Retraining Sessions Research Articles

Effects of two retraining strategies on nursing students’ acquisition and retention of BLS/AED skills: A cluster randomised trial

AimTo determine and compare the effects of two different retraining strategies on nursing students’ acquisition and retention of BLS/AED skills. MethodsNursing students (N=177) from two European universities were randomly assigned to either an instructor-directed (IDG) or a student-directed (SDG) 4-h retraining session in BLS/AED. A multiple-choice questionnaire, the Cardiff Test, Laerdal SkillReporter® software and a self-efficacy scale were used to assess students’ overall competency (knowledge, psychomotor skills and self-efficacy) in BLS/AED at pre-test, post-test and 3-month retention-test. GEE, chi-squared and McNemar tests were performed to examine statistical differences amongst groups across time. ResultsThere was a significant increase in the proportion of students who achieved competency for all variables measuring knowledge, psychomotor skills and self-efficacy between pre-test and post-test in both groups (all p-values<0.05). However, at post-test, significantly more students in the SDG achieved overall BLS/AED competency when compared to IDG. In terms of retention at 3 months, success rates of students within the IDG deteriorated significantly for all variables except ≥70% of chest compressions with correct hand position (p-value=0.12). Conversely, the proportion of students who achieved competency within the SDG only decreased significantly in ‘mean no flow-time≤5s’ (p-value=0.02). Furthermore, differences between groups’ success rates at retention-test also proved to be significantly different for all variables measured (all p-values<0.05). ConclusionThis study demonstrated that using a student-directed strategy to retrain BLS/AED skills has resulted in a higher proportion of nursing students achieving and retaining competency in BLS/AED at three months when compared to an instructor-directed strategy.

How much does a verbal autopsy based mortality surveillance system cost in rural India?

ObjectiveThis paper aims to determine the cost of establishing and sustaining a verbal-autopsy based mortality surveillance system in rural India.Materials and MethodsDeaths occurring in 45 villages (population 185,629) were documented over a 4-year period from 2003–2007 by 45 non-physician healthcare workers (NPHWs) trained in data collection using a verbal autopsy tool. Causes of death were assigned by 2 physicians for the first year and by one physician for the subsequent years. Costs were calculated for training of interviewers and physicians, data collection, verbal autopsy analysis, project management and infrastructure. Costs were divided by the number of deaths and the population covered in the year.ResultsVerbal-autopsies were completed for 96.7% (5786) of all deaths (5895) recorded. The annual cost in year 1 was INR 1,133,491 (USD 24,943) and the total cost per death was INR 757 (USD 16.66). These costs included training of NPHWs and physician reviewers Rs 67,025 (USD 1474), data collection INR 248,400 (USD 5466), dual physician review for cause of death assignment INR 375,000 (USD 8252), and project management INR 341,724 (USD 7520). The average annual cost to run the system each year was INR 822,717 (USD18104) and the cost per death was INR 549 (USD 12) for the next 3 years. Costs were reduced by using single physician review and shortened re-training sessions. The annual cost of running a surveillance system was INR 900,410 (USD 19814).DiscussionThis study provides detailed empirical evidence of the costs involved in running a mortality surveillance site using verbal-autopsy.

Lack of attentional retraining effects in cigarette smokers attempting cessation: A proof of concept double-blind randomised controlled trial

BackgroundObservational studies have shown that attentional bias for smoking-related cues is associated with increased craving and relapse. Laboratory experiments have shown that manipulating attentional bias may change craving. Interventions to reduce attentional bias could reduce relapse in smokers seeking to quit. We report a clinical trial of attentional retraining in treatment-seeking smokers. MethodsThis was a double-blind randomised controlled trial that took place in UK smoking cessation clinics. Smokers interested in quitting were randomised to five weekly sessions of attentional retraining (N=60) or placebo training (N=58) using a modified visual probe task from one week prior to quit day. Both groups received 21mg nicotine patches (from quit day onwards) and behavioural support. Primary outcomes included change in attentional bias reaction times four weeks after quit day on the visual probe task and craving measured weekly using the Mood and Physical Symptoms Scale. Secondary outcomes were changes in withdrawal symptoms, time to first lapse and prolonged abstinence. ResultsNo attentional bias towards smoking cues was found in the sample at baseline (mean difference=3ms, 95% CI=−2, 9). Post-training bias was not significantly lower in the retraining group compared with the placebo group (mean difference=−9ms, 95% CI=−20, 2). There was no difference between groups in change in craving (p=0.89) and prolonged abstinence at four weeks (risk ratio=1.00, 95% CI=0.70, 1.43). ConclusionsTaken with one other trial, there appears to be no effect from clinic-based attentional retraining using the visual probe task. Attentional retraining conducted out of clinic may prove more effective. Clinical trial registrationUK Clinical Trials ISRCTN 54375405.

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.

Attentional bias retraining in cigarette smokers attempting smoking cessation (ARTS): study protocol for a double blind randomised controlled trial.

BackgroundSmokers attend preferentially to cigarettes and other smoking-related cues in the environment, in what is known as an attentional bias. There is evidence that attentional bias may contribute to craving and failure to stop smoking. Attentional retraining procedures have been used in laboratory studies to train smokers to reduce attentional bias, although these procedures have not been applied in smoking cessation programmes. This trial will examine the efficacy of multiple sessions of attentional retraining on attentional bias, craving, and abstinence in smokers attempting cessation.Methods/DesignThis is a double-blind randomised controlled trial. Adult smokers attending a 7-session weekly stop smoking clinic will be randomised to either a modified visual probe task with attentional retraining or placebo training. Training will start 1 week prior to quit day and be given weekly for 5 sessions. Both groups will receive 21 mg transdermal nicotine patches for 8–12 weeks and withdrawal-orientated behavioural support for 7 sessions. Primary outcome measures are the change in attentional bias reaction time and urge to smoke on the Mood and Physical Symptoms Scale at 4 weeks post-quit. Secondary outcome measures include differences in withdrawal, time to first lapse and prolonged abstinence at 4 weeks post-quit, which will be biochemically validated at each clinic visit. Follow-up will take place at 8 weeks, 3 months and 6 months post-quit.DiscussionThis is the first randomised controlled trial of attentional retraining in smokers attempting cessation. This trial could provide proof of principle for a treatment aimed at a fundamental cause of addiction.Trial registrationCurrent Controlled Trials: ISRCTN54375405.

Varied Response to Mirror Gait Retraining of Gluteus Medius Control, Hip Kinematics, Pain, and Function in 2 Female Runners With Patellofemoral Pain

Case report. The underlying mechanism of the changes in running mechanics after gait retraining is presently unknown. This case report assesses changes in muscle coordination and kinematics during treadmill running and step ascent in 2 female runners with patellofemoral pain after mirror gait retraining. Two female runners with chronic patellofemoral pain underwent 8 sessions of mirror gait retraining during treadmill running. Subjective measures and hip abductor strength were recorded at baseline and after the retraining phase. Changes in hip mechanics and electromyography data of the gluteus medius during treadmill running and step ascent were also assessed. Both runners reported improvements in pain and function that were maintained for at least 3 months. During running, peak contralateral pelvic drop (baseline-postretraining difference: runner 1, 2.6° less; runner 2, 1.7° less) and peak hip adduction (baseline-postretraining difference: runner 1, 5.2° less; runner 2, 6.3° less) were reduced after retraining. Kinematic reductions accompanied earlier activation of the gluteus medius relative to foot strike (baseline-postretraining difference: runner 1, 12.6 milliseconds earlier; runner 2, 37.3 milliseconds earlier) and longer duration of gluteus medius activity (runner 1, 55.8 milliseconds longer; runner 2, 44.4 milliseconds longer). Runner 1 transferred reduced contralateral pelvic drop to step ascent, whereas runner 2 did not (contralateral pelvic drop baseline-postretraining difference: runner 1, 3.6° less; runner 2, 1.5° more; hip adduction baseline-postretraining difference: runner 1, 3.0° less; runner 2, 0.5° more). Both runners demonstrated earlier onset of gluteus medius activity during step ascent (baseline-postretraining difference: runner 1, 48.0 milliseconds earlier; runner 2, 28.3 milliseconds earlier), but only runner 1 demonstrated longer activation duration (runner 1, 25.0 milliseconds longer; runner 2, 69.4 milliseconds shorter). While changes in hip mechanics and gluteus medius activity during running were consistent with those noted during step ascent for runner 1, runner 2 failed to demonstrate similar consistency between the tasks. Earlier onset and longer duration of gluteus medius activity may have been necessary to alter step mechanics for runner 2. Therapy, level 4.

Dietary cholesterol degrades rabbit long term memory for discrimination learning but facilitates acquisition of discrimination reversal

We have shown previously that feeding dietary cholesterol before learning can improve acquisition whereas feeding cholesterol after learning can degrade long term memory. To examine these different findings within a single paradigm, we fed groups of rabbits 2% cholesterol or normal chow with or without 0.12ppm copper added to the drinking water following two-tone discrimination learning of the nictitating membrane response in which a 8-kHz tone (conditioned stimulus, CS+) was followed by air puff and a 1-kHz tone (CS−) was not. After eight weeks on the diet, we assessed the rabbits’ conditioned responding during testing and retraining. We then reversed the two-tone discrimination and assessed responding to the 1-kHz tone CS+and the 8-kHz CS−. During testing, rabbits given cholesterol without copper had lower levels of responding to CS+than rabbits in the other groups suggesting they did not retain the discrimination as well. However, during a brief discrimination retraining session, their response levels to the CS+returned to the level of the other groups, demonstrating a return of the memory of the original discrimination. At the end of discrimination reversal, these same rabbits exhibited superior discrimination indexed by lower response levels to CS− but similar levels to CS+, suggesting they were better able to acquire the new relationship between the two tones by inhibiting CS− responses. These results add to our previous data by showing cholesterol diet-induced degradation of an old memory and facilitation of a new memory can both be demonstrated within a discrimination reversal paradigm. Given discrimination reversal is a hippocampally-dependent form of learning, the data support the role of cholesterol in modifying hippocampal function as we have shown previously with in vitro brain slice recordings.

Validity of the Microsoft Kinect for providing lateral trunk lean feedback during gait retraining

Gait retraining programs are prescribed to assist in the rehabilitation process of many clinical conditions. Using lateral trunk lean modification as the model, the aim of this study was to assess the concurrent validity of kinematic data recorded using a marker-based 3D motion analysis (3DMA) system and a low-cost alternative, the Microsoft Kinect™ (Kinect), during a gait retraining session. Twenty healthy adults were trained to modify their gait to obtain a lateral trunk lean angle of 10°. Real-time biofeedback of the lateral trunk lean angle was provided on a computer screen in front of the subject using data extracted from the Kinect skeletal tracking algorithm. Marker coordinate data were concurrently recorded using the 3DMA system, and the similarity and equivalency of the trunk lean angle data from each system were compared. The lateral trunk lean angle data obtained from the Kinect system without any form of calibration resulted in errors of a high (>2°) magnitude (mean error=3.2±2.2°). Performing global and individualized calibration significantly (P<0.001) improved this error to 1.7±1.5° and 0.8±0.8° respectively. With the addition of a simple calibration the anatomical position coordinates of the Kinect can be used to create a real-time biofeedback system for gait retraining. Given that this system is low-cost, portable and does not require any sensors to be attached to the body, it could provide numerous advantages when compared to laboratory-based gait retraining systems.

561 Inflammatory Bowel Disease and Non-Relaxing Pelvic Floor Dysfunction

Symptoms of non-relaxing pelvic floor dysfunction may overlap with those of inflammatory bowel disease (IBD) and include abdominal and pelvic pain, bloating, and straining with bowel movements. Aim: To assess the prevalence of non-relaxing pelvic floor dysfunction (N-RPFD), clinical features, and response to pelvic floor biofeedback therapy in patients with ulcerative colitis (UC), Crohn's Disease (CD) and ileal J pouch dysfunction (IJPD) after Ileal j-pouch anal anastomosis(IPAA) with symptoms suggestive of disordered stool evacuation.. Methods: We reviewed the medical records of patients with IBD at our institution who underwent high resolution anorectal manometry (ARM) for clinical indications from January 2007-April 2012. We recorded and summarized data from their medical records. N-RPFD was characterized by high anal sphincter pressures (ASP) at rest (maximum .90mmHg), or inability to expel a 50 mL balloon from the rectum despite addition of .200g weight. Results: ARM was performed in 177 patients with IBD including 66 with CD, 62 with UC, and 49 with IJPD. There were 125 females and 52 males. The median age was 48 years, range 13-83. ARM was abnormal in 82/177 patients (46%): 80 had NRPFD and 2 patients had low anal pressures and fecal incontinence. In patients with IJPD, 35/49 (71%) had pouchitis and 20/35 pouchitis patients (57%) had N-RPFD. Among the14/ 49 (29%) who did not have pouchitis, 4/14 (29%) had N-RPFD. Among 22 patients with CD and UC who did not have diarrhea or rectal bleeding, 8 (36%) had N-RPFD. Twenty of 80 patients with N-RPFD underwent multiple pelvic floor retraining sessions with rectal sensor and EMG monitoring for anorectal biofeedback: 12/20 (60%) had improvement in symptoms, including 8/13 (62%) with IJPD. Conclusions: Non-relaxing pelvic floor dysfunction was confirmed in 45% of patients with IBD referred for a suspected disorder of stool evacuation. The prevalence of N-RPFD is highest in patients with pouchitis after IPAA. Importantly, 60% of patients with IBD and non-relaxing pelvic floor dysfunction improved with pelvic floor retraining. These data support the hypothesis that PFDmay be a contributing factor and in some cases a major cause of symptoms in patients with IBD.

Six‐week gait retraining program reduces knee adduction moment, reduces pain, and improves function for individuals with medial compartment knee osteoarthritis

This study examined the influence of a 6-week gait retraining program on the knee adduction moment (KAM) and knee pain and function. Ten subjects with medial compartment knee osteoarthritis and self-reported knee pain participated in weekly gait retraining sessions over 6 weeks. Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores and a 10-point visual-analog pain scale score were measured at baseline, post-training (end of 6 weeks), and 1 month after training ended. Gait retraining reduced the first peak KAM by 20% (p < 0.01) post-training as a result of a 7° decrease in foot progression angle (i.e., increased internal foot rotation), compared to baseline (p < 0.01). WOMAC pain and function scores were improved at post-training by 29% and 32%, respectively (p < 0.05) and visual-analog pain scale scores improved by two points (p < 0.05). Changes in WOMAC pain and function were approximately 75% larger than the expected placebo effect (p < 0.05). Changes in KAM, foot progression angle, WOMAC pain and function, and visual-analog pain score were retained 1 month after the end of the 6-week training period (p < 0.05). These results show that a 6-week gait retraining program can reduce the KAM and improve symptoms for individuals with medial compartment knee osteoarthritis and knee pain.

Effectiveness of Executive Functions Training Within a Virtual Supermarket for Adults With Traumatic Brain Injury: A Pilot Study

Impairments of executive functions (EF) significantly affect the ability to lead an independent lifestyle. Virtual environments offer a way to rehabilitate EF due to their ecological validity. The purpose of this pilot study was to examine the effectiveness of a virtual reality (VR) supermarket (VMall) for treatment of EF in patients with Traumatic Brain Injury (TBI), compared to conventional occupational therapy (OT), in order to provide initial data regarding the effect sizes for calculation of sample size as well as to establish an intervention protocol for future Randomized Control Trials (RCTs). Twelve men and women, aged 19-55 years, who had TBI resulting in EF impairments participated in this study. Outcome measures were the Multiple Errands Test-Simplified Version (MET-SV) and the Executive Function Performance Test (EFPT). Cognitive treatment provided to both groups was based on the same principles; the participants in the experimental group received 10 45-min VR-based treatment sessions and the control group participants received 10 sessions of occupational therapy cognitive retraining without VR. Baseline performance prior to intervention showed no statistically significant differences between groups. Most participants improved their performance after therapy. Following a Bonferroni correction for multiple comparisons, no significant between or within group differences were found, Nevertheless, large effect sizes (0.51) for the percent (%) relative change of the MET-SV total score and EFPT total score after intervention were high in favor of the experimental group indicating a larger improvement in EF. Based on this pilot study, results show a trend towards an advantage to VR therapy compared to cognitive retraining OT without VR, as it leads to greater improvement in complex everyday activities.

Action Research on the Implementation of Active Learning at an Elementary School in Aceh

Teachers in the state elementary schools and state Islamic elementary schools of the Indonesian province of Aceh have been trained repeatedly over the past several years on a variety of educational reform initiatives. One of the most important of these has been the effort to promote teaching for active learning in Acehnese schools. Research in other countries, and past experience with teacher training efforts in Aceh, suggest that such a transformation in classroom practice will not be easy. In order to investigate whether and how teachers were transferring their training in active learning into actual classroom practice, a team of lecturers from three universities in Banda Aceh conducted an action research project in one state elementary school. We found that teachers’, principals’, and school supervisors’ understanding of teaching for active learning remained extremely tentative months after receiving training in active learning, and their tentative understanding prevented their active experimentation with what they had learned. A brief retraining session focused on arriving at a common understanding of the concept, committed school leadership, and learning from peers appeared to have a significant impact on teachers’ willingness and ability to try to teach for active learning. Key Words: Active Learning, Action Research, Aceh, Elementary Schools

Intra-amygdala ZIP injections impair the memory of learned active avoidance responses and attenuate conditioned taste-aversion acquisition in rats

We have investigated the effect of protein kinase Mzeta (PKMζ) inhibition in the basolateral amygdala (BLA) upon the retention of a nonspatial learned active avoidance response and conditioned taste-aversion (CTA) acquisition in rats. ZIP (10 nmol/μL) injected into the BLA 24 h after training impaired retention of a learned avoidance-jumping response assessed 7 d later when compared with control groups injected with scrambled-ZIP. Nevertheless, a retraining session applied 24 h later indicated no differences between the groups. Additionally, a similar ZIP injection into the BLA during the conditioned stimulus-unconditioned stimulus (CS-US) interval attenuated CTA acquisition. These findings support the BLA PKMζ role in various forms of memory.

Evaluation of the Routine Clinical Use of the Brief Psychiatric Rating Scale (BPRS) and the Abnormal Involuntary Movement Scale (AIMS)

To evaluate the routine clinical use of the Brief Psychiatric Rating Scale (BPRS) (in psychiatrists' monthly notes) and the Abnormal Involuntary Movement Scale (AIMS) (done at admission and annually) in a state hospital. Two residents and a medical student were trained in the use of the BPRS and the AIMS. These "key raters" then rated 21 patients before and 28 patients after the ward psychiatrists had one retraining session on the BPRS. These raters' results were compared with the ward psychiatrists' results before and after the BPRS retraining as well as with the ward psychiatrists' annual AIMS ratings. The key raters had high correlations among themselves (0.85 for total BPRS and a mean of 0.83 for individual BPRS items), but the correlations with the ward psychiatrists' ratings were very low (0.17 for total BPRS and a mean of 0.37 for individual BPRS items), and those correlations improved only slightly after the retraining of the ward psychiatrists (0.33 for total BPRS and a mean of 0.41 for individual BPRS items). Ward psychiatrists both missed tardive dyskinesia and labelled parkinsonism as tardive dyskinesia. The BPRS and AIMS are useful, practical rating scales, but if they are to be used routinely in clinical care, users must be regularly trained and retrained and rating performance evaluated. (Journal of Psychiatric Practice 2011;17:300-303).

The Effect of Physiotherapy-Based Breathing Retraining on Asthma Control

Background. The mechanism of the breathing retraining effect on asthma control is not adequately based on evidence. Objective. The present study was designed to evaluate the effect of physiotherapy-based breathing retraining on asthma control and on asthma physiological indices across time. Study design. A 6-month controlled study was conducted. Adult patients with stable, mild to moderate asthma (n = 40), under the same specialist’s care, were randomized either to be trained as one group receiving 12 individual breathing retraining sessions (n = 20), or to have usual asthma care (n = 20). The main outcome was the Asthma Control Test score, with secondary outcomes the end-tidal carbon dioxide, respiratory rate, spirometry, and the scores of Nijmegen Hyperventilation Questionnaire, Medical Research Council scale, and SF-36v2 quality-of-life questionnaire. Results. The 2 × 4 ANOVA showed significant interaction between intervention and time in asthma control (F = 9.03, p < .001, η2 = 0.19), end-tidal carbon dioxide (p < .001), respiratory rate (p < .001), symptoms of hypocapnia (p = .001), FEV1% predicted (p = .022), and breathlessness disability (p = .023). The 2 × 4 MANOVA showed significant interaction between intervention and time, with respect to the two components of the SF-36v2 (p < .001). Conclusion. Breathing retraining resulted in improvement not only in asthma control but in physiological indices across time as well. Further studies are needed to confirm the benefits of this training in order to help patients with stable asthma achieve the control of their disease.

Single-session tDCS-supported retraining does not improve fine motor control in musician's dystonia

Focal dystonia in musicians (MD) is a task-specific movement disorder with a loss of voluntary motor control during instrumental playing. Defective inhibition on different levels of the central nervous system is involved in the pathophysiology. Sensorimotor retraining is a therapeutic approach to MD and aims to establish non-dystonic movements. Transcranial direct current stimulation (tDCS) modulates cortical excitability and alters motor performance. In this study, tDCS of the motor cortex was expected to assist retraining at the instrument. Nine professional pianists suffering from MD were included in a placebo-controlled double-blinded study. Retraining consisted of slow, voluntarily controlled movements on the piano and was combined with tDCS. Patients were treated with three stimulation protocols: anodal tDCS, cathodal tDCS and placebo stimulation. No beneficial effects of single-session tDCS-supported sensorimotor retraining on fine motor control in pianists with MD were found in all three conditions. The main cause of the negative result of this study may be the short intervention time. One retraining session with a duration of 20 min seems not sufficient to improve symptoms of MD. Additionally, a single tDCS session might not be sufficient to modify sensorimotor learning of a highly skilled task in musicians with dystonia.

Horizontal ladder task-specific re-training in adult rats with contusive thoracic spinal cord injury.

Using the horizontal ladder task, we examined some issues that need to be resolved before task-specific rehabilitative training can be employed clinically for the frequent contusive spinal cord injury (SCI). We hypothesized that improving recovery in task performance after contusive thoracic SCI requires frequent re-training and initiating the re-training early during spontaneous recovery. Contusive SCI was produced at the adult female Sprague Dawley rat T10 vertebra. Task re-training was initiated one week later when occasional weight-supported plantar steps were taken overground (n = 8). It consisted of 2 repetitions each day, 5 days each week, for 3 weeks. Task performance and overground locomotion were assessed weekly. Neurotransmission through the SCI ventrolateral funiculus was examined. SCI morphometry was determined. Re-training did not improve task performance recovery compared to untrained Controls (n = 7). Untrained overground locomotion and neurotransmission through the SCI did not change. Lesion area at the injury epicenter as a percentage of the total spinal cord area as well as total tissue, lesion, and spared tissue, white matter, or gray matter volumes did not differ. For the horizontal ladder task after contusive thoracic SCI, earlier re-training sessions with more repetitions and critical neural circuitry may be necessary to engender a rehabilitation effect.

Gait retraining to reduce lower extremity loading in runners

Background Tibial stress fractures, which are among the most common running related injuries, have been associated with increased lower extremity loading (i.e., peak positive acceleration of the tibia, vertical force impact peak, and average and instantaneous vertical force loading rates) during initial contact. This study was conducted to evaluate the efficacy of a gait retraining program designed to reduce this loading during running and to assess the short-term persistence of these reductions. Methods Ten runners (six females and four males) with peak positive tibial acceleration greater than 8 g, measured in an initial screening, participated in the retraining program. During the retraining sessions, subjects ran on a treadmill and received real-time visual feedback from an accelerometer attached to their distal tibias. Tibial acceleration and vertical ground reaction force data were collected from subjects during overground data collection sessions held pre-training, post-training, and at a 1-month follow-up. Findings Peak positive acceleration of the tibia, vertical force impact peak, and average and instantaneous vertical force loading rates were all reduced immediately following the gait retraining. The decrease in tibial acceleration was nearly 50%. The reductions in vertical force loading rates and vertical force impact peak were approximately 30% and 20%, respectively. These reductions were maintained at the 1-month follow-up. Interpretation Subjects were able to run with reduced tibial acceleration and vertical force loading immediately following completion of the gait retraining program and at the 1-month follow-up evaluation. This may reduce their risk of stress fractures.

Effect of Pedestrian Safety Retraining for Elementary and Middle School Students

A pedestrian safety educational training program was presented to more than 930 students in Grades 2 through 7 at five public schools in Detroit, Michigan. Initial student training was performed at four of the schools during spring 2008 and at the remaining school during fall 2008. Retraining was performed 7 to 12 months after the initial training. The same training procedures were used during both the initial training and the retraining sessions. The training program was evaluated with the use of both written pre- and posttesting and before-and-after observations of the street-crossing behavior of children near the schools included in the study. Two measures of effectiveness (MOEs) were used for the evaluation: (a) the violation rate for child pedestrians and (b) the percentage of correct test responses. The child pedestrian violation rate decreased shortly after the initial training; this decrease was sustained for several months. Retraining produced an additional incremental decrease in the child pedestrian violation rate. Initial training also produced increases in the percentages of correct responses between the pre- and posttests for children in all participating grade levels. The increases in correct response percentages were partially sustained several months after the initial training, although measurable decreases in test scores were observed. Retraining provided a statistically significant incremental increase in test scores that negated the decreases observed several months after the initial training. The cumulative impact of initial training combined with retraining was consistently larger than the impact of initial training alone for both the testing and the violation rate MOEs.

Avoidance-suppressing effect of antipsychotic drugs is progressively potentiated after repeated administration: an interoceptive drug state mechanism

Antipsychotic drugs selectively suppress conditioned avoidance response. Using a two-way active avoidance response paradigm, we examined the role of drug-induced interoceptive state in the mediation of avoidance-suppressive effect. In Experiment 1, we found that rats intermittently treated with olanzapine (OLZ) (1.0 mg/kg, s.c.) or haloperidol (0.03 mg/kg, s.c.) on the 1st day of a 3-day cycle for seven cycles exhibited a progressive across-session decline in avoidance responding, despite the fact that they exhibited a comparable high level of avoidance responding on the 3rd day of each cycle during the drug-free retraining session. In Experiments 2 and 3, rats that were previously treated with OLZ (0.5-2.0 mg/kg, s.c.) or risperidone (0.2-1.0 mg/kg) during the acquisition phase of avoidance conditioning exhibited significantly fewer avoidance responses when they were retested 3 weeks later to the same drug in comparison to rats that were previously treated with nonantipsychotic drugs (chlordiazepoxide, 10 mg/kg, citalopram 10 mg/kg, or sterile water). Overall, these findings indicate a 'drug memory'-like mechanism that maintains the avoidance-suppressing effect of antipsychotics over time. This mechanism is likely driven by the interoceptive state caused by the antipsychotics, which may also be an important behavioral mechanism mediating the clinical effects of antipsychotic treatments.