imaging. Compared to diagnostic imaging, the sensitivity, specificity, Negative Predictive Value and Positive Predictive Value of iBE is 86%, 91%, 98%, 57%, respectively. Compared to diagnostic imaging, the sensitivity, specificity, Negative Predictive Value and Positive Predictive Value of CBE is 63%, 82%, 94%, 32%, respectively. Conclusions: Compared to Clinical Breast Exam, iBreastExam demonstrated significantly (23%) higher sensitivity and moderately (9%) higher specificity to detect breast lesions. Given that iBE requires minimal training and provides objective breast examination with digital documentation; better performance than clinical exam highlights the tools’ utility as a triaging tool by identifying women in need for follow-up diagnostics. iBreastExam may enable community health worker led triaging to detect clinically relevant breast lesions in LMIC settings. Citation Format: Suma Nair, Thejas Kathrikolly, PU Prakash Saxena. Clinical efficacy evaluation of a novel palpation imaging device for early detection of breast cancer in the developing world [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr P1-01-01.

Quality of eyeglass prescriptions from a low-cost wavefront autorefractor evaluated in rural India: results of a 708-participant field study

ObjectiveTo assess the quality of eyeglass prescriptions provided by an affordable wavefront autorefractor operated by a minimally trained technician in a low-resource setting.Methods and Analysis708 participants were recruited from consecutive...

Inactivation of prelimbic and infralimbic cortex respectively affects minimally-trained and extensively-trained goal-directed actions.

Several studies have examined a role for the prelimbic cortex (PL) and infralimbic cortex (IL) in free operant behavior. The general conclusion has been that PL controls goal-directed actions (instrumental behaviors that are sensitive to reinforcer devaluation) whereas IL controls habits (instrumental behaviors that are not sensitive to reinforcer devaluation). To further examine the involvement of these regions in the expression of instrumental behavior, we first implanted male rats with bilateral guide cannulae into their PL, then trained two responses to produce a sucrose pellet reinforcer, R1 and R2, each in a distinct context. R1 received extensive training and R2 received minimal training. Rats then received lithium chloride injections either paired or unpaired with sucrose pellets in both contexts until paired rats rejected all pellets. Following acquisition, in Experiment 1, rats received either an infusion of saline or baclofen/muscimol into the PL and were tested (in extinction) on both R1 and R2. In vehicle controls, both responses were goal-directed actions, as indicated by their sensitivity to reinforcer devaluation. PL inactivation decreased expression of the minimally-trained action without affecting expression of the extensively-trained action. Experiment 2 utilized the same experimental design but with IL inactivation at test. The extensively-trained response was again a goal-directed action. However, now expression of the extensively-trained goal-directed action was suppressed by IL inactivation. The overall pattern of results suggests that the PL is involved in expression of minimally trained goal-directed behavior while the IL is involved in expression of extensively trained goal-directed behavior. This implies that the PL does not control all types of actions and the IL can control some types of actions. These results expand upon the traditional view that the PL controls action while the IL controls habit.

Benefits of Structured After-School Literacy Tutoring by University Students for Struggling Elementary Readers

ABSTRACTThis study examines the effectiveness of minimally trained tutors providing a highly structured tutoring intervention for struggling readers. We screened students in Grades K–6 for participation in an after-school tutoring program. We randomly assigned those students not meeting the benchmark on a reading screening measure to either a tutoring group or a control group. Students in the tutoring group met twice per week across one school year to receive tutoring from non–education major college students participating in a service-learning course. The goal of this study was to determine whether tutors without prior teaching experience or instruction could improve student reading outcomes with minimal training, a structured reading curriculum, and access to ongoing coaching. Tutored students displayed significantly more growth than control students in letter-word identification, decoding, and passage comprehension, with robust effect sizes of 0.99, 1.02, and 0.78, respectively. We discuss the implications and limitations of these findings.

Mothers Understand And Can do it (MUAC): a comparison of mothers and community health workers determining mid-upper arm circumference in 103 children aged from 6months to 5years.

BackgroundMid-upper arm circumference (MUAC) was recently endorsed and recommended for screening for acute malnutrition in the community. The objective of this study was to determine whether a colour-banded MUAC strap would allow minimally trained mothers to screen their own children for malnutrition, without locating the mid-point of the left upper arm by measurement, as currently recommended.MethodsA non-randomised non-blinded evaluation of mothers’ performance when measuring MUAC after minimal training, compared with trained Community Health Workers (CHW) following current MUAC protocols. The study was conducted in 2 villages in Mirriah, Zinder region, Niger where mothers classified one of their children (n = 103) aged 6–59 months (the current age range for admission into community malnutrition programs) using the MUAC tape.ResultsMothers’ had a sensitivity and specificity for classification of their child’s nutritional status of > 90% and > 80% respectively for global acute malnutrition (GAM, defined by a MUAC < 125 mm) and > 73% and > 98% for severe acute malnutrition (SAM, defined by a MUAC < 115 mm). The few children misclassified as not having SAM, were classified as having moderate acute malnutrition (MAM). The choice of arm did not influence the classification results; weighted Kappa of 0.88 for mothers and 0.91 for CHW represent almost perfect agreement. Errors occurred at the class boundaries and no gross errors were made.ConclusionsAdvanced SAM is associated with severe complications, which often require hospital admission or cause death. Mothers (with MUAC tapes costing $0.06) can screen their children frequently allowing early diagnosis and treatment thereby becoming the focal point in scaling-up community management of acute malnutrition.Trial registrationThe trial is registered with clinicaltrials.gov (Trial number NCT01790815)

Contextual control of instrumental actions and habits.

After a relatively small amount of training, instrumental behavior is thought to be an action under the control of the motivational status of its goal or reinforcer. After more extended training, behavior can become habitual and insensitive to changes in reinforcer value. Recently, instrumental responding has been shown to weaken when tested outside of the training context. The present experiments compared the sensitivity of instrumental responding in rats with a context switch after training procedures that might differentially generate actions or habits. In Experiment 1, lever pressing was decremented in a new context after either short, medium, or long periods of training on either random-ratio or yoked random-interval reinforcement schedules. Experiment 2 found that more minimally trained responding was also sensitive to a context switch. Moreover, Experiment 3 showed that when the goal-directed component of responding was removed by devaluing the reinforcer, the residual responding that remained was still sensitive to the change of context. Goal-directed responding, in contrast, transferred across contexts. Experiment 4 then found that after extensive training, a habit that was insensitive to reinforcer devaluation was still decremented by a context switch. Overall, the results suggest that a context switch primarily influences instrumental habit rather than action. In addition, even a response that has received relatively minimal training may have a habit component that is insensitive to reinforcer devaluation but sensitive to the effects of a context switch.

Do you see what I see? Can non-experts with minimal training reproduce expert ratings in behavioral assessments of working dogs?

Working-dog organizations often use behavioral ratings by experts to evaluate a dog's likelihood of success. However, these experts are frequently under severe time constraints. One way to alleviate the pressure on limited organizational resources would be to use non-experts to assess dog behavior. Here, in populations of military working dogs (Study 1) and explosive-detection dogs (Study 2), we evaluated the reliability and validity of behavioral ratings assessed by minimally trained non-experts from videotapes. Analyses yielded evidence for generally good levels of inter-observer reliability and criterion validity (indexed by convergence between the non-expert ratings and ratings made previously by experts). We found some variation across items in Study 2 such that reliability and validity was significantly lower for three out of the 18 items, and one item had reliability and validity estimates that were impacted heavily by the behavioral test environment. There were no differences in reliability and validity based on the age of the dog. Overall the results suggest that ratings made by minimally trained non-experts for most items can serve as a viable alternative to expert ratings freeing limited resources of highly trained staff.This article is part of a Special Issue entitled: Canine Behavior.

The Role of Training in Experimental Auctions

In this paper we examine the role of providing extensive training to subjects in the context of experimental auctions. We conducted an experiment where we auctioned several lotteries with varying payoffs. One group of subjects was extensively trained while another group of subjects was only minimally trained. We find that subjects in the extensive training treatment, were submitting bids significantly higher than subjects in the minimal training treatment, suggesting that subjects without proper training may underreport their WTP.

Intuitive ultrasonography for autonomous medical care in limited-resource environments

Management of health problems in limited resource environments, including spaceflight, faces challenges in both available equipment and personnel. The medical support for spaceflight outside Low Earth Orbit is still being defined; ultrasound (US) imaging is a candidate since trials on the International Space Station (ISS) prove that this highly informative modality performs very well in spaceflight. Considering existing estimates, authors find that US could be useful in most potential medical problems, as a powerful factor to mitigate risks and protect mission. Using outcome-oriented approach, an intuitive and adaptive US image catalog is being developed that can couple with just-in-time training methods already in use, to allow non-expert crew to autonomously acquire and interpret US data for research or diagnosis. The first objective of this work is to summarize the experience in providing imaging expertise from a central location in real time, enabling data collection by a minimally trained operator onsite. In previous investigations, just-in-time training was combined with real-time expert guidance to allow non-physician astronauts to perform over 80 h of complex US examinations on ISS, including abdominal, cardiovascular, ocular, musculoskeletal, dental/sinus, and thoracic exams. The analysis of these events shows that non-physician crew-members, after minimal training, can perform complex, quality US examinations. These training and guidance methods were also adapted for terrestrial use in professional sporting venues, the Olympic Games, and for austere locations including Mt. Everest. The second objective is to introduce a new imaging support system under development that is based on a digital catalog of existing sample images, complete with image recognition and acquisition logic and technique, and interactive multimedia reference tools, to guide and support autonomous acquisition, and possibly interpretation, of images without real-time link with a human expert. In other words, we are attempting to replace, to the extent possible, expert guidance by guidance from a digital information resource. This is a next logical phase of the authors’ sustained effort to make US imaging available to sites lacking proper expertise. This effort will benefit NASA as the agency plans to develop future human exploration programs requiring increased medical autonomy. The new system will be readily adaptable to terrestrial medicine including emergency, rural, and military applications.

Diagnostic Ultrasound at MACH 20: Retroperitoneal and Pelvic Imaging in Space

An operationally available diagnostic imaging capability augments spaceflight medical support by facilitating the diagnosis, monitoring and treatment of medical or surgical conditions, by improving medical outcomes and, thereby, by lowering medical mission impacts and the probability of crew evacuation due to medical causes. Microgravity-related physiological changes occurring during spaceflight can affect the genitourinary system and potentially cause conditions such as urinary retention or nephrolithiasis for which ultrasonography (U/S) would be a useful diagnostic tool. This study describes the first genitourinary ultrasound examination conducted in space, and evaluates image quality, frame rate, resolution requirements, real-time remote guidance of nonphysician crew medical officers and evaluation of on-orbit tools that can augment image acquisition. A nonphysician crew medical officer (CMO) astronaut, with minimal training in U/S, performed a self-examination of the genitourinary system onboard the International Space Station, using a Philips/ATL Model HDI-5000 ultrasound imaging unit located in the International Space Station Human Research Facility. The CMO was remotely guided by voice commands from experienced, earth-based sonographers stationed in Mission Control Center in Houston. The crewmember, with guidance, was able to acquire all of the target images. Real-time and still U/S images received at Mission Control Center in Houston were of sufficient quality for the images to be diagnostic for multiple potential genitourinary applications. Microgravity-based ultrasound imaging can provide diagnostic quality images of the retroperitoneum and pelvis, offering improved diagnosis and treatment for onboard medical contingencies. Successful completion of complex sonographic examinations can be obtained even with minimally trained nonphysician ultrasound operators, with the assistance of ground-based real-time guidance. (E-mail: jeffrey.a.jones@nasa.gov)

Self-Rotations in Simulated Microgravity: Performance Effects of Strategy Training

This research studies reorientation methodologies in a simulated microgravity environment using an experimental framework to reduce astronaut adaptation time and provide for a safety countermeasure during extravehicular activity. There were 20 subjects (10 men, 10 women, mean age of 23.6 +/- 3.5) who were divided into 2 groups, fully trained and minimally trained, which determined the amount of motion strategy training received. Subjects performed a total of 48 rotations about their pitch, roll, and yaw axes in a suspension system that simulated microgravity. In each trial subjects either rotated 90 degrees in pitch, 90 degrees in roll, or 180 degrees in yaw. Experimental measures include subject coordination, performance time, cognitive workload assessments, and qualitative motion control strategies. Subjects in the fully trained group had better initial performance with respect to performance time and workload scores for the pitch and yaw rotations. Further, trained subjects reached a steady-state performance time in fewer trials than those with minimal training. The subjects with minimal training tended to use motions that were common in an Earth environment since no technique was provided. For roll rotations they developed motions that would have led to significant off-axis (pitch and yaw) rotations in a true microgravity environment. We have shown that certain body axes are easier to rotate about than others and that fully trained subjects had an easier time performing the body rotations than the minimally trained subjects. This study has provided the groundwork for the development of an astronaut motion-control training program.

Battling fire and ice: remote guidance ultrasound to diagnose injury on the International Space Station and the ice rink

Background National Aeronautical and Space and Administration (NASA) researchers have optimized training methods that allow minimally trained, non-physician operators to obtain diagnostic ultrasound (US) images for medical diagnosis including musculoskeletal injury. We hypothesize that these techniques could be expanded to non-expert operators including National Hockey League (NHL) and Olympic athletic trainers to diagnose musculoskeletal injuries in athletes. Methods NHL and Olympic athletic trainers received a brief course on musculoskeletal US. Remote guidance musculoskeletal examinations were conducted by athletic trainers, consisting of hockey groin hernia, knee, ankle, elbow, or shoulder evaluations. US images were transmitted to remote experts for interpretation. Results Groin, knee, ankle, elbow, or shoulder images were obtained on 32 athletes; all real-time US video stream and still capture images were considered adequate for diagnostic interpretation. Conclusions This experience suggests that US can be expanded for use in locations without a high level of on-site expertise. A non-physician with minimal training can perform complex, diagnostic-quality examinations when directed by a remote-based expert.

NEEMO 7 undersea mission

The NEEMO 7 mission was the seventh in a series of NASA-coordinated missions utilizing the Aquarius undersea habitat in Florida as a human space mission analog. The primary research focus of this mission was to evaluate telementoring and telerobotic surgery technologies as potential means to deliver medical care to astronauts during spaceflight. The NEEMO 7 crewmembers received minimal pre-mission training to perform selected medical and surgical procedures. These procedures included: (1) use of a portable ultrasound to locate and measure abdominal organs and structures in a crewmember subject; (2) use of a portable ultrasound to insert a small needle and drain into a fluid-filled cystic cavity in a simulated patient; (3) surgical repair of two arteries in a simulated patient; (4) cystoscopy and use of a ureteral basket to remove a renal stone in a simulated patient; and (5) laparoscopic cholecystectomy in a simulated patient. During the actual mission, the crewmembers performed the procedures without or with telementoring and telerobotic assistance from experts located in Hamilton, Ontario. The results of the NEEMO 7 medical experiments demonstrated that telehealth interventions rely heavily on a robust broadband, high data rate telecommunication link; that certain interventional procedures can be performed adequately by minimally trained individuals with telementoring assistance; and that prior clinical experience does not always correlate with better procedural performance. As space missions become longer in duration and take place further from Earth, enhancement of medical care capability and expertise will be required. The kinds of medical technologies demonstrated during the NEEMO 7 mission may play a significant role in enabling the human exploration of space beyond low earth orbit, particularly to destinations such as the Moon and Mars.

Can minimally trained observers provide valid global ratings?

From a cost-benefit perspective, the validity of minimally trained (MT) coders' ratings was examined individually and relative to ratings by coders who had undergone "gold standard" (GS) training in the rating of maternal overreactive discipline. The ratings of MT and GS coders were strongly associated (r = .72). MT ratings were also correlated with maternal self-reported overreactive discipline (r = .39), laxness (r = .46), depressive symptoms (r = .32), and observed child misbehavior (r = .40). These correlations were of similar magnitude to correlations based on GS ratings. MT ratings were more strongly associated with GS ratings than with child misbehavior. Thus, their ratings demonstrated convergent, concurrent, and discriminant validity. Implications and limitations of these findings are discussed.

SPOT Panchromatic Imagery and Neural Networks for Information Extraction in a Complex Mountain Environment

High resolution satellite imagery is often required to obtain accurate information about landforms and the terrain. In mountain environments, the magnitude, frequency, and interaction of lithospheric and atmospheric processes cause high topographic and spatial reflectance variability. Consequently, information extraction is difficult and new approaches are required to assess and map complex spatial patterns. The purpose of this research was to evaluate the utility of artificial neural network (ANN) technology for recognizing spatial reflectance variation related to alpine glacier characteristics. Specifically, we wanted to determine if a minimally trained neural network could be used to map the supraglacial characteristics of glaciers on the Nanga Parbat massif in Pakistan. We trained a three‐layer feed forward network using the back‐propagation learning algorithm to recognize reflectance variations from SPOT Panchromatic data. We compared ANN classification results to a stratified unsupervised classification approach using the ISODATA clustering algorithm. Results indicated that minimal training of a ANN is sufficient to produce accurate information regarding supraglacial characteristics. Overall classification results were relatively high with kappa coefficients ranging from 0.85 ‐ 0.91. Accuracy assessment and comparative visual analysis indicated that ANN performance was superior to the performance of the ISODATA algorithm. Results demontrate that there is significant potential associated with using ANN technology for information extraction and for mapping complex spatial patterns in mountainous terrain.

The reproducibility of the mandibular cortical index.

To assess the reproducibility and diagnostic validity of Mandibular Cortical Index (MCI) when used by minimally trained observers. Four 'experts' and 45 final-year dental students classified the appearance of the lower border of the mandibular cortex in 30 panoramic radiographs using the MCI. Experts viewed the original radiographs. The students received instruction in the MCI and viewed slides of the radiographs in a lecture theatre. For intra-observer agreement, the experts had significantly higher overall values of weighted kappa, indicating substantial agreement in MCI assessment, whereas the students showed moderate agreement. For inter-observer agreement, there was fair agreement between the experts and poor agreement between the students. Using the experts' MCI assessment as the 'gold standard', the mean sensitivity of the students in diagnosis of C3 was 0.71 (maximum 0.95, minimum 0.25) and mean specificity was 0.56 (maximum 0.9, minimum 0.20). The MCI has important limitations in terms of intra- and inter-observer agreement. Minimal training in its use, such as might be given in a lecture format to dentists, was ineffective and associated with poor inter-observer agreement and limited diagnostic validity in identifying signs of osteoporosis. More lengthy training and experience in using the MCI would be needed for it to be effective as a diagnostic tool in general dental practice.

Personal Problem-Solving Scoring of the TAT: Sensitivity to Training

The Thematic Apperception Test (TAT; Murray, 1943) is one of the most frequently taught and administered projective instruments in the United States. Nevertheless, formal scoring systems are not often used when evaluating story responses; thus, the reliability and validity of response interpretations remain controversial. The sensitivity-to-training of a procedure that uses the TAT to assess personal problem-solving skills, namely the Personal Problem-Solving System (PPSS; Ronan, 1990), was evaluated. In Experiment 1, undergraduate students received either detailed (n = 30) or minimal (n = 29) training in the problem-solving skill of generating alternative solutions to personal problems and subsequently wrote responses to three TAT cards. In Experiment 2, subjects received either detailed (n = 22) or minimal (n = 22) training in a utility model of decision making and thereafter responded to the same three TAT cards. Subjects who received detailed training, when compared to their minimally trained counterparts, reported an increase in their knowledge of the relevant problem-solving skill, and this increased knowledge influenced their responses to the TAT cards as measured by the PPSS scores. Implications for the construct validity of the PPSS are discussed.