Multiple Training Sessions Research Articles

Being smart makes stressed snails drop a grade

Sometimes life is just too stressful. Whether you're a freshwater snail struggling to breathe in a dwindling puddle or a student facing an assessment that could change your future, it can be hard to form memories when the pressure is on; even the smartest can struggle. ‘We have been exploring how stress alters both memory formation and the ability to recall memory for a number of years’, says Ken Lukowiak from the University of Calgary, Canada, who is intrigued by how the humble pond snail (Lymnaea stagnalis) forms memories. Having recently discovered a ‘smart’ colony of pond snails at White Sand Lake in Saskatchewan that learn quickly (after just one training session) to keep their breathing tubes closed when immersed in deoxygenated water – compared with ‘average’ snails, which require multiple training sessions before they get the point – Lukowiak wondered how resilient the ‘smart’ Saskatchewan snails’ memories would be when they experienced a snail-scale shock.Lukowiak and a large team of assistants trained ‘smart’ and ‘average’ snails to keep their breathing tubes closed when immersed in deoxygenated water by gently tapping the snails on the breathing tube whenever they tried to extend it above the surface to breathe. While the unstressed ‘smart’ snails got to grips with the idea of keeping their breathing tubes closed after a single training session, the ‘average’ unstressed snails – which had been found in a pond outside Calgary – required two training sessions, 1 h apart to catch on. Then, considering a range of scenarios that are stressful for pond snails – including experiencing a heat wave, starvation, an approaching predator and incurring damage to the shell – the team wondered how the memories of the ‘smart’ snails would fare after experiencing the stress and whether the ‘average’ snails might receive a memory boost and recall the tube-tapping lesson after just one training session.Impressively, the stressful sensations seemed to sharpen the ‘average’ Calgary snails’ memories, allowing them to recall that they must keep their breathing tubes closed after the reduced training regime. However, the A-grade snails seemed to be struggling. While a sniff of the scary odour of the aggressive crayfish that share their Saskatchewan home did not affect the snails’ memories, a heat wave, the smell of food when hungry and receiving a small amount of damage to their shells all impaired the ‘smart’ snails’ ability to form memories.‘Being smart made them less resilient and thus they could not handle stress as well as the more average individuals’, says Lukowiak, who admits that he was surprised that the Saskatchewan snails were so badly affected. ‘Even though both the ‘smart’ and ‘average’ snails were freshly collected from ponds that experience temperature spikes in the summer, the ‘smart’ snails have their ability to form memory obstructed by a thermal shock’, he says. Adding that many of the snails that he encountered in the wild had also incurred damage to their shells – which should affect their memories – Lukowiak says, ‘How that alters their ability to survive in the wild is not clear to us’.In short, the ‘smart’ snails’ superior intellect is a clear disadvantage for their memories in stressful situations and Lukowiak is now eager to understand why the snails are so impaired. ‘One idea is that maybe the ‘smart’ snails do in fact make memory, but they can't retrieve it because of the stress, much like a smart student taking an exam’, he suggests. Maybe exam-brain-freeze has a longer history than any of us knew.

Can training change attentional breadth? Failure to find transfer effects.

Recently, there is increasing interest in the causal relationship between attentional breadth and emotion regulation. To test this causal relationship, attentional breadth needs to be manipulated stringently. The aim of the current research was to establish whether visual attentional breadth could be manipulated through experimental training procedures. We conducted two single-session training experiments and one multiple-session training experiment, all of which contained pre- and post-training assessments to test the direct transfer effects of training on attentional breadth construed in different measures. For the first single-session training (Experiment 1), no training effects were found to transfer to the subsequent attentional breadth measures in terms of global-local processing preference. For the second single-session training (Experiment 2) and the 5-day training (Experiment 3) which combined both trainings from Experiment 1 and 2, there were some indications that attentional breadth can be decreased, but there was no evidence that it could be increased neither in terms of global-local processing preference nor in terms of scope of visual perception. Bayesian analysis confirmed the null hypothesis of no increase in attentional breadth through delivery of these training procedures. Therefore, our findings do not support the hypothesis that training variants of the Global-Local attentional breadth task or of the visuospatial attentional breadth task can stably alter attentional breadth in healthy students. Possible explanations and implications are discussed.

PERSIAN REGISTRY OF CARDIOVASCULAR DISEASE (PROVE)

AbstractIntroduction: The Persian Registry Of cardioVascular diseasE (PROVE) aimed to study the demographic, clinical, diagnosis and treatment of patients with cardiovascular disease (CVD) and to follow them for 1 to 3 years, looking for short- and long-term outcomes. PROVE started in Isfahan in 2014 to test the feasibility of its implementation for later national dissemination. Therefore, we aimed to explain its design, methodology, development, validity of protocols and questionnaires of each CVD and its quality control (QC) design Methods: PROVE feasibility study is an observational (descriptive and analytical) open-label registry that collects patient’s data in hospitals or at population level, and follows them for between 1 to 3 years. Patients with acute coronary syndrome (ACS), ST Elevation Myocardial Infarction (STEMI), stroke, atrial fibrillation (AF), heart failure(HF); congenital heart disease (CHD), percutaneous coronary intervention (PCI) and recently, chronic ischemic cardiovascular disease (CICD) were enrolled. Four types of registered CVD (AF, STEMI, HF, CICD) had joined the European observational Research Programme (EORP). ACS and stroke registry started back in 1999 in the surveillance unit of Isfahan Cardiovascular Research Institute (ICRI) using the WHO MONICA (Multinational MONItoring of trends and determinants in CArdiovascular disease) protocol. Physicians and nurses who worked in each registry, received multiple training sessions based on the design of the registry. The development and validity of questionnaires, protocols, data collection, entry and management, and its analysis are supervised by a well-established QC protocol. Results: PROVE subtypes followed different approaches. ACS, STEMI, stroke, HF and CICD are hospital based while AF and CHD are population based. The validity of questionnaires was performed by a QC committee before starting registry. More than 900 questionnaires of HF and 800 of STEMI, 350 of AF, 800 of stroke, more than 1000 of CHD and PCI and 9 of CICD were registered and all its data were managed by mid-September 2016. Using the WHO MONICA method for ACS and stroke since the year 1999, there were more than 150,000 and 37,000 patients registered and followed respectively. The follow up frequency, duration and method was different according to type of disease registry. The case report forms (CRFs) of AF, STEMI, HF, and CICD were sent to the EORP site. Conclusion: PROVE implementation is feasible and can be considered as a valuable source of valid data to improving the management, treatment, prevention and control of patients with CVD. The data can be later used by policy makers and for future research

Reducing training requirements through evolutionary based dimension reduction and subject transfer

Training Brain Computer Interface (BCI) systems to understand the intention of a subject through Electroencephalogram (EEG) data currently requires multiple training sessions with a subject in order to develop the necessary expertise to distinguish signals for different tasks. Conventionally the task of training the subject is done by introducing a training and calibration stage during which some feedback is presented to the subject. This training session can take several hours which is not appropriate for on-line EEG-based BCI systems. An alternative approach is to use previous recording sessions of the same person or some other subjects that performed the same tasks (subject transfer) for training the classifiers. The main aim of this study is to generate a methodology that allows the use of data from other subjects while reducing the dimensions of the data. The study investigates several possibilities for reducing the necessary training and calibration period in subjects and the classifiers and addresses the impact of i) evolutionary subject transfer and ii) adapting previously trained methods (retraining) using other subjects data. Our results suggest reduction to 40% of target subject data is sufficient for training the classifier. Our results also indicate the superiority of the approaches that incorporated evolutionary subject transfer and highlights the feasibility of adapting a system trained on other subjects.

Examining a Novel Gamified Approach to Attentional Retraining: Effects of Single and Multiple Session Training

Negative attention biases (AB) may play a causal role in the development of emotional disorders. In order to examine this proposed causal role, researchers have developed Attention Bias Modification (ABM) paradigms to experimentally induce or reduce AB. To date, most ABM studies have been based on modified dot-probe tasks. However, this task is only moderately successful in changing patterns of AB. In two laboratory-based experiments, we explored the effects of a novel visual search ABM paradigm, called “Intrinsically-Motivating Playable Attentional Control Training”, on AB processes and mood in undergraduate participants. Motivation was fostered by active task involvement (i.e., searching for target faces while ignoring irrelevant faces) and gamification techniques. In both experiments, training performance significantly improved, but failed to transfer to attention and mood measures. Possible explanations for the failure to find transfer effects are discussed.

Robot-Enhanced Mobility Training of Children With Cerebral Palsy: Short-Term and Long-Term Pilot Studies

Mobility is a causal factor in infant development. Neural impaired infants, e.g., with cerebral palsy (CP), are at risk for further developmental delays due to lack of self-generated mobility. It is possible that these infants may benefit from robot-enhanced mobility, where the mobility comes from a robot that the child drives via a joystick. We believe that such a mobility experience will enrich the child and minimize further delays in attaining some of the childhood developmental and social milestones. In order to address the broad goal posed earlier, one can ask the following simpler questions: 1) Will children with CP learn to drive a robot using a joystick? 2) Will these children with CP sustain interest in doing so over multiple training sessions? 3) Will such a robot-enhanced mobility impact development scores in this group of children? 4) Will a larger number of robotic training sessions be more effective to enhance these developmental scores ? This paper reports the first results from two pilot studies conducted by our research group on robot-assisted mobility training, where children with CP performed two tasks across multiple training sessions. We found that, after training with the robot, children who performed 30 training sessions, labeled as “long-term study,” advanced in their driving skills and showed significant improvements in clinical scores such as Gross Motor Function Measure, Quality of Upper Extremity Skills Test, and Pediatric Evaluation of Disability Inventory (mobility with/without caregiver and social function with/without caregiver).

ADDRESSING THE CHALLENGES OF PARAMEDIC RECRUITMENT AND ENGAGEMENT IN AIRWAYS-2

AIRWAYS-2 is an NIHR-funded study to determine the best initial approach to advanced airway management during out of hospital cardiac arrest (OHCA). Four NHS ambulance trusts are taking part in AIRWAYS-2: East Midlands, South Western, Yorkshire and East of England. One of the key challenges has been the need to recruit approximately 1300 study paramedics for the trial.The three main challenges in engaging and recruiting paramedics to participate in AIRWAYS-2 have been:▸ Concerns relating to the potential results of the trial and what this will mean for the continuation of intubation for paramedics▸ Concerns relating to the restriction on paramedic choice of advanced airway in OHCA and potential skill erosion▸ Provision of training over large geographical areas at a time when morale is low and many ambulance trusts have recruitment and retention issues.How have these challenges been overcome?▸ Communication: Identifying the most appropriate communication methods in each Trust e.g. face to face, email, internal trust operational updates▸ Delivery of key messages: Emphasising why the trial is important and needed, and that its goal is not to remove intubation from paramedic practice. Obtaining the engagement of senior operational management to allay fears over impacts on service performance▸ Valuing study paramedics: Paying clinicians overtime to attend training sessions, which contributes to their own continuing professional development▸ Equity and opportunity: Delivery of multiple training sessions throughout each of the four ambulance trusts.Key achievementsBy November 2015, research paramedics had delivered nearly 350 training sessions and recruited in excess of 1300 paramedics to AIRWAYS-2.ConclusionThe research paramedics leading AIRWAYS-2 have collaboratively, and successfully, overcome the main challenges relating to recruiting and engaging the paramedics in their Trusts. This should contribute to achieving the target patient sample size for the trial.

EP 121. Motor sequence learning in patients with limb apraxia – The effects of long-term training

Background Recent studies show that limb apraxia is often not recognized as a higher motor impairment in patients suffering from a stroke. Because it is adversely affecting every-day life and personal independence, a successful rehabilitation of apraxia is critical for personal well-being ( Cappa et al., 2005 , Dovern et al., 2012 ). Yet, evidence of an effective treatment approach with long-lasting effects and generalization to untrained actions is still missing ( Binkofski and Klann, 2013 , Dovern et al., 2011 ). One possible reason for the treatment-resistance of this neurological disorder may be a deficit in motor memory storage of (re-) learned motor acts. So far, however, such a hypothesis has not been tested. Objective The present study aimed at assessing the ability of apractic stroke patients to acquire and retain a new motor sequence skill. Methods Eleven stroke patients suffering from chronic upper limb apraxia participated in a four-weeks multiple session training program using a motor sequence learning paradigm. Patients were required to perform a standardized finger sequence movement task, which is a well-established paradigm to explore motor learning and procedural memory abilities (e.g. Doyon et al., 2009 ). Motor performance was recorded with a modified four-button PC gaming keypad (Belkin Razer Nostromo, Belkin, Playa Vista, USA) and analyzed using customized Matlab (MathWorks, Natick, USA) scripts. Motor sequence learning was measured in terms of speed and accuracy. According to the hypothesis of disturbed motor memory abilities, no training induced simultaneous improvement in both, speed and accuracy, was expected. Results All patients improved in terms of speed in producing the learned finger sequence. While patients were slow at the beginning of the training program, nearly all ended up with performance within age related norms. In contrast, accuracy varied across sessions. The latter finding can be explained through the notion of stroke-specific capacity problems (improving one capacity at cost of another). Moreover and unexpectedly, most of patients showed clinical improvement of their apraxia symptoms. Conclusions All of our patients with limb apraxia were able to improve the speed of producing novel motor sequences, while accuracy remained variable. Thus, the present findings did not unequivocally reveal that the ability to acquire a new motor skill was retained. Further studies must determine whether the unexpected improvement of apraxia in patients with stable deficits is causally and specifically related to motor sequence training.

Dental Hygiene Faculty Calibration Using Two Accepted Standards for Calculus Detection: A Pilot Study

Faculty calibration studies for calculus detection use two different standards for examiner evaluation, yet the only therapeutic modality that can be used for nonsurgical periodontal treatment is scaling/root debridement or planing. In this study, a pretest-posttest design was used to assess the feasibility of faculty calibration for calculus detection using two accepted standards: that established by the Central Regional Dental Testing Service, Inc. (CRDTS; readily detectible calculus) and the gold standard for scaling/root debridement (root roughness). Four clinical dental hygiene faculty members out of five possible participants at Halifax Community College agreed to participate. The participants explored calculus on the 16 assigned teeth (64 surfaces) of four patients. Calculus detection scores were calculated before and after training. Kappa averages using CRDTS criteria were 0.561 at pretest and 0.631 at posttest. Kappa scores using the scaling/root debridement or planing standard were 0.152 at pretest and 0.271 at posttest. The scores indicated improvement from moderate (Kappa=0.41-0.60) to substantial agreement (Kappa=0.61-0.80) following training using the CRDTS standard. Although this result differed qualitatively and Kappas were significantly different from 0, the differences for pre- to post-Kappas for patient-rater dyads using CRDTS were not statistically significant (p=0.778). There was no difference (p=0.913) in Kappa scores pre- to post-training using the scaling/root debridement standard. Despite the small number of participants in this study, the results indicated that training to improve interrater reliability to substantial agreement was feasible using the CRDTS standard but not using the gold standard. The difference may have been due to greater difficulty in attaining agreement regarding root roughness. Future studies should include multiple training sessions with patients using the same standard for scaling/root debridement used for evaluation of students.

Learning Warps Object Representations in the Ventral Temporal Cortex.

The human ventral temporal cortex (VTC) plays a critical role in object recognition. Although it is well established that visual experience shapes VTC object representations, the impact of semantic and contextual learning is unclear. In this study, we tracked changes in representations of novel visual objects that emerged after learning meaningful information about each object. Over multiple training sessions, participants learned to associate semantic features (e.g., "made of wood," "floats") and spatial contextual associations (e.g., "found in gardens") with novel objects. fMRI was used to examine VTC activity for objects before and after learning. Multivariate pattern similarity analyses revealed that, after learning, VTC activity patterns carried information about the learned contextual associations of the objects, such that objects with contextual associations exhibited higher pattern similarity after learning. Furthermore, these learning-induced increases in pattern information about contextual associations were correlated with reductions in pattern information about the object's visual features. In a second experiment, we validated that these contextual effects translated to real-life objects. Our findings demonstrate that visual object representations in VTC are shaped by the knowledge we have about objects and show that object representations can flexibly adapt as a consequence of learning with the changes related to the specific kind of newly acquired information.

The effect of session order on the physiological, neuromuscular, and endocrine responses to maximal speed and weight training sessions over a 24-h period.

Athletes are often required to undertake multiple training sessions on the same day with these sessions needing to be sequenced correctly to allow the athlete to maximize the responses of each session. We examined the acute effect of strength and speed training sequence on neuromuscular, endocrine, and physiological responses over 24h. 15 academy rugby union players completed this randomized crossover study. Players performed a weight training session followed 2h later by a speed training session (weights speed) and on a separate day reversed the order (speed weights). Countermovement jumps, perceived muscle soreness, and blood samples were collected immediately prior, immediately post, and 24h post-sessions one and two respectively. Jumps were analyzed for power, jump height, rate of force development, and velocity. Blood was analyzed for testosterone, cortisol, lactate and creatine kinase. There were no differences between countermovement jump variables at any of the post-training time points (p>0.05). Likewise, creatine kinase, testosterone, cortisol, and muscle soreness were unaffected by session order (p>0.05). However, 10m sprint time was significantly faster (mean±standard deviation; speed weights 1.80±0.11s versus weights speed 1.76±0.08s; p>0.05) when speed was sequenced second. Lactate levels were significantly higher immediately post-speed sessions versus weight training sessions at both time points (p<0.05). The sequencing of strength and speed training does not affect the neuromuscular, endocrine, and physiological recovery over 24h. However, speed may be enhanced when performed as the second session.

Web Camera Use in the Neonatal Intensive Care Unit: Impact on Nursing Workflow.

Many neonatal intensive care units (NICU) are using web camera systems to allow virtual visitation of the infant by family members. Generally, families appreciate the web camera and utilize this service. However, no one has looked into the change on nursing workload after implementation of a web camera. This study was designed to explore the perception of nurses and their workflow and identify determinants that may disrupt or facilitate the use of a commercially available camera service. Our primary goal was to see if the camera system interferes with the nursing care. This was a prospective, questionnaire-based study conducted between March and September 2014. Parents were offered the camera service and signed a consent form before use. Parents who refused the camera were the group designated as "off camera." There were two infant groups; one cared for using the cameras and the other not. The camera service was used continuously during the study period, except during procedures, baby care, and feedings. Demographic information on nursing staff and neonates was collected weekly. Questionnaires were placed at each bedside for nurses to complete on each shift for each infant once weekly. The questionnaires for infants off-camera did not have questions regarding the camera. However, the rest of the questions were similar regarding time spent interacting with family members, face to face, or on the phone. Data on time spent manipulating the camera per shift were also obtained. Surveys for 623 on-camera and 130 off-camera infants were completed by 42 nursing staff. Findings showed that caring for multiple infants while using the web camera increased nurses' workload and stress, which they perceived as having an adverse effect on the ability to provide quality care. Family decisions not to utilize the camera service were mainly cultural, and noted among Mennonite, Amish, and Hmong families. Some families residing close to the hospital also preferred visiting the baby personally rather than using the camera service. Parents and nurses perceived web cameras as beneficial in the NICU setting. However, nurses spent significant time manipulating cameras and addressing parental concerns over the phone, causing disruption in their workflow, which had the potential to decrease quality of care for infants. To compensate for these disruptions, we recommend increasing awareness of the potential issues with both cameras and families and providing multiple training sessions to nursing staff before systems are implemented.

Using executive control training to suppress amygdala reactivity to aversive information

The ability to regulate emotions is essential for adaptive behavior. This ability is suggested to be mediated by the connectivity between prefrontal brain regions and the amygdala. Yet, it is still unknown whether the ability to regulate emotions can be trained by using a non-emotional procedure, such as the recruitment of executive control (EC).Participants who were trained using a high-frequent executive control (EC) task (80% incongruent trials) showed reduced amygdala reactivity and behavioral interference of aversive pictures. These effects were observed only following multiple-session training and not following one training session. In addition, they were not observed for participants exposed to low-frequent EC training (20% incongruent trials). Resting-state functional connectivity analysis revealed a marginally significant interaction between training group and change in the connectivity between the amygdala and the right inferior frontal gyrus (IFG). Amygdala–IFG connectivity was significantly increased following the training only in the high-frequent EC training group. These findings are the first to show that non-emotional training can induce changes in amygdala reactivity to aversive information and alter amygdala–prefrontal connectivity.

Sensorimotor Modulation Assessment and Brain-Computer Interface Training in Disorders of Consciousness

ObjectivesTo assess awareness in subjects who are in a minimally conscious state by using an electroencephalogram-based brain-computer interface (BCI), and to determine whether these patients may learn to modulate sensorimotor rhythms with visual feedback, stereo auditory feedback, or both. DesignInitial assessment included imagined hand movement or toe wiggling to activate sensorimotor areas and modulate brain rhythms in 90 trials (4 subjects). Within-subject and within-group analyses were performed to evaluate significant activations. A within-subject analysis was performed involving multiple BCI technology training sessions to improve the capacity of the user to modulate sensorimotor rhythms through visual and auditory feedback. SettingHospital, homes of subjects, and a primary care facility. ParticipantsSubjects (N=4; 3 men, 1 woman) who were in a minimally conscious state (age range, 27–53y; 1–12y after brain injury). InterventionsNot applicable. Main Outcome MeasuresAwareness detection was determined from sensorimotor patterns that differed for each motor imagery task. BCI performance was determined from the mean classification accuracy of brain patterns by using a BCI signal processing framework and assessment of performance in multiple sessions. ResultsAll subjects demonstrated significant and appropriate brain activation during the initial assessment, and real-time feedback was provided to improve arousal. Consistent activation was observed in multiple sessions. ConclusionsThe electroencephalogram-based assessment showed that patients in a minimally conscious state may have the capacity to operate a simple BCI-based communication system, even without any detectable volitional control of movement.

Investigating Forward Velocity and Symmetry in Freestyle Swimming Using Inertial Sensors.

Investigating the performance of an athlete and monitoring them is important to athletes and coaches because it can provide information about the training progress and injury recovery. Coaches are not always on side when athletes doing their training, so a device which is small and easy to use will increase the monitored training sessions significantly and allow the athlete to compare multiple training sessions. This technology has seen rapid development over the last years and is now available in very small sizes which have little effect on the swimmer. Using this kind of sensor, kinematics can be measured and extracted for stroke characteristics investigations. This research used an sacrum mounted self-developed inertial sensor, providing a triaxial accelerometer, gyroscope and RF capability in a waterproof casing to investigate the arm symmetry and swimming velocity in freestyle swimming. The recorded data were filtered using a high-pass Hamming windowed FIR filter to remove the gravity components from the wanted signal. The acceleration signal was then processed to find the velocity of the swimmer. A zero-crossing detection algorithm was used to investigate the arm symmetry and to find the individual stroke rates (SR), the differences between left and right arm stroke durations and the left and right arm stroke velocities (asymmetry). The investigation of the left and right arm velocity patterns of each individual swimmer allowed the investigation of each swimmers asymmetry in propulsion and velocity for the individual arms. The results of the mean lap velocities showed that the two different methods agree with an R2 of 0.92. Furthermore a conducted Bland-Altman analysis showed a low bias of -0.04 with an upper limit of agreement of 0.03 and a lower limit of agreement of -0.11.

Sustained effects of attentional re-training on chocolate consumption

Background and objectivesAccumulating evidence shows that cognitive bias modification produces immediate changes in attentional bias for, and consumption of, rewarding substances including food. This study examined the longevity of these attentional bias modification effects. MethodsA modified dot probe paradigm was used to determine whether alterations in biased attentional processing of food cues, and subsequent effects on consumption, were maintained at 24-h and one-week follow-up. One hundred and forty-nine undergraduate women were trained to direct their attention toward (‘attend’) or away from (‘avoid’) food cues (i.e., pictures of chocolate). Within each group, half received a single training session, the other half completed 5 weekly training sessions. ResultsAttentional bias for chocolate cues increased in the ‘attend’ group, and decreased in the ‘avoid’ group immediately post training. Participants in the ‘avoid’ group also ate disproportionately less of a chocolate food product in a so-called taste test than did those in the ‘attend’ group. Importantly, the observed re-training effects were maintained 24 h later and also one week later, but only following multiple training sessions. LimitationsThere are a number of limitations that could be addressed in future research: (a) the inclusion of a no-training control group, (b) the inclusion of a suspicion probe to detect awareness of the purpose of the taste test, and (c) the use of different tasks to assess and re-train attentional bias. ConclusionsThe results showed sustained effects of attentional re-training on attentional bias and consumption. They further demonstrate the importance of administering multiple re-training sessions in attentional bias modification protocols.

Barriers to self-administered therapy for hereditary angioedema.

Presently, the movement of care for hereditary angioedema (HAE) is out of the clinic, emergency department, and hospitals and into the home. Much of the transition relies on specialized nurses who teach patients self-administration skills. Our goal was to assess nurses to uncover barriers that they have encountered in an effort to improve self-therapy education and patient care. A survey of 21 questions was sent to 38 HAE home care nurses throughout the United States. Results were collected anonymously and data were analyzed. Nurses feel that there is an increased need for teaching patients self-therapy skills. The majority are very comfortable teaching self-administration and troubleshooting-associated problems. Perceived difficulties in providing adequate teaching include distance to patient's home and logistics of coordinating, scheduling, and obtaining supplies. Teaching is preferred when done at home by a visiting nurse with a care partner available and multiple training sessions are needed. Very few patients refused self-administration after initially being taught; reasons cited for refusal include fear of injection or infection, lack of skills, interference of daily activities, and financial restraints. As for nurses, they were most worried about safety, lack of skill retention, and inappropriate use of the drug. Self- administration of HAE treatment is increasingly more accessible and should be offered to patients as a safe and practical option. The barriers to self-administration revealed in this study include distance to the patient's home, coordinating care, obtaining medications/equipment, and scheduling training sessions. Moving to self- or home treatment through nursing instruction will improve patient's independence and quality of life, lead to earlier therapy, and reduce costs associated with care.

The Relationship Between Workloads, Physical Performance, Injury and Illness in Adolescent Male Football Players

The expectation that training enhances performance is well explored in professional sport. However, the additional challenges of physical and cognitive maturation may require careful consideration when determining workloads to enhance performance in adolescents. The objective of this study was to determine the state of knowledge on the relationship between workloads, physical performance, injury and/or illness in adolescent male football players. A systematic review of workloads, physical performance, injury and illness in male adolescent football players was conducted. Studies for this review were identified through a systematic search of six electronic databases (Academic Search Complete, CINAHL, PsycINFO, PubMed, SPORTDiscus, and Web of Science). For the purpose of this review, load was defined as the cumulative amount of stress placed on an individual from multiple training sessions and games over a period of time, expressed in terms of either the external workloads performed (e.g., resistance lifted, kilometres run) or the internal response (e.g., heart rate, rating of perceived exertion) to that workload. A total of 2,081 studies were initially retrieved from the six databases, of which 892 were duplicates. After screening the titles, abstracts and full texts, we identified 23 articles meeting our criteria around adolescent football players, workloads, physical performance, injury and/or illness. Seventeen articles addressed the relationship between load and physical performance, four articles addressed the relationship between load and injury and two articles addressed both. A wide range of training modalities were employed to improve the physical performance of adolescent football players, with strength training, high-intensity interval training, dribbling and small-sided games training, and a combination of these modalities in addition to normal football training, resulting in improved performances on a wide range of physiological and skill assessments. Furthermore, there was some (limited) evidence that higher workloads may be associated with the development of better physical qualities, with one study demonstrating enhanced submaximal interval shuttle run performance with each additional hour of training or game play. Of the few studies examining negative consequences associated with workloads, increases in training load led to increases in injury rates, while longer training duration was associated with a greater incidence of illness. The combined capacity for adolescent males to grow, train and improve physical performance highlights and underscores an exciting responsiveness to training in the football environment. However, the capacity to train has some established barriers for adolescents experiencing high workloads, which could also result in negative consequences. Additional research on stage-appropriate training for adolescent male footballers is required in order to address the knowledge gaps and enhance safe and efficient training practices.

Dissociable mechanisms of speed-accuracy tradeoff during visual perceptual learning are revealed by a hierarchical drift-diffusion model.

Two phenomena are commonly observed in decision-making. First, there is a speed-accuracy tradeoff (SAT) such that decisions are slower and more accurate when instructions emphasize accuracy over speed, and vice versa. Second, decision performance improves with practice, as a task is learnt. The SAT and learning effects have been explained under a well-established evidence-accumulation framework for decision-making, which suggests that evidence supporting each choice is accumulated over time, and a decision is committed to when the accumulated evidence reaches a decision boundary. This framework suggests that changing the decision boundary creates the tradeoff between decision speed and accuracy, while increasing the rate of accumulation leads to more accurate and faster decisions after learning. However, recent studies challenged the view that SAT and learning are associated with changes in distinct, single decision parameters. Further, the influence of speed-accuracy instructions over the course of learning remains largely unknown. Here, we used a hierarchical drift-diffusion model to examine the SAT during learning of a coherent motion discrimination task across multiple training sessions, and a transfer test session. The influence of speed-accuracy instructions was robust over training and generalized across untrained stimulus features. Emphasizing decision accuracy rather than speed was associated with increased boundary separation, drift rate and non-decision time at the beginning of training. However, after training, an emphasis on decision accuracy was only associated with increased boundary separation. In addition, faster and more accurate decisions after learning were due to a gradual decrease in boundary separation and an increase in drift rate. The results suggest that speed-accuracy instructions and learning differentially shape decision-making processes at different time scales.

Top Medical Director Has Caring Heart, Clear Vision

Top Medical Director Has Caring Heart, Clear Vision