Self-guided Training Research Articles

1 Million Turtles: empowering communities to save Australian freshwater turtles

ABSTRACT Australian freshwater turtle populations have declined substantially, with consequent losses to aquatic ecosystem functions. A leading hypothesis is that turtles have declined through lost recruitment caused by high nest predation by invasive foxes. The ‘fox hypothesis’ is supported by experiments showing that nest predation rates exceed 95% in many regions. Furthermore, population surveys have repeatedly found absences of juvenile turtles, and headstarting experiments have successfully replaced those juveniles in some species. We are currently leading a nationwide citizen science program, ‘1 Million Turtles’ (1millionturtles.com), to engage local communities to protect turtles from threats like nest predation using a suite of novel approaches. Our key innovation is to leverage community passion and interest for turtles to create positive conservation impacts via a nationwide support network. We provide a data collection tool and framework (TurtleSAT) and self-guided training in conservation methods. We assist with guidance for gaining licencing and permission, and applying for grants. We are evaluating our approach through both the impacts on turtle populations as well as through surveys of our engaged citizen scientists. Ultimately, we aim to create a science-supported, national grassroots conservation model where community champions can lead their own evidence-based approaches to help wildlife.

Abstract P371: The Retrain Your Brain for Healthy Eating Study: Promising Results in Reducing Cravings and Supporting Healthier Eating Habits Among Diverse Patients With Obesity

Introduction: Adopting healthy eating habits can improve cardiovascular health. However, following dietary guidelines can be challenging, partly due to neural pathways that influence cravings and appetite. While medications exist to reduce appetite and cravings, behavioral interventions targeting cravings are less common. The innovative Food Trainer mobile application, FoodT, employs a go no-go paradigm, where participants learn to respond to healthy foods presented in green circles (go-trials) and withhold their response to unhealthy foods presented in red circles (no-go trials). Growing evidence suggests that this training can reduce food cravings and energy intake. Nonetheless, its feasibility in clinical and at-home settings and among diverse populations remains underexplored. To address this gap, this study investigates the feasibility of the FoodT application for a diverse patient population with obesity. Hypothesis: Food response training is feasible to decrease food cravings (scores: 15-75) and energy intake (kcal). Methods: The Retrain Your Brain for Healthy Eating trial is a single-group feasibility study of participants with obesity from diverse racial and ethnic backgrounds. Participants engage in a food response training intervention, with a video-conference introduction session, followed by a self-guided training regimen of three or more sessions weekly for 12 weeks. Study staff conduct weekly meetings to monitor adherence and offer support. Assessments include weekly food craving reports via a validated survey (Food Craving Questionnaire - State) and energy intake (kcal) via weekly self-guided ASA-24 dietary recalls. We averaged reports in cravings and kcal for Month 1, Month 2, and Month 3 and used linear mixed-effect models. Results: Of 17 participants, 87% self-identified as female, 42% as non-Hispanic Black, and 23% as Hispanic (age: 50.0±13.4, BMI: 36.53±4.59). On average, participants used FoodT 4.22±2.91 times per week. We observed significant reductions in cravings (Month 1: 37.59±10.42, Month 2: 32.43±10.22, Month 3: 31.36±9.80), P = .001, and kcal (Month 1: 1872.54 ±740.22, Month 2: 1818.05 ±724.43, Month 3: 1563.14 ±682.78), P = .046. Conclusion: Preliminary findings from this feasibility study suggest that FoodT has the potential to decrease food cravings and energy intake among a diverse population with obesity. However, this study is limited by a small sample size, gender imbalance, and reliance on self-reported data. This mobile app offers a low-cost scalable tool to support patients with obesity in adopting healthier diets, and improve cardiovascular health, needing further research to confirm these findings and assess its long-term sustainability and clinical implications.

Pharmacy technician development: Insight into training, preparedness, and career-path perceptions

BackgroundAlthough opportunities for pharmacy technicians may be expanding, an increasing number of technicians have transitioned out of their roles. It is important to consider what could be done within education and training to promote the retention of pharmacy technicians. ObjectivesThe purpose of this study was to survey pharmacy technicians in the state of Ohio to identify key components of professional development. MethodsA survey was distributed through REDCap to 24,444 pharmacy technicians with active pharmacy technician licenses in the state of Ohio. Inclusion criteria required survey respondents to be at least 18 years old and currently working as a pharmacy technician. ResultsA total of 1386 surveys were fully completed (approximately 6% response rate). Professional development opportunities provided by employers varied across most practice sites, but continuing education was the most reported opportunity. Attending conferences, taking specialized training courses, and tuition reimbursement were less common. The top 3 barriers to professional development participation included additional cost, time, and perceived value. Guidance and mentorship from peers, achieving national certification, and formal on-the-job training were the most helpful in job preparation and training. The main reasons to achieve certification included increased pay, development opportunity, or employer requirement. When considering preparation for new roles, 57% of pharmacy technicians felt prepared or very prepared for the job after 90 days. As technicians continued throughout their careers, the training transitioned from formal hands-on training to self-guided training. ConclusionPharmacy technicians have a desire to remain in their roles, but participation in professional development opportunities was lacking owing to availability of options and barriers. Pharmacy practice sites interested in retaining technicians should invest in offering and encouraging pharmacy technicians to participate in development opportunities. To continue to develop pharmacy technicians, ongoing education and training tied to increased compensation may improve retention and foster an improved learning environment.

Remote Global Radiation Oncology Education and Training: A Pathway to Increase Access to High-Quality Radiation Therapy Services in Low- and Middle-Income Countries

There is a vital need to train radiation therapy professionals in low- and middle-income countries (LMICs) to develop sustainable cancer treatment capacity and infrastructure. LMICs have started to introduce intensity modulated radiation therapy (IMRT), which is the standard of care in high-income countries, because of improved outcomes and reduced toxicities. This work reports the efficacy of a complementary asynchronous plus synchronous virtual-training approach on improving radiation therapy professions' self-confidence levels and evaluating participants' attitudes toward asynchronous and synchronous didactic hands-on learning in 3 LMICs. Training was provided to 37 participants from Uganda, Guatemala, and Mongolia, which included 4 theoretical lectures, 4 hands-on sessions, and 8 self-guided online videos. The 36-day training focused on IMRT contouring, site-specific target/organ definition, planning/optimization, and quality assurance. Participants completed pre- and postsession confidence surveys on a 0 to 10 scale, which was converted to a 5-point Likert rating scale to evaluate the training outcomes. The pros and cons of the 3 different training formats were compared. The participants included 15 (40.5%) radiation oncologists, 11 (29.7%) medical physicists, 6 (16.2%) radiation therapists, and 5 (13.5%) dosimetrists. Approximately 50% had more than 10 years of radiation therapy experience, 70.8% had no formal IMRT training, and only 25% had IMRT at their institutions. The average experience and confidence levels in using IMRT at baseline were 3.2 and 2.9, which increased to 5.2 and 4.9 (P < .001) after the theoretical training. After the hands-on training, the experience and confidence levels further improved to 5.4 and 5.5 (P < .001). After the self-guided training, the confidence levels increased further to 6.9 (P < .01). Among the 3 different training sessions, hands-on trainings (58.3%) were most helpful for the development of participants' IMRT skills, followed by theoretical sessions with 25%. After completing the training sessions, Uganda and Mongolia started IMRT treatments. Remote training provides an excellent and feasible e-learning platform to train radiation therapy professionals in LMICs. The training program improved the IMRT confidence levels and treatment delivery. The hands-on trainings were most preferred.

Developing knowledge-based psychotherapeutic competencies in non-specialist providers: A pre-post study with a nested randomised controlled trial of a coach-supported versus self-guided digital training course for a problem-solving psychological intervention in India.

We evaluated a digital learning programme for non-specialists to develop knowledge-based competencies in a problem-solving intervention for adolescents to examine the overall impact of training on knowledge-based competencies among learners; and to compare the effects of two training conditions (self-guided digital training with or without coaching) in a nested parallel, two-arm, individually randomised controlled trial. Eligible participants were 18or older; fluent in Hindi or English; able to access digital training; and had no prior experience of delivering structured psychotherapies. 277 participants were enrolled from 31 March 2022 to 19 June 2022 of which 230 (83%) completed the study. There was a significant increase in competency score from pre-training (Mean=7.01, SD=3.29) to post-training (Mean=8.88, SD=3.80), 6weeks after the pre-training assessment. Knowledge competency scores showed larger increase among participants randomised to the coaching arm (AMD=1.09, 95% CI 0.26-1.92, p=0.01) with an effect size (d) of 0.33 (95% CI 0.08-0.58). More participants completed training in the coaching arm (n=96, 69.6%) compared to the self-guided training arm (n=56, 40.3%). In conclusion, a coach-supported remote digital training intervention is associated with enhanced participation by learners and increased psychotherapeutic knowledge competencies.

'It gives you encouragement because you're not alone': A pilot study of a multi-component social media skills intervention for people with acquired brain injury.

People with an acquired brain injury (ABI) find it challenging to use social media due to changes in their cognition and communication skills. Using social media can provide opportunities for positive connection, but there is a lack of interventions specifically designed to support safe and successful social media use after ABI. To investigate the outcomes of completing a social media skills intervention and identify barriers and facilitators for future implementation. The study used a mixed-methods, pre-post-intervention design. A total of 17 adults with an ABI were recruited. Participants completed an intervention that included a short self-guided course about social media skills (social-ABI-lity course), and then participated in a private, moderated Facebook group over a 12-week period (social-ABI-lity Facebook group). Data were collected over this period through observation of group activity and weekly surveys. They were also collected on social media use and quality of life at pre-intervention, post-intervention and after 3 months. Participants provided feedback on the experience of participating in the programme via a post-intervention interview. At post-intervention, there were significant improvements in confidence in using Facebook (p = 0.002) and enjoyment of using Facebook to connect with others (p = 0.013). There was no significant change in reported quality of life, although participants described the multiple benefits of connection they perceived from involvement in the group. Observational data and feedback interviews were informative about the feasibility and acceptability of the intervention. This pilot study provided preliminary evidence that an intervention comprising a short, self-guided training course and a private, moderated Facebook group improved outcomes for people with ABI. Key recommendations for future implementation include embedding active peer moderators within groups and taking an individualized approach to delivery of the intervention. What is already known on the subject Research has documented the challenges that people with ABI experience in using social media, and the difficulty for rehabilitation clinicians in providing appropriate support in this field. What this paper adds to existing knowledge This pilot study reports the outcomes of people with ABI completing a short, self-guided social media skills course and participating in a private, moderated Facebook group. After the intervention, participants reported significantly increased confidence and enjoyment in using Facebook, described the benefits of connection found in the groups, and suggested potential improvements for future implementation. What are the potential or actual clinical implications of this work? With the growing use of social media for connection and participation, there is a professional obligation to address social media communication skills in cognitive-communication rehabilitation for people with ABI. The findings of this study will inform interventions and future research to assist people with ABI to build their social media skills for communication, social support and a sense of connection.

In women with stress UI, device-guided pelvic floor muscle training safely improved symptoms more than self-guided training.

Weinstein MM, Dunivan G, Guaderrama NM, et al. Digital therapeutic device for urinary incontinence: a randomized controlled trial. Obstet Gynecol. 2022;139:606-15. 35271539.

SONNET: A Self-Guided Ordinal Regression Neural Network for Segmentation and Classification of Nuclei in Large-Scale Multi-Tissue Histology Images.

Automated nuclei segmentation and classification are the keys to analyze and understand the cellular characteristics and functionality, supporting computer-aided digital pathology in disease diagnosis. However, the task still remains challenging due to the intrinsic variations in size, intensity, and morphology of different types of nuclei. Herein, we propose a self-guided ordinal regression neural network for simultaneous nuclear segmentation and classification that can exploit the intrinsic characteristics of nuclei and focus on highly uncertain areas during training. The proposed network formulates nuclei segmentation as an ordinal regression learning by introducing a distance decreasing discretization strategy, which stratifies nuclei in a way that inner regions forming a regular shape of nuclei are separated from outer regions forming an irregular shape. It also adopts a self-guided training strategy to adaptively adjust the weights associated with nuclear pixels, depending on the difficulty of the pixels that is assessed by the network itself. To evaluate the performance of the proposed network, we employ large-scale multi-tissue datasets with 276349 exhaustively annotated nuclei. We show that the proposed network achieves the state-of-the-art performance in both nuclei segmentation and classification in comparison to several methods that are recently developed for segmentation and/or classification.

Abstract 6393: The Cancer Genomics Cloud enables bioinformatics training in a hybrid educational world

Abstract The Cancer Genomics Cloud (CGC), powered by Seven Bridges, is an NCI-funded platform that streamlines access to large cancer datasets, bioinformatic tools, and cloud computation for cancer researchers. The attributes of the CGC designed to democratize data analysis also make it ideal for training the next generation of data scientists. During the Covid-19 pandemic, it has become clear that remote/virtual learning is of great importance for workforce development, and that reducing barriers to high quality educational resources is critical for many populations. Here we present our best practices for education of bioinformatics using the CGC, taking advantage of both distributed cloud networks and platform features to enhance learning. Our best practices methods are focused on a systematic approach that takes the instructor and students through a typical bioinformatics workflow in their field of research. Briefly, the organizational structure of the CGC, known as “projects,'' contains all aspects of an analysis, including data files, tools, and tool settings. Projects have fine-grained permission settings, which allow the owner to securely share their project for viewing or editing. An instructor can generate an example analysis from start to finish then share an entire project with trainees. Both students and instructors have access to the same data on the cloud, so the teacher can pre-populate the projects with specific files, ensuring the same starting point. All members within the project can communicate, including adding notes directly on the results, allowing students to troubleshoot in real time with the teacher. Instructors can manage costs for the whole class through the CGC’s billing system. The CGC also provides Public Projects for self-guided training, where a researcher can learn by example using the data, tools, and completed tasks within the project, including detailed instructions embedded in markdown language. We have successfully used these methods to train masters students in bioinformatics at Georgetown University for three years, as well as high school students, college students, and current cancer researchers. This approach to virtual learning of bioinformatics can democratize training for the next generation of data scientists. The FAIR practices built into the CGC enables education across all levels of expertise, empowering users to drive cancer research from any stage of their career. Citation Format: Manisha Ray, Sai Lakshmi Subramanian, David Roberson, Zelia Worman, Dennis A. Dean, Soner Koc, Jack DiGiovanna, Brandi Davis-Dusenbery. The Cancer Genomics Cloud enables bioinformatics training in a hybrid educational world [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 6393.

PENINGKATAN HASIL BELAJAR SISWA DENGAN METODE PEMBERIAN LATIHAN PRAKTEK MANDIRI TERBIMBING PADA MATA PELAJARAN INSTALASI PENERANGAN LISTRIK DI KELAS XI TITL 1 SMK NEGERI 1 MANDAU SEMESTER 1 TAHUN PELAJARAN 2019 / 2020

This research begins with students who cannot do practical job sheets and only copy and copy their friends' work, the authors see that students need guidance / direction so that they are willing to work and be active in PHB assembly practice activities and are able to complete practical job sheets. well and perfectly. The research that the writer did was Classroom Action Research (CAR). The subjects in this action research were students of Class XI Electrical Power Installation Engineering (TITL 1) at SMK Negeri 1 Mandau with 11 students. The data collection technique used in this research is a series of photo folio assessments to evaluate the quality and quantity of the self-guided training method carried out by researchers collaborating with an observer. Data analysis was carried out qualitatively. Based on the results of observations and student learning outcomes in each cycle, it is known that: (1) Providing Guided Independent Practice Exercises is proven to improve student learning outcomes in the subject of Electrical Lighting Installation in Class XI TITL SMK Negeri 1 Mandau, amounting to 96.29% (2) Carrying out practical competency exams (UKP) with not too many test materials can spur students to get good grades of 96%. It can be concluded that the implementation of research using learning with this training method can improve learning outcomes.Keywords: Method of Giving Guided Independent Practice Exercises, Electrical Lighting Installation Subjects.

Considerations for Voice and Communication Training Software for Transgender and Nonbinary People

Transgender and gender diverse people often experience voice-gender incongruence, which is inversely correlated with health and quality of life. Such incongruence could be reduced with voice and communication training, but expert-administered training is often inaccessible while self-guided training is difficult and potentially risky. Training could alternatively be provided through software (eg, smartphone apps), but such software is at an early stage. This qualitatively driven mixed-methods study thus includes surveys and interviews with 21 transfeminine, transmasculine and nonbinary people to identify general views of voice and communication training software as well as most desirable features of such software. Participants were positive about the general idea and described ways to effectively implement four critical features: feedback, accountability, automated goal setting, and training characteristics other than pitch. They also discussed optional or undesirable features. These findings may inform development of voice and communication training software, thus improving health and quality of life for gender minorities.

Assessing effectiveness of a self-guided training program for oncology financial advocates.

271 Background: Financial toxicity can be a devastating side effect for patients with cancer and their families, and may impact access to and delivery of care, treatment compliance, and outcomes. Financial advocates mitigate financial toxicity for patients and their families, liaise between payers/providers/pharmacies/patients, support shared decision-making and care planning processes through provision of cost and coverage information, and mitigate institutional financial toxicity. Training on effective financial navigation interventions, financial health literacy, patient engagement, oncology fundamentals, and measurement of impact is critical for advocates. Methods: The Association of Community Cancer Centers (ACCC) Financial Advocacy Boot Camp is a self-paced eLearning program consisting of 9 modules designed to build knowledge and skills of financial advocates. Users interact with education across two levels within the ACCC Learning Management System. To evaluate effectiveness of this content, pre- and post-assessments and evaluation forms for registered learners from 1/1/2020 to 12/31/20 were exported and exploratory analysis was performed on this data set of 538 participants. Results: 51% of respondents are oncology financial advocates; 7% are industry representatives; and the remaining 42% are a mix of patient navigators, nurse navigators, social workers, pharmacists, APPs, and nurses. 363 participants fully completed at least one of two levels. Most participants agreed or strongly agreed that each of the modules improved their knowledge and skills: 94% increased their ability to incorporate effective screening methods to identify patients at risk of financial toxicity, 95% are better able to review the evolving landscape of health insurance provided by public and private payers, and 97% both increased their ability to find patient assistance programs and resources for patients and can describe how to guide patients through the process of improving insurance coverage. 79% identified specific examples of what they will do differently after the training, including implementing screening and follow-up protocols, adjusting communication approaches with patients, proposing quality improvement projects, and accessing resources. Conclusions: Training, such as the Financial Advocacy Boot Camp, that builds knowledge and skills in financial screening, communication, and navigation can help cancer programs improve staffs’ ability to mitigate patient and institutional financial toxicity. Future research efforts should further define financial advocacy competencies, measure patient and institutional impact of financial navigation interventions, and assess effective practices for implementation of financial advocacy training in cancer programs.

Mindful Hand Hygiene and Self-Guided Training Using a Mobile Phone App

This paper presents a preliminary concept for a ‘Mobile Phone App’ providing training in mindful hand hygiene integrated with the WHO hand hygiene protocol. A range of human factors action research methods were used to specify the preliminary concept. This includes stakeholder interviews, workshops, and participatory co-design/evaluation sessions. Mindfulness enables HCW to focus on the correct procedure for HH, along with addressing the need for self-care. The proposed Mobile Phone App enables training in mindful HH, from home. Mindful HH training forms parts of a wider learner journey which includes addressing self-care and training in PPE donning and doffing. Mindfulness is an inexpensive strategy to reduce stress and improve the quality of the working lives of healthcare workers. However, it is not a substitute for professional counselling services.

Cognitive and Psychosocial Outcomes of Self-Guided Executive Function Training and Low-Intensity Aerobic Exercise in Healthy Older Adults.

ObjectivesPrior work has demonstrated that executive function training or physical exercise can improve older adults’ cognition. The current study takes an exploratory approach to compare the feasibility and efficacy of online executive function training and low-intensity aerobic exercise for improving cognitive and psychosocial functioning in healthy older adults.MethodFollowing a standard pretest-training-posttest protocol, 40 older adults (aged 65 and above) were randomly assigned to an executive function or a physical training group. A battery of cognitive and psychosocial outcome measures were administered before and after training. During the 10 weeks of self-guided training at home (25–30 min/day, 4 days/week), the executive function training group practiced a set of adaptive online executive function tasks designed by Lumos Labs, whereas the physical training group completed an adaptive Digital Video Disc (DVD)-based low-intensity aerobic exercise program.ResultsTraining transfer effects were limited. Relative to low-intensity aerobic exercise, executive function training yielded cognitive improvement on the 64-card Wisconsin Card Sorting Task (WCST-64), a general executive function measure. Depression and stress levels dropped following both training programs, but this could be driven by decreased stress or excitement in performing the tasks over time.DiscussionThe results revealed limited cognitive benefits of the online executive function training program, specifically to a near transfer test of general executive control. Importantly, the current study supports the feasibility of home-based self-guided executive function and low-intensity physical training with healthy older adults.

Simulation reduces navigational errors in cerebral angiography training

BackgroundSimulation-based medical education (SBME) is growing as a powerful aid in delivering proficient skills training in many specialties. Cerebral angiography (CA), a spatially and navigationally challenging endovascular procedure, can benefit from SBME by training targetable skills outside of the Angiosuite. In order to standardize and specify training requirements, navigational challenges and needs have to be identified. Furthermore, to enable successful adoption of these strategies, simulation adoption barriers, such as necessity of supervisory resources, must be reduced. In this study, we assessed the navigational challenges in simulated CA through a self-guided novice training program.MethodsNovice participants (n = 14) received virtual reality (ANGIO Mentor, Simbionix) diagnostic cerebral angiography training and were tested on a right middle cerebral artery aneurysm case over 8 sessions with a reference instructional outline. The navigational trajectories for the guidewire and catheter were analyzed and rates in erroneous vessel access were analyzed. Participants were given a Mental Rotations Test (MRT) and were analyzed based on MRT performance.ResultsAfter 8 sessions, there was a significant (p < 0.05) reduction on navigational error prevalence. The L-SUB and L-CCA saw the biggest drop in erroneous access, whereas the R-ECA, the biggest consumer of error time, saw no changes in access frequency. Individuals with high MRT score performed much better (p < 0.05) than those with low MRT score.ConclusionsThrough self-guided simulation training, we demonstrated the navigational challenges encountered in simulated CA. To establish better assessments and standards in medical training, we can create self-guided training curricula aimed at correcting errors, enabling repetitive practice, and reducing human resource needs.

Nodular Leptomeningeal Disease—A Distinct Pattern of Recurrence After Postresection Stereotactic Radiosurgery for Brain Metastases: A Multi-institutional Study of Interobserver Reliability

For brain metastases, surgical resection with postoperative stereotactic radiosurgery is an emerging standard of care. Postoperative cavity stereotactic radiosurgery is associated with a specific, underrecognized pattern of intracranial recurrence, herein termed nodular leptomeningeal disease (nLMD), which is distinct from classical leptomeningeal disease. We hypothesized that there is poor consensus regarding the definition of LMD, and that a formal, self-guided training module will improve interrater reliability (IRR) and validity in diagnosing LMD. Twenty-two physicians at 16 institutions, including 15 physicians with central nervous system expertise, completed a 2-phase survey that included magnetic resonance imaging and treatment information for 30 patients. In the "pretraining" phase, physicians labeled cases using 3 patterns of recurrence commonly reported in prospective studies: local recurrence (LR), distant parenchymal recurrence (DR), and LMD. After a self-directed training module, participating physicians completed the "posttraining" phase and relabeled the 30 cases using the 4 following labels: LR, DR, classical leptomeningeal disease, and nLMD. IRR increased 34% after training (Fleiss' Kappa K = 0.41 to K = 0.55, P < .001). IRR increased most among non-central nervous system specialists (+58%, P < .001). Before training, IRR was lowest for LMD (K = 0.33). After training, IRR increased across all recurrence subgroups and increased most for LMD (+67%). After training, ≥27% of cases initially labeled LR or DR were later recognized as nLMD. This study highlights the large degree of inconsistency among clinicians in recognizing nLMD. Our findings demonstrate that a brief self-guided training module distinguishing nLMD can significantly improve IRR across all patterns of recurrence, and particularly in nLMD. To optimize outcomes reporting, prospective trials in brain metastases should incorporate central imaging review and investigator training.

Nodular Leptomeningeal Disease – A Distinct Pattern of Recurrence after Post-Resection Stereotactic Radiosurgery for Brain Metastases: A Multi-Institutional Study of Inter-Observer Reliability

Treatment recommendations for relapsed intracranial disease are dictated by pattern of failure. SRS to the surgical cavity of resected brain metastases is an emerging standard of care that permits withholding or delaying whole brain radiotherapy. Post-resection SRS for brain metastases is associated with a specific and under-recognized pattern of intracranial recurrence, herein termed nodular leptomeningeal disease (nLMD), which is distinct from classical leptomeningeal disease (cLMD). We hypothesize that there is poor consensus with regard to the definition of LMD and that a formal, self-guided training module defining the patterns of intracranial recurrence following post-resection SRS will improve inter-rater reliability (IRR) and validity in the diagnosis of leptomeningeal disease (LMD). This study utilized pre- and post-treatment MRI studies from 30 patients with intracranial recurrence following post-resection SRS for brain metastases. We created two survey arms and disseminated them to ten physicians at multiple institutions with expertise in central nervous system (CNS) oncology, including CNS-dedicated radiation oncologists, neurologists, and neuroradiologists. In the “pre-training” arm, physicians labeled cases of recurrence using the 3 patterns commonly reported in prospective trials: 1. local cavity recurrence (LR); 2. distant parenchymal brain recurrence (DR); 3. LMD. We next supplied raters with a self-directed training module that provided guidance on distinguishing nLMD from other forms of intracranial recurrence. Raters next completed the “post-training” arm and labeled the same 30 cases (order randomized) using 4 labels including our recently described nLMD: 1. LR; 2. DR; 3. cLMD; 4. nLMD. Inter-rater reliability (IRR) increased following the training module. The fraction of cases with 100% agreement across all ten raters increased 84% (from 0.20 to 0.37). The inter-rater Fleiss’ Kappa (K) increased 42% (from K = 0.400 to K = 0.568, Wilcoxon paired rank sum p < 0.001). After training, 26% of cases originally labeled DR were reassigned to nLMD. Subgroup analysis confirmed that prior to training, IRR was lowest among LMD cases (K = 0.323). Inter-rater concordance improved across all subgroups but improved most in LMD (cLMD K = 0.444, nLMD K = 0.598). Physicians’ reported confidence in self-assigned labels also modestly improved after the training module (Wilcoxon p < 0.001). This study highlights the current need for consistent and reproducible identification of LMD. Assignment of nLMD, a dominant form of intracranial recurrence following post-resection SRS, to DR may contribute to discordant rates of LMD reported in studies of post-resection SRS. Our findings demonstrate that a brief self-guided training module distinguishing LR, DR, cLMD, and nLMD can significantly increase IRR while also producing modest increases in confidence for assigned labels.

Effect of self-guided training for the HandbikeBattle on body composition in people with spinal cord injury.

Single-group pre-test post-test study. Examine the change in (1) fitness and body composition due to self-guided training in preparation for the HandbikeBattle in people with spinal cord injury (SCI); and (2) whether these possible body composition changes are associated with changes in fitness. Handcycling teams of Dutch rehabilitation centers training for the HandbikeBattle, a handcycling race on an Austrian mountain. Fitness (peak power output (POpeak) determined during a graded handcycling exercise test) and body composition (body mass, body mass index (BMI), waist circumference (WC), %fat determined with skinfolds and fat and fat free mass (% and kg) assessed by bio-impedance analysis (BIA)) of 18 persons with SCI were evaluated before and after 4 months of training for the HandbikeBattle. The effects of training were evaluated with repeated measures ANOVA. Associations among changes in POpeak and changes in body composition were calculated with Pearson correlation coefficients. Training for the HandbikeBattle led to significant improvements in POpeak, fat mass measured by BIA (19.6 ± 9.6 kg to 18.5 ± 8.3 kg, p = 0.02), %fat measured by skinfolds (28.4 ± 7.8% to 27.2 ± 7.2%, p = 0.02), while body mass and WC approached significance (p = 0.06). Association among changes in body composition and changes in POpeak ranged from trivial (e.g., for %fat BIA r = -0.023) to moderate (e.g., for WC, r = -0.32). Self-guided training for the HandbikeBattle led to a large increase in fitness but had a small effect on body composition, e.g., nutrition may play a more important role than exercise.

Self-guided training for deep brain stimulation planning using objective assessment.

Deep brain stimulation (DBS) is an increasingly common treatment for neurodegenerative diseases. Neurosurgeons must have thorough procedural, anatomical, and functional knowledge to plan electrode trajectories and thus ensure treatment efficacy and patient safety. Developing this knowledge requires extensive training. We propose a training approach with objective assessment of neurosurgeon proficiency in DBS planning. To assess proficiency, we propose analyzing both the viability of the planned trajectory and the manner in which the operator arrived at the trajectory. To improve understanding, we suggest a self-guided training course for DBS planning using real-time feedback. To validate the proposed measures of proficiency and training course, two experts and six novices followed the training course, and we monitored their proficiency measures throughout. At baseline, experts planned higher quality trajectories and did so more efficiently. As novices progressed through the training course, their proficiency measures increased significantly, trending toward expert measures. We developed and validated measures which reliably discriminate proficiency levels. These measures are integrated into a training course, which quantitatively improves trainee performance. The proposed training course can be used to improve trainees' proficiency, and the quantitative measures allow trainees' progress to be monitored.

Fundamentals of Arthroscopic Surgery Training Program Improves Knee Arthroscopy Simulator Performance in Arthroscopic Trainees

To determine the effectiveness of a nonanatomic simulator in developing basic arthroscopy motor skills transferable to an anatomic model. Forty-three arthroscopy novice individuals currently enrolled in medical school were recruited to perform a diagnostic knee arthroscopy using a high-fidelity virtual reality arthroscopic simulator providing haptic feedback after viewing a video of an expert performing an identical procedure. Students were then randomized into an experimental or control group. The experimental group then completed a series of self-guided training modules using the fundamentals of arthroscopy simulator training nonanatomic modules including camera centering, tracking, periscoping, palpation, and collecting stars in a three-dimensional space. Both groups completed another diagnostic knee arthroscopy between 1 and 2weeks later. Camera path length, time, tibia and femur cartilage damage, as well as a composite score were recorded by the simulator on each attempt. The experimental group (n= 22) showed superior performance in composite score (30.09 vs 24, P= .046) and camera path length (71.51cm vs 109.07cm, P= .0274) at the time of the second diagnostic knee arthroscope compared with the control group (n= 21). The experimental group also showed significantly greater improvement in composite score between the first and second arthroscopes compared with the control group (14.27 vs 4.95, P < .01). Femoral and tibial cartilage damage were not significantly improved between arthroscopy attempts (-0.86% vs-1.45%, P= .40) and (-1.10 vs-1.27%, P= .83), respectively. The virtual reality-based fundamentals of arthroscopy simulator training nonanatomic simulator is beneficial in developing basic motor skills in arthroscopy novice individuals resulting in significantly greater composite performance in an anatomic knee model. Based on the results of this study, it appears that there may be benefit from nonanatomic simulators in general as part of an arthroscopy training program. Level II, randomized trial.