Standardized Training Protocol Research Articles

Why standard brain-computer interface (BCI) training protocols should be changed: an experimental study

Objective. While promising, electroencephaloraphy based brain–computer interfaces (BCIs) are barely used due to their lack of reliability: 15% to 30% of users are unable to control a BCI. Standard training protocols may be partly responsible as they do not satisfy recommendations from psychology. Our main objective was to determine in practice to what extent standard training protocols impact users’ motor imagery based BCI (MI-BCI) control performance. Approach. We performed two experiments. The first consisted in evaluating the efficiency of a standard BCI training protocol for the acquisition of non-BCI related skills in a BCI-free context, which enabled us to rule out the possible impact of BCIs on the training outcome. Thus, participants (N = 54) were asked to perform simple motor tasks. The second experiment was aimed at measuring the correlations between motor tasks and MI-BCI performance. The ten best and ten worst performers of the first study were recruited for an MI-BCI experiment during which they had to learn to perform two MI tasks. We also assessed users’ spatial ability and pre-training μ rhythm amplitude, as both have been related to MI-BCI performance in the literature. Main results. Around 17% of the participants were unable to learn to perform the motor tasks, which is close to the BCI illiteracy rate. This suggests that standard training protocols are suboptimal for skill teaching. No correlation was found between motor tasks and MI-BCI performance. However, spatial ability played an important role in MI-BCI performance. In addition, once the spatial ability covariable had been controlled for, using an ANCOVA, it appeared that participants who faced difficulty during the first experiment improved during the second while the others did not. Significance. These studies suggest that (1) standard MI-BCI training protocols are suboptimal for skill teaching, (2) spatial ability is confirmed as impacting on MI-BCI performance, and (3) when faced with difficult pre-training, subjects seemed to explore more strategies and therefore learn better.

Wildlife detection dog training: A case study on achieving generalization between target odor variations while retaining specificity

Wildlife detection dogs are required to correctly discriminate target wildlife species odor from nontarget species odors (specificity), while enabling some degree of target odor variation (generality). Because there is no standardized training protocol, and little knowledge on training efficiency, we conducted a case study to test a dog’s training efficiency in detecting 2-week-old wild otter (Lutra lutra) feces (spraint) odor among feces odors from 6 other large mammal species that often share the otter’s natural habitat, including fox (Vulpes vulpes), hare (Lepus europaeus), roe deer (Capreolus capreolus), and cattle (Bos taurus). The dog was trained using a standard multiple-choice carrousel in a stepwise protocol. We started with odor samples from fresh captive otter spraints and progressed toward 2-week-old spraints from wild otters among other mammalian dung odors and tested for specificity and generality after each training step. We show that training on only 2 variations of spraints from captive otters enabled the dog to detect all desired spraint odor variations in our protocol, indicating a rapid generalization to variations of spraint odor the dog was not trained on, while retaining specificity. Testing such concept formation of target odors should be included in detection dog training and certification and could serve as a quality control measure of detection dog performance.

A pilot study on the benefit of cognitive rehabilitation in Parkinson's disease.

Patients with Parkinson's disease (PD) show inefficiencies in cognitive performance including working memory functions. Since these problems impact on quality of life and overall well-being, the current study was aimed at improving patients' situations by evaluating the computerized cognitive training tool, BrainStim. A total of 19 healthy controls (HCs) and six patients with PD were included in the study. While all PD patients received cognitive training, the HC sample was subdivided into 12 subjects with training (HC-T) and 10 subjects without (HC-NT). Participants underwent a double baseline assessment, a post-training assessment, and a 3-month follow up on neuropsychological tests and self-report measures on fatigue and depression. Training was administered between the second baseline and postassessment. It comprised 16 supervised sessions according to a standardized training protocol over 4 weeks. Significant improvements in verbal and visuospatial short-term and long-term memory were found in both training groups. In addition, the HC-T improved on mental speed, and verbal and visuospatial working memory. Both training groups showed stable results for all short-term visuospatial measures after 3 months. Further, the HC-T showed stable results for working memory, verbal, and visuospatial short-term and long-term memory. The efficacy of the applied computerized cognitive training tool BrainStim could be verified in patients with PD and healthy age-matched controls. The preliminary findings highlighted the suitability of a specific cognitive intervention to improve cognitive inefficiencies in patients with PD as well as in healthy older people. Further research on cognitive training in combination with PD drug therapy is needed to better understand the mutual interaction and to offer optimal therapeutic approaches to patients.

PBMCs express a transcriptome signature predictor of oxygen uptake responsiveness to endurance exercise training in men.

Peripheral blood cells are an accessible environment in which to visualize exercise-induced alterations in global gene expression patterns. We aimed to identify a peripheral blood mononuclear cell (PBMC) signature represented by alterations in gene expression, in response to a standardized endurance exercise training protocol. In addition, we searched for molecular classifiers of the variability in oxygen uptake (V̇o2). Healthy untrained policemen recruits (n = 13, 25 ± 3 yr) were selected. Peak V̇o2 (measured by cardiopulmonary exercise testing) and total RNA from PBMCs were obtained before and after 18 wk of running endurance training (3 times/wk, 60 min). Total RNA was used for whole genome expression analysis using Affymetrix GeneChip Human Gene 1.0 ST. Data were normalized by the robust multiarray average algorithm. Principal component analysis was used to perform correlations between baseline gene expression and V̇o2peak. A set of 211 transcripts was differentially expressed (ANOVA, P < 0.05 and fold change > 1.3). Functional enrichment analysis revealed that transcripts were mainly related to immune function, cell cycle processes, development, and growth. Baseline expression of 98 and 53 transcripts was associated with the absolute and relative V̇o2peak response, respectively, with a strong correlation (r > 0.75, P < 0.01), and this panel was able to classify the 13 individuals according to their potential to improve oxygen uptake. A subset of 10 transcripts represented these signatures to a similar extent. PBMCs reveal a transcriptional signature responsive to endurance training. Additionally, a baseline transcriptional signature was associated with changes in V̇o2peak. Results might illustrate the possibility of obtaining molecular classifiers of endurance capacity changes through a minimally invasive blood sampling procedure.

Diagnostic angiography skill acquisition with a secondary curve catheter: phase 2 of a curriculum-based endovascular simulation program

BackgroundWe have previously reported the efficacy of a simulator-based training paradigm for residents in neurosurgery with little or no prior experience in diagnostic cerebral angiography with straightfoward arch anatomy. This...

Transesophageal Monitoring in Anaesthesia: An Update

Transesophageal echocardiography (TEE) is increasingly used for diagnosis and monitoring in a number of clinical areas for assessment of cardiac structure and function. The use of TEE is well established in cardiac surgery but in non-cardiac surgery, TEE is recommended in preexistent cardiovascular disease causing hemodynamic compromise or in the presence of refractory hemodynamic instability or hypoxemia. Real-time 3-dimensional TEE provides exceptional images and unique views which have been pivotal in the success of minimally invasive surgery and transcatheter interventions. Although TEE is a relatively safe procedure, guidelines for standardized training, techniques and research protocols are recommended by most august bodies. The use of simulation-based learning has aided training by providing structured training opportunities and sufficient training time. TEE is a semi-invasive, portable, safe and readily available imaging modality that is likely to see an upsurge due to innovations in technology, miniaturization and an increase in minimally invasive procedures.

Protocol of physical and technical-tactical training in football for schizophrenic patients

The central idea of this work is that Sport may enhance the therapeutic effects of medical treatment. In particular football is anhealthy activity stimulating the psychophysical wellness, the clinical stabilization and the social interaction. Starting from thisbackground and from empirical experiences in roman environment we drown this pilot work with the aim of develop a standardtraining protocol for schizophrenic patients.

Length of Acupuncture Training and Structural Plastic Brain Changes in Professional Acupuncturists

BackgroundThe research on brain plasticity has fascinated researchers for decades. Use/training serves as an instrumental factor to influence brain neuroplasticity. Parallel to acquisition of behavioral expertise, extensive use/training is concomitant with substantial changes of cortical structure. Acupuncturists, serving as a model par excellence to study tactile-motor and emotional regulation plasticity, receive intensive training in national medical schools following standardized training protocol. Moreover, their behavioral expertise is corroborated during long-term clinical practice. Although our previous study reported functional plastic brain changes in the acupuncturists, whether or not structural plastic changes occurred in acupuncturists is yet elusive.Methodology/Principal FindingsCohorts of acupuncturists (N = 22) and non-acupuncturists (N = 22) were recruited. Behavioral tests were delivered to assess the acupuncturists’ behavioral expertise. The results confirmed acupuncturists’ tactile-motor skills and emotion regulation proficiency compared to non-acupuncturists. Using the voxel-based morphometry technique, we revealed larger grey matter volumes in acupuncturists in the hand representation of the contralateral primary somatosensory cortex (SI), the right lobule V/VI and the bilateral ventral anterior cingulate cortex/ventral medial prefrontal cortex. Grey matter volumes of the SI and Lobule V/VI positively correlated with the duration of acupuncture practice.ConclusionsTo our best knowledge, this study provides first evidence for the anatomical alterations in acupuncturists, which would possibly be the neural correlates underlying acupuncturists’ exceptional skills. On one hand, we suggest our findings may have ramifications for tactile-motor rehabilitation. On the other hand, our results in emotion regulation domain may serve as a target for our future studies, from which we can understand how modulations of aversive emotions elicited by empathic pain develop in the context of expertise. Future longitudinal study is necessary to establish the presence and direction of a causal link between practice/use and brain anatomy.

How to implement monitoring tools for sedation, pain and delirium in the intensive care unit: an experimental cohort study

Systematic monitoring of sedation, pain and delirium in the ICU is of paramount importance in delivering adequate patient care. While the use of systematic monitoring instruments is widely agreed upon, these tools are infrequently implemented into daily ICU care. The aim of this study is to compare the effectiveness of two different training strategies (training according to the local standard vs. modified extended method) on the implementation rate of scoring instruments on the ICU. In this experimental cohort study we analyzed the frequency of scoring on three surgical ICUs before and after training, and in a 1 year follow-up. A modified extended training included establishing a local support team helping to resolve immediate problems. In addition we evaluated the impact on patients' outcome. ICUs trained by the modified extended method showed increased documentation rates of all scores per patient and day. In a 1 year follow-up, increased scoring rates for all scores were maintained. Scoring rates with training according to the local standard training protocol did not increase significantly. Implementation of delirium and pain monitoring were associated with a decrease in mortality [odds ratio (OR) 0.451; 95 % confidence interval (CI): 0.22-0.924, and, respectively, OR 0.348; 95 % CI: 0.140-0.863]. Monitoring had no significant influence on ventilation time or ICU length of stay. A modified extended training strategy for ICU monitoring tools (sedation, pain, delirium) leads to higher intermediate and long-term implementation rates and is associated with improved patient outcome. However, these findings may have been biased by unmeasured confounders.

Reply from M. J. Gibala, J. P. Little, M. J. MadDonald and J. A. Hawley

Thank you for the opportunity to respond to the letter submitted by Gayda and colleagues in response to our recent review published in The Journal of Physiology (Gibala et al. 2012). With regards to their first comment regarding our new ‘practical’ high-intensity interval exercise (HIIE) protocol, we disagree with the assertion that ‘exercise intensity at 60% of peak power cannot be considered high intensity.’ In our efforts to develop a low-volume HIIE protocol that can be applied across different cohorts including clinical populations, we devised a model comprising 10 × 60 s work bouts at an intensity eliciting ∼85–90% of maximal heart rate (HRmax; averaged over the 10 intervals), interspersed by 60 s of recovery. We have found that the percentage of peak power output (PPO; determined using a standard ramp test to volitional fatigue which does not always elicit peak O2 uptake) that approximates the desired target heart rate (i.e. the % of HRmax) varies considerably between subjects and is exercise-mode specific. For example, in the study by Hood et al. (2011) which was conducted on sedentary healthy adults, a workload equivalent to 60% of PPO during upright cycling was sufficient to elicit a training intensity of ∼90% HRmax. However, in our recent study conducted on patients with type 2 diabetes, the intensity required to elicit ∼90% HRmax was ∼95% of PPO determined during recumbent cycling (Little et al. 2011). We agree with the assertion by Gayda and colleagues that ‘acute physiological responses during different HIIE protocols as well as patient's safety, tolerance and comfort should be tested before their implementation into training programs’. Ongoing protocol optimization work in our laboratory reveal that when interval exercise was prescribed as 80% of PPO in coronary artery disease (CAD) patients – most of whom were taking beta-blocker medication – the 10 × 60 s protocol resulted in peak heart rates during the exercise that averaged ∼85% of age-predicted HRmax. Further, the 10 × 60 s protocol was best tolerated and rated as most preferred by CAD patients in comparison with a modified Wingate protocol (repeated 30 s efforts at 100% PPO with 4 min unloaded cycling for recovery), the standard aerobic interval training protocol used by Wisloff and colleagues (2007), or a moderate-intensity continuous exercise (MICE) protocol. It is likely that high-intensity interval training (HIT) does not conform to a ‘one size fits all’ approach and the interval training stimulus needs to be tailored to individuals depending on their initial level of fitness, exercise tolerance, use of prescription medications and other factors. We also concur with the other main comment by Gayda and colleagues that ‘the superiority of this HIIE protocol [our 10 × 60 s ‘hard’/60 s ‘easy’ model]… needs to be demonstrated.’ Indeed, our review concluded ‘One aspect that is unclear from the present literature is the precise intensity and minimal volume of training that is needed to potentiate the effect of the stimulus-adaptation on outcomes such as mitochondrial biogenesis and relevant health markers. To answer such questions, a complex series of studies needs to be undertaken that systematically ‘titrate’ levels of the ‘training impulse’ and determine subsequent cellular, performance and clinical responses after divergent training interventions.’ Specifically with respect to the use of HIIE in patients with cardiovascular risk or cardiovascular disease, the letter by Gayda and colleagues highlights four references from their laboratory that were not cited in our review. Given the relatively broad scope of our review and the fact that Journal guidelines restricted the number of references to 50, it was obviously not possible to cite all relevant work. Moreover, two of the citations listed by Gayda et al. were acute exercise studies (whereas the focus of our review was training adaptations) and the other two citations were a journal abstract and a recent paper published in February 2012 (neither of which we had access to at the time of submission of our original manuscript). We are also aware of the pioneering research conducted by Meyer and colleagues (e.g. Meyer et al. 1998) and have acknowledged this work in a previous commentary (MacDonald & Currie, 2009). We apologize to all authors whose work on interval training we could not cite due to the broad focus of our review and referencing limitations imposed by The Journal.

Simulated diagnostic cerebral angiography in neurosurgical training: a pilot program

IntroductionSurgical simulation provides a zero-risk setting in which technical skills can be obtained through repetition. The feasibility and utility of simulated diagnostic cerebral angiography among neurosurgical residents and fellows was...

The effects of whole-body vibration training on gait and walking ability – A systematic review comparing two quality indexes

Background: Whole-body vibration (WBV) training has been introduced in the last decade and become a popular training method and may increase muscle performance. Objectives: To evaluate the evidence degree of the effect of WBV training on gait and walking ability by a critical examination of scientific studies. In addition, a minor objective was to compare two quality indexes. Method: Literature search in Scopus; quality assessments with The Risk of Bias and The PEDro Scale; and evidence appraisal according to GRADE. Result: Ten studies with varying populations using gait-related measurements after at least 1-month WBV intervention were included. Only two studies report significant positive effects. This is defined as low-quality evidence. Eighty percent and 90% of the studies were rated as high quality according to The PEDro Scale and The Risk of Bias, respectively. Discussion: The low-quality evidence indicates a need for further research. A standardized training protocol would make comparisons and conclusions of WBV training more reliable and feasible. Conclusion: There is low-quality evidence for WBV training having effects on gait and walking ability. Further research is needed. The evidence did not alter between the quality indexes.

Cerebral Vascular Response in Airmen Exposed to Hypobaric Hypoxia

Cerebral vascular response via local and reflex adjustments is part of the integrated response to hypoxia and is coupled with changes in systemic vascular resistances that allow a redistribution of blood flow toward the brain. The cerebral vascular response in airmen exposed to simulated high altitude is not clear, thus we sought to investigate this aspect. Four healthy military airmen were exposed to simulated high altitude in a hypobaric chamber according to a standard training protocol. Blood saturation (SpO2) and blood flow velocity with transcranial Doppler from the left middle cerebral artery (Vm) were continuously recorded. Pulsatility Index (PI), resistance index (RI), and systolic/diastolic ratio (S/D ratio) were computed. Alternate hypoxia-hyperoxia trials for 2 and 1 min, respectively, were used to assess the cerebrovascular response. Acute hypoxia induced an increase in Vm that promptly recovered when the oxygen supply was restored (mean increase of 5.5% at 18,000 ft and 17.2% at 25,000 ft). Alternate hypoxia-hyperoxia at 25,000 and 18,000 ft elicited changes in both SpO2 and Vm. In hypoxia, PI significantly decreased (mean decrease o" 25.6% at 18,000 ft and 39.5% at 25,000 ft), as did RI (mean decrease of 18.7% at 18,000 ft and 34.4% at 25,000 ft), while S/D ratio increased. The standard altitude training protocol induced a transient cerebrovascular response. The response was as expected, with hypoxia-induced vasodilation and opposite changes when breathing pure oxygen.

How far have we come with trace DNA since 2004? The Australian and New Zealand experience

In 2004, a survey was sent to forensic organisations in every jurisdiction in Australia and New Zealand, benchmarking practices in relation to trace DNA analysis. Concerning issues were identified such as a lack of standard training protocols, little ongoing training or proficiency testing, and poor information gathering and sharing. To assess the changes occurring in the five years since this survey, a follow-up was devised and distributed to the same organisations in early 2009. Seventy-seven surveys were received from persons active in the field of trace DNA including crime scene and laboratory personnel, and managers. The major difference noted between the two surveys was the implementation of new technologies, primarily robotic automation and subsequent changes in extraction methodology. Disappointingly, training, research and proficiency test levels were still found to be lacking, a concern given the findings of recent international forensic reviews. A major deficiency still noted from the 2004 survey was the absence of effective data management systems, indicating that the wider intelligence-led application of this evidence is not fully utilised. Reviewing the methods and processes of the dissemination of forensic data in the policing environment has the potential to broaden its application to crime prevention strategies.

P-008 Simulated diagnostic cerebral angiography in neurosurgical training: a pilot program

IntroductionSurgical simulation provides a zero-risk setting in which skills can be obtained through repetition. Advanced, technically accurate simulation systems that provide sensory feedback can further aid the trainee in developing...

Telesonography: Foundations and Future Directions

The practice of telesonography has yielded promising results in several domestic and international projects aimed at providing basic sonography services. Common themes that recur within telesonography-based research include the quality of transmitted images, clinical applications, and technical and nontechnical barriers to implementation. The research base continues to grow in concert with expanding telecommunications capabilities and refinement of small portable sonographic devices. Persistent barriers to the deployment of telesonography systems include a lack of telecommunications access, a lack of standard training and operational protocols, and a paucity of research regarding the long-term health impact of telesonography within target communities. Telesonography may be used directly to improve the standard of care within a given community; however, limited resources and interest may prevent sustained operations. Future projects may use telesonography to supplement the training of health care providers in remote locations in an effort to establish permanent sonography services for their respective communities.

Rat behavior in go/no-go and two-alternative choice odor discrimination: Differences and similarities.

To elucidate the cognitive structures of animals, neuroscientists use several behavioral tasks. Therefore, it is imperative to have a firm understanding of each task's behavioral parameters in order to parse out possible task effects. We compare two operant discrimination tasks (Go/No-Go: GNG; Two-Alternative Choice: TAC) that are commonly used in olfactory research. Past research has suggested that solving the two tasks requires divergent cognitive strategies. One hypothesis is that the two tasks differ in how an animal optimizes reward rate by means of a speed-accuracy trade-off (SAT). If this is true, then changing tasks could give researchers an additional tool to understand animal cognition. However, no study has systematically analyzed the two tasks in parallel using odor stimuli. Using standardized training protocols, we test GNG and TAC in parallel. Our protocols allow us to isolate the stimulus sampling period from a general reaction time period. We find that the two tasks do not differ with regard to the stimulus sampling period and conclude that the two tasks do not differ in the amount of time it takes an animal to perform a discrimination. Instead, tasks differ in the time it takes to make an overt behavioral response, with GNG showing shorter periods than TAC. We also find no evidence of rats using either task-specific or intertrial interval-dependent SAT schema in order to optimize reward rate. We show that similarities between dependent variables, with the possible exception of response delay, appear to be under experimenter control.

Controlling Quality in CME/CPD by Measuring and Illuminating Bias

There has been a surge of interest in the area of bias in industry-supported continuing medical education/continuing professional development (CME/CPD) activities. In 2007, we published our first study on measuring bias in CME, demonstrating that our assessment tool was valid and reliable. In light of the increasing interest in this area, and building on our experience, we wanted to further understand the application of this tool in different environments. We invited other CME/CPD providers from multiple sites in Canada to participate in a second CME bias study. A new steering committee was established with representatives from 5 academic CME/CPD offices nationally, the Royal College of Physicians and Surgeons, and the College of Family Physicians of Canada to outline the project in terms of review of the literature, refining items on the tool, updating the training guide for implementation, and establishing a resource Web site for reviewers. Training involved a train-the-trainer session with the event coordinators at each of the 5 participating centers via videoconferencing. The content reviews from the study showed moderate inter-rater reliability (ICC = 0.54), and the live reviews showed poor overall inter-rater reliability; however, one center achieved substantial inter-rater reliability (ICC = 0.68). The analysis from this study suggests that the tool can be used as a part of a multistage process to introduce quality control mechanisms to help raise standards for CME/CPD. It is imperative to develop a cost-effective standardized training protocol that can be implemented at all sites to maximize the reliability of the tool.

Effects of a Plyometric Training Program With and Without Added Load on Jumping Ability in Basketball Players

The purpose of this investigation was to examine the effect of a standard plyometric training protocol with or without added load in improving vertical jumping ability in male basketball players. Twenty-seven players were randomly assigned to 3 groups: a control group (no plyometric training), plyometric training group (PG), and loaded plyometric group (LPG, weighted vests 10-11% body mass). Before and after the 10-week training program, all the players were tested for the 5-jump test (5JT), the squat jump (SJ), and the countermovement jump (CMJ). The PG and LPG groups performed 2 and 3 training sessions per week, during the first 3 and the last 7 weeks, respectively. The results showed that SJ, CMJ, and 5JT were significantly improved only in the PG and LPG groups. The best effects for jumps were observed in LPG (p < 0.01), which showed significantly higher gains than the PG (p < 0.05). In conclusion, it appears that loads added to standard plyometric training program may result in greater vertical and horizontal-jump performances in basketball players.

Effects of standard training in the use of closed-circuit televisions in visually impaired adults: design of a training protocol and a randomized controlled trial

BackgroundReading problems are frequently reported by visually impaired persons. A closed-circuit television (CCTV) can be helpful to maintain reading ability, however, it is difficult to learn how to use this device. In the Netherlands, an evidence-based rehabilitation program in the use of CCTVs was lacking. Therefore, a standard training protocol needed to be developed and tested in a randomized controlled trial (RCT) to provide an evidence-based training program in the use of this device.Methods/DesignTo develop a standard training program, information was collected by studying literature, observing training in the use of CCTVs, discussing the content of the training program with professionals and organizing focus and discussion groups. The effectiveness of the program was evaluated in an RCT, to obtain an evidence-based training program. Dutch patients (n = 122) were randomized into a treatment group: normal instructions from the supplier combined with training in the use of CCTVs, or into a control group: instructions from the supplier only. The effect of the training program was evaluated in terms of: change in reading ability (reading speed and reading comprehension), patients' skills to operate the CCTV, perceived (vision-related) quality of life and tasks performed in daily living.DiscussionThe development of the CCTV training protocol and the design of the RCT in the present study may serve as an example to obtain an evidence-based training program. The training program was adjusted to the needs and learning abilities of individual patients, however, for scientific reasons it might have been preferable to standardize the protocol further, in order to gain more comparable results.Trial registrationhttp://www.trialregister.nl, identifier: NTR1031