Pre-training Group Research Articles

Patient-specific deep learning for 3D protoacoustic image reconstruction and dose verification in proton therapy.

Protoacoustic (PA) imaging has the potential to provide real-time 3D dose verification of proton therapy. However, PA images are susceptible to severe distortion due to limited angle acquisition. Our previous studies showed the potential of using deep learning to enhance PA images. As the model was trained using a limited number of patients' data, its efficacy was limited when applied to individualpatients. In this study, we developed a patient-specific deep learning method for protoacoustic imaging to improve the reconstruction quality of protoacoustic imaging and the accuracy of dose verification for individualpatients. Our method consists of two stages: in the first stage, a group model is trained from a diverse training set containing all patients, where a novel deep learning network is employed to directly reconstruct the initial pressure maps from the radiofrequency (RF) signals; in the second stage, we apply transfer learning on the pre-trained group model using patient-specific dataset derived from a novel data augmentation method to tune it into a patient-specific model. Raw PA signals were simulated based on computed tomography (CT) images and the pressure map derived from the planned dose. The reconstructed PA images were evaluated against the ground truth by using the root mean squared errors (RMSE), structural similarity index measure (SSIM) and gamma index on 10 specific prostate cancer patients. The significance level was evaluated by t-test with the p-value threshold of 0.05 compared with the results from the groupmodel. The patient-specific model achieved an average RMSE of 0.014 ( ), and an average SSIM of 0.981 ( ), out-performing the group model. Qualitative results also demonstrated that our patient-specific approach acquired better imaging quality with more details reconstructed when comparing with the group model. Dose verification achieved an average RMSE of 0.011 ( ), and an average SSIM of 0.995 ( ). Gamma index evaluation demonstrated a high agreement (97.4% [ ] and 97.9% [ ] for 1%/3 and 1%/5mm) between the predicted and the ground truth dose maps. Our approach approximately took 6 s to reconstruct PA images for each patient, demonstrating its feasibility for online 3D dose verification for prostate protontherapy. Our method demonstrated the feasibility of achieving 3D high-precision PA-based dose verification using patient-specific deep-learning approaches, which can potentially be used to guide the treatment to mitigate the impact of range uncertainty and improve the precision. Further studies are needed to validate the clinical impact of thetechnique.

Assessing the Impact of Crossfit Exercise - Based Fitness Activities to The Physical Fitness of Line Dancers

Experimental analysis and research were conducted on the practice and application effects of CrossFit training for line dance athletes at Chengdu University. The CrossFit training program lasted for six weeks, and the researcher collected data through observation and notes during the actual experiment. The specific experimental results showed that CrossFit training significantly improved the strength of the students. In terms of balance training, the pre-training group who did not undergo CrossFit training, had noticeably lower balance abilities compared to the post-training group. This indicated that CrossFit training is greatly beneficial for linedance athletes. Regarding flexibility, the post-training group, who underwent CrossFit training, exhibited noticeably higher flexibility compared to the pre-training group. In terms of speed, the post-training group's speed significantly increased after CrossFit training, suggesting that it greatly enhances the speed of linedance athletes. Based on these results, the paper specifically presented training plans and suggestions. The recommendations highlighted that each athlete's physical constitution and capabilities and responses. Therefore, the first step is to devise training plans. CrossFit training has proven to be highly effective in improving muscle strength, flexibility, and balance. Hence, the next step is the comprehensive application of CrossFit training, followed by focusing on flexibility and balance training, such as schedule at least one day of yoga or Pilates training per week; Strengthening speed and agility exercises, such as short-distance sprints and agility training at least twice a week. Pay attention to personalized training and establish a regular evaluation mechanism.

Effectiveness of the six-step approach guided online training program to improve knowledge of Mycoplasma pneumoniae pneumonia among pediatricians: a pretest-posttest study.

In 2023, China witnessed an earlier and more widespread outbreak of Mycoplasma pneumoniae pneumonia (MPP). To address this situation, an online training program was designed to enhance the knowledge of MPP among pediatricians in Shanghai, China. An online training program on the diagnosis and treatment of MPP, guided by Kern's six-step approach, was developed by the Shanghai Pediatric Clinical Quality Control Center. A pre- and post-training survey was conducted using a 20-item self-administered questionnaire to investigate the pediatricians' knowledge of MPP. A linkage mechanism was established to match pretest/posttest questionnaires using personal identifiers. Paired t-tests and McNemar tests were performed to measure the differences, as appropriate, between pre- and post-training groups. A higher survey score indicated better knowledge. There were 289 participants performed pre- and post-tests. The average age of the respondents was 38.7 years (standard deviation: 8.9). Over 80% of the participants were primary (32.5%) and intermediate (47.8%) pediatricians. Those from specialized hospitals accounted for the highest proportion (41.5%). The post-training group achieved significantly higher total scores than the pre-training group (91.3 vs. 67.7, t=22.48, P<0.001), regardless of the professional titles or hospital levels (all P<0.001). The accuracy rates of each question increased significantly in the post-training group (all P<0.001). The online training program effectively enhanced pediatricians' understanding of diagnosing and treating MPP. It is recommended to maintain continuous education and training targeting all healthcare providers.

Dual Energy X-ray Absorptiometry: Radiographer'S Role in Assessing Fracture Risk Assessment Tool (FRAX) Questionnaire Variables

Background: The FRAX® algorithm is a tool used to calculate the 10-year probability of fracture in patients with osteoporosis and is based the assessment of several risk factors. We assessed the performance and accuracy of the completion of the FRAX® anamnestic questionnaire by the radiographer without impact on the clinical workflow.Methodology: We evaluated the accuracy of fracture risk calculation by the radiographer using the FRAX® algorithm before and after specific training. A total of 100 women were enrolled in the study. The radiographer preliminarily administered the FRAX® questionnaire to all subjects before the execution of the DXA examination. After the end of the examination, a radiologist administered the questionnaire to the patient. Women were divided into two groups: group A (pre-training) and group B (post-training). The radiographer in group A completed the FRAX® questionnaire for the patients before training. For group B, the same radiographer completed the FRAX® questionnaire after training. The results of the FRAX® questionnaire completed by radiographer were compared with that completed by the referring physician.Results: Before training, radiographer's accuracy ranged from 92% (question 7, alcohol consumption) to 36% (question 6, secondary osteoporosis). After training, accuracy values improved substantially, ranging from 100% to 92%. Analysis of the absolute values of FRAX® showed that in the pre-training group data tended to be overestimated by the radiographer, with both major and fractures probabilities being significantly higher when assessed by the radiographer (12% and 5.8%, respectively). After the training, there was a marked decrease in the variation between the FRAX® data calculated by the radiographer and the radiologist.Conclusions: The accuracy of fracture risk calculation by the radiographer using the FRAX® algorithm is significantly improved after a specific training period. This study demonstrates the importance of dedicated training radiographers on the FRAX® algorithm.

Addressing data inadequacy challenges in personal comfort models by combining pretrained comfort models

Occupant thermal-comfort complaints are the biggest operational headache of facilities managers. Many of the complaints can be attributed to the diverse nature of individuals’ thermal comfort needs which are not accounted for in the de facto standard for thermal comfort. This has motivated research on developing data-driven personal comfort models and incorporating them in control loops. But the progress on this front has been hampered by the lack of sufficient ground-truth thermal comfort data to train accurate thermal comfort models. To address this problem, in this paper we explore how artificial labels, indicating individuals’ true thermal preference, can be generated from their heating and cooling behaviour with a personal comfort system. Furthermore, we use clustering to identify individuals with similar comfort requirements in a rich dataset collected from 37 individuals in an office building, and develop a small number of group comfort models, each achieving a high accuracy in predicting the thermal comfort of individuals within the respective cluster. The pretrained group comfort models are then combined using an ensemble method to create a general thermal comfort model that can accurately predict the thermal comfort of any individual without knowing their thermal preferences or group membership a priori. We evaluate the efficacy of two ensemble methods as more training data becomes available and show that they outperform two conventional comfort models (PMV, Adaptive) and the personal comfort model that is developed from scratch for a particular individual. Specifically, the best ensemble comfort model yields on average 71% accuracy in predicting individuals’ thermal preference using only 6 hours of training data, excluding no occupancy periods.

Direct radiation exposure of the eye lenses in cranial computed tomography and exposure reduction through radiographer training

IntroductionIonizing radiation can cause increased opacity of the lens and later lead to radiation-induced cataract.Therefore, the eye lens should be positioned outside of the direct radiation beam in cranial computed tomography (CCT). If this is not possible, protective measures must be taken, which includes the use of external lens protectors. In this study we assess whether direct radiation exposure of the eyes in CCT can be reduced by trained radiographers and whether the use of eye lens protectors improves after training. MethodsFirst, we evaluated 763 non-enhanced CCT regarding direct radiation exposure of eyeballs and eye lenses and usage of lens shielding. Afterwards, we trained radiographers to avoid radiation exposure of the eyes by head adjustment and protectors and assessed the improvements in a subsequent study of 678 CCT. We tried to identify factors that influenced radiation exposure of the eye lens. ResultsAfter training, frequency of radiation exposure of lenses was significantly reduced by 5.9% (220/763 patients in pre- vs. 155/678 patients in post-training group, p = 0.01). The use of external lens protectors significantly increased after training by 9.8% (37/763 patients in pre- vs. 99/678 patients in post-training group, p < 0.001). The absence of tiltable headrest was a risk factor for increased eye lens radiation exposure in the pre-training group. The presence of cervical spine immobilizer was associated with more frequent radiation exposure of the lenses in the pre- and post-training group. ConclusionsRadiographer training and the use of tiltable headrest lead to reduction of radiation exposure to the eye lens. Implications for practiceRadiographer training is an effective method to reduce eye lens exposure in CCT. The usage of tiltable headrest minimizes the radiation exposure of the lenses.

Working Memory Training and Cortical Arousal in Healthy Older Adults: A Resting-State EEG Pilot Study.

The current pilot study aimed to test the gains of working memory (WM) training, both at the short- and long-term, at a behavioral level, and by examining the electrophysiological changes induced by training in resting-state EEG activity among older adults. The study group included 24 older adults (from 64 to 75 years old) who were randomly assigned to a training group (TG) or an active control group (ACG) in a double-blind, repeated-measures experimental design in which open eyes, resting-state EEG recording, followed by a WM task, i.e., the Categorization Working Memory Span (CWMS) task, were collected before and after training, as well as at a 6-month follow-up session. At the behavioral level, medium to large Cohen's d effect sizes was found for the TG in immediate and long-term gains in the WM criterion task, as compared with small gains for the ACG. Regarding intrusion errors committed in the CWMS, an index of inhibitory control representing a transfer effect, results showed that medium to large effect sizes for immediate and long-term gains emerged for the TG, as compared to small effect sizes for the ACG. Spontaneous high-beta/alpha ratio analyses in four regions of interest (ROIs) revealed no pre-training group differences. Significantly greater TG anterior rates, particularly in the left ROI, were found after training, with frontal oscillatory responses being correlated with better post-training CWMS performance in only the TG. The follow-up analysis showed similar results, with greater anterior left high-beta/alpha rates among TG participants. Follow-up frontal high-beta/alpha rates in the right ROI were correlated with lower CWMS follow-up intrusion errors in only the TG. The present findings are further evidence of the efficacy of WM training in enhancing the cognitive functioning of older adults and their frontal oscillatory activity. Overall, these results suggested that WM training also can be a promising approach toward fostering the so-called functional cortical plasticity in aging.

The use of motivational interviewing skills for patient counselling in an interprofessional education learning simulation

Objective: Healthcare training has increasingly focused on interprofessional education (IPE) to provide students opportunities to gain competencies and learn accountability. IPE was incorporated into the curriculum by creating a course for all health science. Motivational interviewing (MI) training was added to enhance the IPE process. The purpose of this study was to determine the effectiveness of MI training in patient counselling simulations. Methods: A cohort of students enrolled in an IPE course were evaluated on MI skills before and after receiving training. MI performance was coded using the Motivational Interviewing Treatment Integrity (MITI) 4.2.1 scoring system. A student perception survey was also administered. Results: A total of 210 students were included in the study. Results from the MITI indicate an improvement in the four global ratings after MI training in individual and group cohorts. For example, for the Cultivating global score, 0% reached at least a fair benchmark in the pre-training groups while 90% (individual) and 50% (group) reached the benchmark post-training. Student perceptions of IPE improved following MI training with more students strongly agreeing that working together was better for patients post-training (66.2% vs 75.5%). Conclusion: The use of MI training in the setting of IPE setting appears to be beneficial. MI gives students a common language and approach to working with patients in an interprofessional setting.

Usefulness of structured-cadaveric training for trans-anal pelvic exenteration.

Structured training using cadaveric simulation is useful for trans-anal surgery; however, no studies have examined the effectiveness of cadaveric training for advanced trans-anal surgery including pelvic exenteration (PE). Twelve colorectal surgeons attended a total of 10 cadaveric simulation training courses between 2016 and 2021 and completed a questionnaire at the end of the program. We divided 14 consecutive patients who underwent trans-anal PE between 2015 and 2021 into two groups: pre-training group and post-training group, and compared the clinico-pathological features between the groups. The median length of clinical experience of the surgeons was 12 years. There was high score agreement among the surgeons that the course was useful for recognition of anatomical and layer structure, training for trans-anal total mesorectal excision and trans-anal PE, and reducing complications specific to the trans-anal approach. Compared with the pre-training group, patients in the post-training group had a higher rate of two-team surgery (77.8% vs 0%, P=.021), and shorter time to specimen removal (273 vs 423 min, P=.045). Structured-cadaveric training has potential use as a technical step-up in advanced trans-anal surgery that might contribute to better short-term outcomes in the clinical setting.

Lexically-guided perceptual learning does generalize to new phonetic contexts

Lexically-guided and visually-guided perceptual learning have been argued to tap into the same general perceptual mechanism. Using the visually-guided paradigm, some have argued that the resulting retuning effect is specific to the phonetic context in which it is learned; which in turn has been used to argue that such retuning targets context-dependent sub-lexical units. We use three new experiments to study the generalizable nature of lexically-guided perceptual learning of fricative consonants and how type variation in the training stimuli affects it. In contrast to visually-guided retuning, we show that lexical retuning does generalize to new phonetic contexts, particularly when listeners are trained with type variation. This suggests that there is an abstract context-independent representation that is used in speech perception and during lexical retuning. While the same generalization is not clearly observed when type variation is eliminated, the lack of a clear interaction effect between training types prevents us from inferring that lexically-guided perceptual learning needs type variation within the training stimuli to generalize to new phonetic contexts. Furthermore, we point out that some of these effects are subtle and are only observable if we take into account pre-training group difference between the control and test groups.

The virtual field trip: Investigating how to optimize immersive virtual learning in climate change education

AbstractImmersive Virtual Reality (IVR) is being used for educational virtual field trips (VFTs) involving scenarios that may be too difficult, dangerous or expensive to experience in real life. We implemented an immersive VFT within the investigation phase of an inquiry‐based learning (IBL) climate change intervention. Students investigated the consequences of climate change by virtually traveling to Greenland and exploring albedo and greenhouse effects first hand. A total of 102 seventh and eighth grade students were randomly assigned to one of two instructional conditions: (1) narrated pretraining followed by IVR exploration or (2) the same narrated training material integrated within the IVR exploration. Students in both conditions showed significant increases in declarative knowledge, self‐efficacy, interest, STEM intentions, outcome expectations and intentions to change behavior from the pre‐ to post‐assessment. However, there was a significant difference between conditions favoring the pretraining group on a transfer test consisting of an oral presentation to a fictitious UN panel. The findings suggest that educators can choose to present important prerequisite learning content before or during a VFT. However, adding pretraining may lead to better transfer test performance, presumably because it helps reduce cognitive load while learning in IVR. Practitioner NotesWhat is already known about this topic? Immersive virtual reality (IVR) simulations lead to higher presence but may lead to less learning when the content is not designed based on the affordances of the technology. One explanation for this finding is that cognitive load may be higher in IVR. The pretraining principle (ie, individuals learn more deeply from interactive multimodal learning environments when they receive pretraining on relevant prior knowledge) can be particularly effective in IVR‐based learning compared to learning through a video. Evidence shows that instructional design principles such as segmentation and generative learning strategies such as summarization can improve learning in IVR simulations. What this paper adds An investigation of the value of two different approaches to designing immersive virtual field trips (VFTs) within a real educational middle school context. Evidence that VFTs featuring IVR climate change simulations, in the context of inquiry‐based learning (IBL), can increase important variables such as declarative knowledge, interest in science and intentions to take climate action in seventh and eighth grade students. Evidence that presenting important learning content before a VFT leads to higher transfer scores. Implications for practice and/or policy Implementing an immersive VFT within the context of an IBL intervention provides students with relevant and engaging learning experiences and results in increased knowledge and interest in science. In the design of instruction using VFTs, educators can choose to either present prerequisite learning content prior to a VFT or during a VFT. However, adding pretraining has an advantage in terms of higher transfer scores.

Effect of Intestinal Cleaning Knowledge Training on Intestinal Cleaning Rate of Enteroscopy in Hospitalized Patients

<i>Objective</i> To investigate the clinical effectiveness of intestinal cleaning knowledge training on intestinal cleaning rate of inpatients undergoing colonoscopy. <i>Methods</i> A comparative study was conducted by selection of 1166 inpatients undergoing colonoscopy in our hospital from January to November in 2016. Among them, 510 inpatients from January to June 2016 were induced into the pre-training group and 656 inpatients from July to December 2016 were induced into in the post-training group. The training contents included the indications and contraindications of colonoscopy, the dietary guidance before colonoscopy, the usage of laxatives for colonoscopy, the standards of intestinal cleanliness, and the precautions before and after colonoscopy. The effective intestinal cleansing rates of the two groups were observed and recorded. <i>Results</i> The average score of intestinal cleaning knowledge assessment of nurses increased from 83.5 before the training to 93.1 after the training; the effective intestinal cleansing rate from July to September of the same year was continuously improved by the training combined rectification, increasing from 73.1% to 92.3%, which was above the target value of 91.2%. <i>Conclusion</i> Intestinal cleaning knowledge training plays a significant role in improvement of the rate of effective intestinal cleaning, which can significantly reduce the rate of missed diagnosis and misdiagnosis.

The Effect of Animal Welfare Training on the Knowledge and Attitudes of Abattoir Stakeholders in China.

Simple SummaryChina is one of the world’s largest producers and exporters of meat, but the welfare of livestock is only now emerging as an important issue. This study looked at whether a “train the trainer” program could be useful in improving the knowledge of employees within Chinese abattoirs about animal welfare during slaughter and transport. Trainers were either taught as a group in a classroom or mailed the training material. They subsequently held training sessions within their own workplace and the participants were surveyed before or after training. The post-training participants were more knowledgeable about animal welfare and were more confident that they could improve welfare for the animals in their care only when they were initially taught in the classroom setting. Participants without a high school education had lower knowledge scores than other participants, and women had more positive attitudes towards animals than men. These results suggest that “train the trainer” initiatives can be successful, but that consideration needs to be given to the mode of training, the level of participant education, and the content in order to ensure that all participants gain equally from the training.Globally, China is one of the largest producers and exporters of meat, and animal welfare is an emerging focal issue for Chinese society and for primary producers. We assessed the effectiveness of a “train the trainer” program to increase awareness of animal welfare issues in stakeholders in the livestock industries of China. Chinese abattoir employees were trained in slaughter and transportation standards in either a classroom setting or using posted materials. They subsequently held training sessions within their own workplace and the participants were surveyed either before (n = 161) or after (n = 147) their training. The post-training group had more confidence to improve the welfare of animals in their care than the pre-training group (p = 0.03), and also scored better on the knowledge section of the survey (p = 0.006) only when the facilitator was trained in the classroom setting. The participants’ knowledge of animal welfare was also affected by living area (p = 0.005) and education (p = 0.005). Participants with the least formal education (to middle school only) scored lower than all other participants. Female respondents reported more positive attitudes towards animal welfare than males (p = 0.009). These results indicate that training can effectively improve stakeholder knowledge on animal welfare during slaughter and transport, however, the mode of delivery has an important influence on learning success, and participant demographics, such as gender and education level, need to be considered when preparing training material.

THE RELATIONSHIP BETWEEN WOMEN´S ARTISTIC GYMNASTICS TECHNICAL SKILL, PHYSICAL PERFORMANCE TEST RESULTS AND SUCCESS IN COMPETITIONS IN FINLAND

The aim of this study was to find out the potential of the Minoritest to identify the most likely talented gymnasts to join the national team pre-training group in Finland. The study examined the relationships between gymnasts´ (N=215, age 10–13) Minoritest results (2006–2010) and success in competitions after the Minoritests until the end of 2016. The competition results were also compared between the gymnasts who had participated in the test and a random number (N=180) of gymnasts who had not. According to this study, the majority (92%) of the best gymnasts in competitions had participated in the Minoritest. 39% of the best in competitions were among the top 10 in the Minoritest. The test results from the technical skills showed a significant connection to the average competition results in all age groups and to the average competition level in the 10–12-year-olds. The test results of the flexibility section did not show relation to competition success. The test results of the strength section showed a significant connection to the average competition results and to the average competition level in the 10–11-year-olds. In the 12–13-year-olds the test results of the strength section showed a relation to the average competition level. According to this study Minoritest success have a positive connection to the future competition success. However, the relation cannot be considered unequivocal. The test results of the strength section can be considered a significant section for the 10–11-year-olds to predict future potential to succeed.&#x0D;

\u201cPrincess and the pea\u201d \u2013 an assessment tool for palpation skills in postgraduate education

BackgroundIn osteopathic medicine, palpation is considered to be the key skill to be acquired during training. Whether palpation skills are adequately acquired during undergraduate or postgraduate training is difficult to assess. The aim of our study was to test a palpation assessment tool developed for undergraduate medical education in a postgraduate medical education (PME) setting.MethodsWe modified and standardized an assessment tool, where a coin has to be palpated under different layers of copy paper. For every layer depth we randomized the hiding positions with a random generator. The task was to palpate the coin or to determine that no coin was hidden in the stack. We recruited three groups of participants: 22 physicians with no training in osteopathic medicine, 25 participants in a PME course of osteopathic techniques before and after a palpation training program, 31 physicians from an osteopathic expert group with at least 700 h of osteopathic skills training. These experts ran the test twice to check for test-retest-reliability. Inferential statistical analyzes were performed using generalized linear mixed models with the dichotomous variable “coin detected / not detected” as the dependent variable.ResultsWe measured a test-retest reliability of the assessment tool as a whole with 56 stations in the expert group of 0.67 (p < 0.001). For different paper layers, we found good retest reliabilities up to 300 sheets. The control group detected a coin significantly better in a depth of 150 sheets (p = 0.01) than the pre-training group. The osteopathic training group showed significantly more correct coin localizations after the training in layer depths of 200 (p = 0.03) and 300 sheets (p = 0.05). This group also had significantly better palpation results than the expert group in the depth of 300 sheets (p = 0.001). When there was no coin hidden, the expert group showed significantly better results than the post-training group (p = 0.01).ConclusionsOur tool can be used with reliable results to test palpation course achievements with 200 and 300 sheets of paper. Further refinements of this tool will be needed to use it in complex assessment designs for the evaluation of more sophisticated palpatory skills in postgraduate medical settings.

Evaluation of an Integrated Rescue Task Force Model for Active Threat Response

Objective: An integrated response to active threat events is essential to saving lives. Coordination of law enforcement officer (LEO) and emergency medical services (EMS) roles requires joint training, as maximizing survival is a shared responsibility. We sought to evaluate the performance of an integrated LEO-EMS Rescue Task Force (RTF) response to a simulated active shooter incident utilizing objective performance measures. Methods: Following prior didactic training, we conducted a series of evaluation scenarios for EMS providers and patrol officers in our urban/suburban advanced life support EMS system (pop. 1,000,000). The scenario-tested command staff, LEOs tasked with neutralizing an active shooter threat, and two RTFs of LEOs and EMS providers each tasked with triage and treatment of 11 simulated casualties scattered over 2 office building floors totaling 13,000 square feet. Trained evaluators recorded performance on 30 objective data elements related to LEO-EMS operations/communication, time intervals, and trauma care. Data were analyzed using descriptive statistics and t-tests for between group comparisons. Results: Over 18 days, 69 scenario events evaluated 388 EMS providers and 468 LEOs. Overall median (90th percentile) times in minutes from dispatch were: unified command established 4.1 (5.5), RTF assembled 9.4 (13.5), first victim contact 11.9 (16.5), first victim to internal casualty collection point (CCP) 16.6 (20.8), all victims ready for evacuation 21.6 (26.0). Life-saving interventions included tourniquet placed: 96% (95% CI 92–99) and LEO placed tourniquet: 88% (79–94). Clinical delays included inappropriate chest decompression: 4% (2–9) and unnecessary initial treatment: 17% (12–25). Correct operational actions included communication with LEO to ensure EMS was safe to treat: 70% (61-77) and appropriate CCP selection: 84% (74–91). Incorrect operational actions included failure to maintain protective LEO-EMS formation: 49% (45–62) and inappropriate single patient evacuation: 20% (14–28). Limitations included the lack of a pre-training control group for this novel program. Conclusions: We described the performance of an integrated LEO-EMS Rescue Task Force response to a simulated active shooter event in a large city. In general, clinical care was appropriate while operational targets can be improved. Objective measurement of response goals may be used for benchmarking and performance improvement for active threat events.

Which neurofeedback session is better for motor skill acquisition; before or after training?

This study aimed to compare the effect of two neurofeedback protocols with two different mechanisms on learning a motor task. Forty-two volunteers aged 18–22 years old were placed in three groups of pre-training, post-training, and control. In the pre-training group, Mu (8–12 Hz) amplitude was suppressed at C4 before the motor skill training, while the participants in the post-training group were instructed to increase theta (4–8 Hz) amplitude at Pz and immediately after motor skill training. After the training session, the subjects participated in retention tests at approximately 90 min, 24 h, and 1 week after training. The results showed that the pre-training group performed better in the first retention test ( p = 0.002). Nevertheless, this superiority was not maintained in subsequent retention tests, where no difference was observed between the groups. Mu amplitude suppression before training led to more beneficial effect on learning of a new motor skill, even though it was not so effective over time. However, it appears that the inhibition of Mu amplitude in the motor cortex and subsequent higher excitability can effect motor skill acquisition.

Infant avoidance training alters cellular activation patterns in prefronto-limbic circuits during adult avoidance learning: II. Cellular imaging of neurons expressing the activity-regulated cytoskeleton-associated protein (Arc/Arg3.1).

Positive and negative feedback learning is essential to optimize behavioral performance. We used the two-way active avoidance (TWA) task as an experimental paradigm for negative feedback learning with the aim to test the hypothesis that neuronal ensembles activate the activity-regulated cytoskeletal (Arc/Arg3.1) protein during different phases of avoidance learning and during retrieval. A variety of studies in humans and other animals revealed that the ability of aversive feedback learning emerges postnatally. Our previous findings demonstrated that rats, which as infants are not capable to learn an active avoidance strategy, show improved avoidance learning as adults. Based on these findings, we further tested the hypothesis that specific neuronal ensembles are "tagged" during infant TWA training and then reactivated during adult re-exposure to the same learning task. Using cellular imaging by immunocytochemical detection of Arc/Arg3.1, we observed that, compared to the untrained control group, (1) only in the dentate gyrus the density of Arc/Arg3.1-expressing neurons was elevated during the acquisition phase of TWA learning, and (2) this increase in Arc/Arg3.1-expressing neurons was not specific for the TWA learning task. With respect to the effects of infant TWA training we found that compared to the naïve non-pretrained group (a) the infant pretraining group displayed a higher density of Arc/Arg3.1-expressing neurons in the anterior cingulate cortex during acquisition on training day 1, and (b) the infant pretraining group displayed elevated density of Arc/Arg3.1-expressing neurons in the dentate gyrus during retrieval on test day 5. Correlation analysis for the acquisition phase revealed for the ACd that the animals which showed the highest number of avoidances and the fastest escape latencies displayed the highest density of Arc/Arg3.1-expressing neurons. Taken together, we are the first to use the synaptic plasticity protein Arc/Arg3.1 to label neuronal ensembles which are involved in different phases of active avoidance learning and whose activity patterns are changing in response to previous learning experience during infancy. Our results indicate (1) that, despite the inability to learn an active avoidance response in infancy, lasting memory traces are formed encoding the subtasks that are learned in infancy (e.g., the association of the CS and UCS, escape strategy), which are encoded in the infant brain by neuronal ensembles, which alter their synaptic connectivity via activation of specific synaptic plasticity proteins such as Arc/Arg3.1 and Egr1, and (2) that during adult training these memories can be retrieved by reactivating these neuronal ensembles and their synaptic circuits and thereby accelerate learning.

Simulation training is useful for shortening the decision-to-delivery interval in cases of emergent cesarean section

Objective: We examined the effect of simulation training for medical staff on the decision-to-delivery interval (DDI) in cases of emergent cesarean delivery and the effect of a shortened DDI on maternal and neonatal outcomes.Material and methods: Our hospital is a tertiary perinatal center. As the simulation training was performed in March 2014, the study population was divided into two groups: pretraining group (November 2011–March 2014, 29 months: n = 15) and post-training group (April 2014–August 2016, 29 months: n = 35).Results: The DDI was significantly shorter in the post-training group than in the pretraining group (p = .009). In particular, the decision-to-entering the operating room interval was significantly shorter in the post-training group than in the pretraining group (p = .003). The umbilical artery pH was significantly better in post-training group than in the pretraining group (p = .019). Furthermore, the umbilical artery pH was significantly improved by simulation training only in “irreversible” cases (p = .012).Conclusions: The DDI was significantly shortened by introducing simulation training. We also demonstrated a beneficial effect of the simulation training on the umbilical artery pH, especially in “irreversible” cases, without increasing the rate of maternal adverse outcome.

Dedicated training program for shoulder sonography: the results of a quality program reverberate with everyone.

The purpose of this study was to define and report on the effect of a comprehensive musculoskeletal sonography training program to improve accuracy (sensitivity and specificity) for the diagnosis of rotator cuff tears in relatively inexperienced operators. Before the training program was implemented, radiologists (n = 12) had a mean of 2 years (range, <1-12 years) of experience performing and interpreting musculoskeletal sonography. Pre- and post-training shoulder sonographic results were compared to surgical reports or, in their absence, to shoulder magnetic resonance imaging or computed tomographic arthrographic results if within 2 months of the sonographic examination. A total of 82 patients were included in the pre-training group (January 2010-December 2011), and 50 patients were included in the post-training group (January 2012-June 2013). The accuracy, sensitivity, specificity, and positive and negative predictive values were determined for the presence or absence of supraspinatus and infraspinatus tendon tears. After implementation of the training program, the sensitivity of sonography for detecting full-thickness rotator cuff tears increased by 14%, and the sensitivity for detecting partial-thickness rotator cuff tears increased by 3%. Quality improvement programs and acquisition standardization along with ongoing, focused case conferences for the entire care team increased the sensitivity of shoulder sonography for diagnosing both full- and partial-thickness rotator cuff tears, independent of the years of operator experience.