Training Location Research Articles

Evaluation of nursing administration records of high‐risk medications at a hospital network: a retrospective audit

AbstractWithin our hospital network, the PINCH acronym (Potassium, Insulin, Narcotics, Chemotherapeutics, Heparin) designates high‐risk medications. As per local guidelines, double‐checking is mandated at the point of administration. This retrospective audit aimed to assess nursing and midwifery staff's ability to recognise PINCH medications by examining their adherence to double‐signing protocols, serving as an indicator of double‐checking. The analysis included overall compliance proportions, categorised by PINCH class and further stratified based on location, specialty, and staffs' level of training. An analysis of the first thousand PINCH medication administrations from 1 January 2023 was conducted, spanning four sites within our hospital network. Data sourced from the Electronic Medication Record system were refined to include one medication per patient per day, totalling 200 administrations per PINCH category. The results revealed that 896 (89.6%) out of 1000 medication administrations were co‐signed, with narcotics showing a co‐signature rate of 100%, followed by potassium at 99%, heparin at 98%, insulin at 97.5%, and chemotherapeutics at 53.5%. Among the orders lacking co‐signature, 90% pertained to chemotherapeutics and the remaining 10% were distributed across other categories. Stratifying by location showed 28 (17.6%) out of 159 administrations in a subacute setting lack co‐signature, compared to 76 (6%) from 841 in an acute setting. Compliance rates were highest in specialty medicine at 94.3%, followed by surgical at 86.2%, general medicine 84.5%, women and children's and mental health units at 83.3% each, and continuing care at 82.2%. Notably, enrolled nurses exhibited the highest level of compliance with co‐signatures. Future research could explore the impact of educational strategies on the administration of high‐risk medications. Ethical approval was granted by the Eastern Health Office of Research and Ethics (Reference no: QA23‐075‐101 386) and the study conforms to the Australian Statement on Ethical Conduct in Human Research.

A Genetic Optimized Federated Learning Approach for Joint Consideration of End-to-End Delay and Data Privacy in Vehicular Networks

In 5G vehicular networks, two key challenges have become apparent, including end-to-end delay minimization and data privacy. Learning-based approaches have been used to alleviate these, either by predicting delay or protecting privacy. Traditional approaches train machine learning models on local devices or cloud servers, each with their own trade-offs. While pure-federated learning protects privacy, it sacrifices delay prediction performance. In contrast, centralized training improves delay prediction but violates privacy. Existing studies in the literature overlook the effect of training location on delay prediction and data privacy. To address both issues, we propose a novel genetic algorithm optimized federated learning (GAoFL) approach in which end-to-end delay prediction and data privacy are jointly considered to obtain an optimal solution. For this purpose, we analytically define a novel end-to-end delay formula and data privacy metrics. Accordingly, a novel fitness function is formulated to optimize both the location of training model and data privacy. In conclusion, according to the evaluation results, it can be advocated that the outcomes of the study highlight that training location significantly affects privacy and performance. Moreover, it can be claimed that the proposed GAoFL improves data privacy compared to centralized learning while achieving better delay prediction than other federated methods, offering a valuable solution for 5G vehicular computing.

Making medical education great again: analysing trainee feedback to identify key drivers of trainee satisfaction and improve experience

ObjectivesThe London School of Paediatrics (LSP) surveys trainees annually regarding their training placements. There is a wide variation in satisfaction. We explored the last 5 years of data to identify trends and determine predictors of overall trainee satisfaction.MethodsThe survey is distributed annually to all London paediatric trainees with response rates of 86–90%. It explores overall placement satisfaction, followed by key questions covering staffing, supervision, teaching, facilities and other facets. The survey blends both quantitative and qualitative feedback.Satisfaction levels were analysed using time series trend analysis. Overall levels were compared using t-tests. Associations between satisfaction and components of the survey were identified using a convergence of multiple regression and other multivariate analyses.ResultsOverall trainee satisfaction increased steadily until 2020. There was a considerable variation across sites, some having consistently higher or lower scores than the median, while others showed an upward or downward trend, or very variable pattern.By training levels, ST3 trainees consistently rated their placement below average and ST7 trainees above average. There was also a considerable variation in responses by training level with regard to perceived staffing levels and teaching.To understand the influences on overall satisfaction, regression coefficients were derived between specific metrics and overall satisfaction using multiple regression and then normalised to 100%. The explanatory power of this list to explain satisfaction overall is high at 82% R2.Trainee satisfaction was most strongly correlated with workplace atmosphere and consultant support. Staffing, educational supervision, facilities and wider MDT (Multidisciplinary Team) support are associated with overall satisfaction, but to a lesser degree.ConclusionsTrainee satisfaction is crucial, affecting patient safety, retention and trainee mental health. Our analysis identified significant associations with satisfaction including modifiable elements such as consultant engagement and team morale. Staffing levels were less related to satisfaction than expected.Experimental data exploring the components of clinical training in real-world situations are lacking. These data use the natural experiment of placing trainees in different training locations to explore the factors that relate to their overall experience.

Comparative Analysis of Treatment Patterns in DoD Beneficiaries With Malignant Central Nervous System Tumors: A Focus on Care Setting.

Malignant brain and other central nervous system tumors (MBT) are deadly and disproportionately affect younger men and women in the age range of most active-duty service members. Timely and appropriate treatment is important to both survival and quality of life of patients. Information on treatment factors across direct care (DC) and private sector care (PSC) networks may be important for provider training and staffing for the DoD. The aim of this study was to analyze treatment patterns for patients with MBT within the DoD's universal access Military Health System (MHS), comparing DC and PSC networks. The Military Cancer Epidemiology database was used to identify patients 18 years and older who were diagnosed with an MBT between 1999 and 2014 who received primary treatment. Differences in first treatment type and time from diagnosis to initial treatment between DC and PSC were assessed using chi-square and Wilcoxon-Mann-Whitney tests, respectively. Frequency of treatment initiation beyond the 28-day TRICARE Prime access standard for Specialty Care was also compared between care settings using chi-square and Fisher's exact tests. Then logistic regression models generated odds of treatment initiation beyond 28 days and 95% confidence intervals (CIs) associated with care setting. Kaplan-Meier survival curves and log-rank tests compared survival between DC and PSC. The study included 857 patients, with n = 540 treated in DC and n = 317 treated in PSC. The proportion of patients receiving each initial treatment type did not differ by care setting (P = .622). Median time from diagnosis to initial treatment (interquartile range) varied significantly between DC at 6 (0 to 25) days and PSC at 12 (0 to 37) days for all treatment types combined (P < .001). For all years combined, treatment was initiated beyond 28 days for 21% of patients using DC compared to 31% of patients using PSC (P = .001). The odds of treatment initiation beyond 28 days for a patient treated in PSC were 1.61 (95% CI, 1.11 to 2.33, P = .012) compared to patients treated in DC when controlling for demographic, military, tumor, and patient variables. Survival did not differ by care setting (P = 1.000). Based on the available data between 1999 and 2014, care setting was associated with differences in time to initial treatment and odds of treatment initiation beyond 28 days among DoD beneficiaries with MBT receiving care in the MHS. Information on these differences may help inform MHS leadership decisions on the most appropriate location for military provider training and staffing.

Trainee growth vs. fixed mindset in clinical learning environments: enhancing, hindering and goldilocks factors

BackgroundDoctors in training (trainees) have higher rates of burnout, anxiety and depression than other professionals. An important psychological tool to combat this crisis is promotion of a growth mindset, which increases resilience and improves mental health outcomes. How growth mindset might be promoted within the clinical learning environment is underexplored. This study aimed to explore the factors promoting a growth mindset versus fixed mindset in trainees from the perspective of the trainees.MethodsThis constructivist study employed a novel method of encouraging trainees’ reflections on mindset adoption in the clinical learning environment. Trainees played Mindset, a tabletop simulation board game that included challenges encountered within training. This was followed by a facilitated debriefing, focusing on factors that promoted growth or fixed mindset adoption in the clinical learning environment. Debriefing transcripts were analysed using template analysis.ResultsThree groups of oncology trainees and one group of medical education fellows participated (16 participants in total). Factors promoting growth mindset adoption included passion, collaboration, diverse career and role modelling. Factors promoting fixed mindset adoption included burnout and competition. Some factors, such as grit, previous success experience and singular training location promoted a fixed mindset when too much or too little were present, and promoted a growth mindset when they were in balance (the Goldilocks principle).ConclusionsThe importance of balance versus excess of certain factors, and the ubiquitous competitive culture in medicine promoting a fixed mindset, were compelling reflections. This study may aid invested parties to reflect on what factors they can upregulate and down regulate to optimise trainees’ adoption of a growth mindset.

Digital Learning and Work Readiness among Marginalized Women

In the era of information communication and technology, all aspects of human life are influenced by ICT. In general, the aim of this research is to identify the readiness of marginalized youth in relation to the use of ICT (knowledge, attitudes, and preferences) in the workplace. The research was conducted in three marginalized communities in three provinces in Indonesia, namely 1) Kalibaru in North Jakarta, 2) Getasan in Semarang Regency, Central Java, and 3) Sekotong in West Lombok, West Nusa Tenggara. This research applies a quantitative approach by conducting a household survey and a youth survey, and a qualitative approach by conducting a series of focus group discussions. The household survey participants were 220 families, and in the youth survey, the participants were 220 youth aged 18-29 years. Questionnaires are used in household and youth surveys. For FGD, an FGD protocol was developed. The results of this research indicate that youth unemployment is considered an important policy in Indonesia. Certification for internships is important to recognize the qualifications and skills of the employees trained and mentored in the company. In addition, considering the limited number of job opportunities in the market, the intense competition, and the limited skills and education of marginalized young people, it seems important to encourage young people to become entrepreneurs. Data obtained from the field shows that only one-third of the participants in this study had attended vocational courses or training provided by any training provider. One of the reasons is that the distance between where they live and the training location is far, while transportation costs are not covered by the training provider. Apart from that, parents also forbid teenagers, especially girls, from going far outside the village to take part in job training. This study shows that young people understand the existence of differences in gender treatment in the workplace. The difference lies in the position of the worker, the regulations, and the salary/wages given to the worker.Men are expected to have higher positions, heavier work responsibilities, and higher salaries/wages than women. There are also gendered jobs, such as sewing and hairdressing for women, while technical jobs are reserved for men. The causes of this segregation are largely rooted in a patriarchal culture that places men as superior. This research shows that the participants have gadgets to communicate with each other. However, only a few of them use sophisticated gadgets to carry out online trading, which can be caused by a lack of knowledge and skills in digital trading and marketing, as well as online management and supply chains. This means that people have sophisticated gadgets just to communicate on social media and play games just to fill their time. They do not use it for economic activities.

Constraining the Possible Mechanisms Underlying Performance Improvements Following Peripheral Vision Training

AbstractSome training paradigms can improve performance specific to the trained portion of the visual field. Similarly, experience with both pathological and simulated central vision loss can result in compensatory improvement in performance specific to a spared retinal location. The mechanisms underlying these improvements are still debated. Modifications in the capacity to allocate attention to trained locations might explain some of the changes in performance after learning, especially given similarities between behavioral improvements due to training and improvements due to changes in attention. Using a gaze-contingent simulated scotoma paradigm which simulates central vision loss, we tested whether training to use peripheral vision influenced three aspects of visual attention: habitual attention, dynamic exogenous attention, and dynamic endogenous attention. After training, performance improvements were consistent with increased habitual attention to the trained location. Conversely, measures of dynamic shifts of attention (exogenous and endogenous attention) improved similarly in both trained and untrained locations. The lack of retinotopic specificity in dynamic attention improvements suggests that retinotopically specific perceptual improvements following simulated central vision loss are not mediated by dynamic attention changes. On the other hand, habitual attention did change retinotopically, leaving the possibility open that this aspect of attention may drive some retinotopically specific training effects. This work constrains the range of mechanisms that could underlie performance improvements after peripheral vision training, suggesting that habitual attention and dynamic attention are affected independently.

Innovation Adaptive UKF Train Location Method Based on Kinematic Constraints

To address the issue of reduced positioning accuracy caused by satellite signal interruptions when trains pass through long tunnels, a novel train positioning method based on an innovative adaptive unscented Kalman filter (UKF) under kinematic constraints is proposed. This method aims to improve the accuracy of the location of trains during operation. By considering the dynamic characteristics of the train, a dynamic kinematic-constrained inertial navigation system (INS)/odometer (ODO) combination positioning system is established. This system utilizes kinematic constraints to correct the accumulated errors of the INS. Additionally, the algorithm incorporates real-time estimation of the measurement noise covariance using innovation sequences. The updated adaptive estimation algorithm is applied within the UKF framework for nonlinear filtering, forming the innovative adaptive UKF algorithm. At each time step, the difference between the ODO sensor data and the INS output is used as the measurement input for the innovative adaptive UKF algorithm, enabling global estimation. This process ultimately yields the actual positioning result for the train. Simulation results demonstrate that the innovative adaptive UKF train positioning method, incorporating kinematic constraints, effectively mitigates the impact of satellite signal interruptions. Compared with the traditional INS/ODO positioning method, the innovative adaptive UKF method reduces position errors by 34.35% and speed errors by 36.33%. Overall, this method enhances navigation accuracy, minimizes train positioning errors, and meets the requirements of modern train positioning systems.

Flowfield reconstruction in a supersonic isolator based on proper orthogonal decomposition and sensor compression coupling under variable Mach numbers

The supersonic inflow passes through the shock train in the isolator of the scramjet to complete deceleration and pressurization, followed by combustion and energy release, providing strong thrust. When the back pressure generated by combustion is disturbed forward, the location of shock train leading edge (STLE) will also change accordingly. Once it moves to the entrance of the isolator, it will cause unstart. Accurately detecting STLE in the isolator of a scramjet is crucial for controlling the shock train and preventing the inlet from unstart. Therefore, based on the sparse reconstruction of compressive sensing and sensor compression coupling, a supersonic flowfield reconstruction model (POD-STLE) based on proper orthogonal decomposition (POD) was constructed to reconstruct the supersonic flowfield and detect the location of STLE in the supersonic isolator. The experiments were conducted on the shock oscillation under variable Mach numbers and back pressures, to construct the experimental dataset. Combining supersonic flowfield reconstruction and matrix decomposition, different sensor layouts were constructed, which can ensure accuracy and stability while saving sensor resources. The POD-STLE was applied to the flowfield reconstruction of the supersonic isolator, and the location of STLE was detected under variable and constant conditions, ultimately achieving the expected reconstruction effect and detection accuracy. This study provides a new research method for detecting the location of STLE in the supersonic isolator of a scramjet and provides technical for exploring supersonic flowfield.

A Whodunit Gamified Flipped Classroom For High Yield Bite Injuries And Envenomation.

Clerkship-level medical students, sub-interns, junior and senior residents, attending physicians. Bite injuries and envenomation are core content found in the model of the clinical practice of emergency medicine.1 However, depending on the geographic location of training or clinical practice, physicians may or may not be exposed to these pathologies. For example, a qualitative analysis conducted in 2022 discovered a significant range in emergency medicine (EM) physician perception of snake antivenom use and level of comfort, noting that experiences with its use ranged from hundreds of cases treated to purely didactic understanding.2 Such discrepancies necessitate supplemental education and activities to bridge the knowledge gap. Ideally, these activities would utilize tenets of experiential learning to allow learner processing comparable to that of clinical experience.3 Flipped classroom and audience participation promote engagement and active learning when compared to the passive learning of lectures.4 In that vein, there is a growing body of gamified resources in medical education which utilize pattern recognition and problem solving skills that can be analogous to clinical practice.5,6. By the end of this activity, learners will be able to: 1) identify and name species responsible for bite/sting/envenomation injuries, 2) recognize associated signs, symptoms, physical exam findings and complications associated with bites/stings/envenomations by certain species, 3) discuss management such as antibiotics, antivenom, and supportive care. We designed a small group activity asking residents to identify, research, and present the "culprits" implicated in environmental exposures to animals and insects, and match them to corresponding clinical scenarios. Participants anonymously answered electronic multiple-choice quizzes before and after completing the activity to gauge its effectiveness in conveying the material. They also completed an additional anonymous, electronic survey regarding their attitudes towards this activity and the possibility of other gamified didactics within the curriculum. Each resident class showed an upward trend in their average multiple-choice score, the greatest of which was seen in the post-graduate year (PGY) 1 class. The residency demonstrated a statistically significant improvement in their ability to answer multiple choice questions (MCQs), with an average pre-activity score of 67.14%, and post-activity score of 87.14%. Participants showed determination and enthusiasm to engage with the material when presented in a gamified format, and 100% of post-activity survey respondents wanted to participate in further gamified activities. Gamified small group activities are a fun and effective method of supplementing residency and medical student education for both common and esoteric clinical presentations that they may not encounter in the clinical environment. Toxicology, bite injury, envenomation, gamification.

Modeling the importance of physician training in practice location for Ohio otolaryngologists.

Underserved communities in southeastern Ohio and Appalachia face significant healthcare accessibility challenges, with the Midwest offering a lower density of healthcare providers compared to coastal regions. Specifically, underserved communities in southeastern Ohio and Appalachia are disadvantaged in otolaryngology care. This analysis aims to identify factors that lead otolaryngologists to a respective practice location, and if any of that influence comes from where otolaryngologists completed their medical education. The proportion of otolaryngologists who performed medical school, residency, and/or fellowship in Ohio was analyzed utilizing a three-sample test for equality. Multivariate logistic regression and Pearson prediction models were produced to analyze the impact of performing medical training (medical school, residency, and fellowship) in Ohio. Going to medical school in Ohio significantly increases the odds of going to an otolaryngology residency in the state (p<0.001). Moreover, between medical school and residency, medical school was a significantly better predictor of otolaryngologists practicing in Appalachia (Δ Bayesian Information Criterion [BIC]>2) and southeast Ohio (ΔBIC>10). Medical school in state was also a better predictor of percent rural and median household income than residency (ΔBIC>10). The multivariate model of medical school and residency was significantly better than either predictor alone for the population (ΔBIC>2). All models predicting percent rural were significantly improved with the addition of a Doctor of Osteopathy (DO) degree (ΔBIC>10). Where physicians complete their medical training (medical school, residency, and fellowship) in state has a significant impact on predicting their future place of practice. This study found that the location of such training has a positive predictive nature as to whether that physician will practice in a rural and underserved area in the future. Notably, the addition of being licensed as a DO also increased the probability of that physician practicing in a rural area.

Awareness and adoption of climate-resilient practices by smallholder farmers in central and upper Eastern Kenya

Climate change and soil fertility decline are major hurdles to agricultural ecosystems. Despite the importance of climate-resilient practices (CRPs) in enhancing food security, poverty alleviation and nutritional security, awareness and adoption remain low in most developing countries, including Kenya. We assessed the determinants of simultaneous awareness and adoption of CRPs and their intensity in Central Highlands of Kenya. The CRPs considered in this study were inorganic fertilizer and manure integration, manure, mulching, crop residues, cover crop, crop rotation and intercrop. The study used a cross-sectional survey design and collected data from 400 smallholders in Central Highlands of Kenya. The data were analyzed using descriptive statistics, multivariate probit and Poisson regression. Our findings showed that awareness and adoption of specific CRPs and their intensity were determined by occupation, age, farming experience, household size, soil fertility management, climate change adaptation, agricultural training, and geographical location. Smallholders’ agricultural training was an important determinant of awareness, adoption level, and intensity. Our findings underscored the need for agricultural policymakers and extension systems to design farmer-driven training programs for enhanced awareness and adoption of CRPs.

Rehabilitating homonymous visual field deficits: white matter markers of recovery-stage 2 registered report.

Damage to the primary visual cortex or its afferent white matter tracts results in loss of vision in the contralateral visual field that can present as homonymous visual field deficits. Evidence suggests that visual training in the blind field can partially reverse blindness at trained locations. However, the efficacy of visual training is highly variable across participants, and the reasons for this are poorly understood. It is likely that variance in residual neural circuitry following the insult may underlie the variation among patients. Many stroke survivors with visual field deficits retain residual visual processing in their blind field despite a lack of awareness. Previous research indicates that intact structural and functional connections between the dorsal lateral geniculate nucleus and the human extrastriate visual motion-processing area hMT+ are necessary for blindsight to occur. We therefore hypothesized that changes in this white matter pathway may underlie improvements resulting from motion discrimination training. Eighteen stroke survivors with long-standing, unilateral, homonymous field defects from retro-geniculate brain lesions completed 6 months of visual training at home. This involved performing daily sessions of a motion discrimination task, at two non-overlapping locations in the blind field, at least 5 days per week. Motion discrimination and integration thresholds, Humphrey perimetry and structural and diffusion-weighted MRI were collected pre- and post-training. Changes in fractional anisotropy (FA) were analysed in visual tracts connecting the ipsilesional dorsal lateral geniculate nucleus and hMT+, and the ipsilesional dorsal lateral geniculate nucleus and primary visual cortex. The (non-visual) tract connecting the ventral posterior lateral nucleus of the thalamus and the primary somatosensory cortex was analysed as a control. Changes in white matter integrity were correlated with improvements in motion discrimination and Humphrey perimetry. We found that the magnitude of behavioural improvement was not directly related to changes in FA in the pathway between the dorsal lateral geniculate nucleus and hMT+ or dorsal lateral geniculate nucleus and primary visual cortex. Baseline FA in either tract also failed to predict improvements in training. However, an exploratory analysis showed a significant increase in FA in the distal part of the tract connecting the dorsal lateral geniculate nucleus and hMT+, suggesting that 6 months of visual training in chronic, retro-geniculate strokes may enhance white matter microstructural integrity of residual geniculo-extrastriate pathways.

Detecting floating litter in freshwater bodies with semi-supervised deep learning

Researchers and practitioners have extensively utilized supervised Deep Learning methods to quantify floating litter in rivers and canals. These methods require the availability of large amount of labeled data for training. The labeling work is expensive and laborious, resulting in small open datasets available in the field compared to the comprehensive datasets for computer vision, e.g., ImageNet. Fine-tuning models pre-trained on these larger datasets helps improve litter detection performances and reduces data requirements. Yet, the effectiveness of using features learned from generic datasets is limited in large-scale monitoring, where automated detection must adapt across different locations, environmental conditions, and sensor settings. To address this issue, we propose a two-stage semi-supervised learning method to detect floating litter based on the Swapping Assignments between multiple Views of the same image (SwAV). SwAV is a self-supervised learning approach that learns the underlying feature representation from unlabeled data. In the first stage, we used SwAV to pre-train a ResNet50 backbone architecture on about 100k unlabeled images. In the second stage, we added new layers to the pre-trained ResNet50 to create a Faster R-CNN architecture, and fine-tuned it with a limited number of labeled images (≈1.8k images with 2.6k annotated litter items). We developed and validated our semi-supervised floating litter detection methodology for images collected in canals and waterways of Delft (the Netherlands) and Jakarta (Indonesia). We tested for out-of-domain generalization performances in a zero-shot fashion using additional data from Ho Chi Minh City (Vietnam), Amsterdam and Groningen (the Netherlands). We benchmarked our results against the same Faster R-CNN architecture trained via supervised learning alone by fine-tuning ImageNet pre-trained weights. The findings indicate that the semi-supervised learning method matches or surpasses the supervised learning benchmark when tested on new images from the same training locations. We measured better performances when little data (≈200 images with about 300 annotated litter items) is available for fine-tuning and with respect to reducing false positive predictions. More importantly, the proposed approach demonstrates clear superiority for generalization on the unseen locations, with improvements in average precision of up to 12.7%. We attribute this superior performance to the more effective high-level feature extraction from SwAV pre-training from relevant unlabeled images. Our findings highlight a promising direction to leverage semi-supervised learning for developing foundational models, which have revolutionized artificial intelligence applications in most fields. By scaling our proposed approach with more data and compute, we can make significant strides in monitoring to address the global challenge of litter pollution in water bodies.

Factors associated with early-career GPs' retention as independent specialists in former training practices.

Retention of general practice registrars in their training practices is important for addressing the GP workforce deficit and maldistribution of GPs. Given that rural and remote general practices are disproportionately affected by low retention, identifying the factors that promote retention may be as important as developing recruitment strategies in these areas. Quantifying the impact of relevant factors on registrar retention will enable a better understanding of how to incentivise retention and attenuate the loss of the rural workforce to other areas. We sought to establish the prevalence and associations of retention of general practice registrars in their training practices. This analysis was a component of the New alumni Experience of Training and independent Unsupervised Practice (NEXT-UP) study: a cross-sectional questionnaire-based study of early-career GPs in conjunction with evaluation of data contemporaneously recorded as part of vocational training. Participants were former registrars of three regional training organisations delivering general practice training in New South Wales, Tasmania, the Australian Capital Territory and Eastern Victoria, who had attained Fellowship of the Royal Australian College of General Practitioners or the Australian College of Rural and Remote Medicine between January 2016 and July 2018. The outcome measured was whether the registrar had previously worked at their current practice during vocational training. Multivariable logistic regression was used to estimate the association between relevant explanatory variables and the outcome. A total of 354 alumni responded (response rate 28%), of whom 322 provided data regarding previous training practice retention, with 190 (59%) having previously worked at their current practice as registrars. Among respondents who reported currently working in a regional-rural practice location (n=100), 69% reported having previously worked at their current practice during training. GPs were more likely to be retained by a practice they had trained at if it was of lower socioeconomic status (adjusted odds ratio (aOR) 0.82 (95% confidence interval (CI) 0.73-0.91), p<0.001 for each decile of socioeconomic status) and if the practice provided two or more of home visits, nursing home visits or after-hours services (aOR 4.29 (95%CI 2.10-8.75), p<0.001). They were less likely to be retained by the practice if training was completed in a regional-rural area (aOR 0.35 (95%CI 0.17-0.72), p=0.004). Regional-rural training location is associated with reduced odds of subsequent retention of general practice registrars. This is occurring despite significant government investment in expansion of general practice training in regional and rural areas. The practice factor most strongly associated with GP retention was the provision of out-of-practice and after-hours care. There may be altruistic, rather than monetary, reasons that explain this finding. Such training opportunities, if provided to all trainees, especially in regional and rural areas, would be a learning opportunity, a way of promoting holistic community-based care and an incentive for subsequent retention within the practice and community as an established GP.

Dynamic Analysis of Rockfall Impact on Bridges: Implications for Train Safety

The threat of rockfall impacting bridges in mountainous areas poses a great risk to the safety of passing trains. This study delves into the dynamics of rockfall impact and its implications on the interaction between train vehicles and bridges. Leveraging LS-DYNA, this study first captured the force–time history of rockfall impact on bridge structures. Subsequently, there was a comparison with the impact forces generated at various speeds with those predicted by established formulas, validating the accuracy of simulations. Employing BANSYS software, the dynamic responses of both bridge structures and the vehicle–bridge coupling system to falling rocks were analyzed. The investigation encompassed parameters such as impact speed, position, and train location. The findings reveal that escalating impact speeds correlate with increased average and maximum impact forces from falling rocks. Notably, the average impact force does not linearly correspond with rock speed and often exceeds values calculated by conventional formulas. Impact position minimally affects maximum impact force, yet alterations in position prolong impact duration, consequently reducing average impact force. Rockfall-induced impacts precipitate notable spikes in train lateral acceleration, lateral wheelset force, wheel unloading rate, and derailment coefficient, albeit with a comparatively lesser impact on vertical acceleration. Increasing impact speed and altering position intensifies the vehicle’s response, particularly when the train is in close proximity to the impact site.

Simulation on passenger evacuation of metro train fire in the tunnel

The metro tunnel space is relatively closed, it is difficult to rescue after the metro train fire accident, which causes heavy casualties and property losses. Studying the safe evacuation of passengers under fire smoke spread has important significance. The numerical simulation methods are used to analyze the reliability of passenger evacuation in metro train fire scenarios. Firstly, the required safety evacuation time (RSET) calculation methods in short-distance and long-distance tunnels are developed combining the pre-action time and train response time. Then, a passenger evacuation model in metro trains is established in Pathfinder software to simulate the evacuation process under different passenger loads, carriage layouts, evacuation strategies, and train locations. The simulation results show that the RSET is affected by passenger load, seat arrangement, evacuation strategies and train locaitons. The critical point calculation method effectively finds out the critical point of the train location, which guides emergency evacuation strategies in fire scenarios.

Understanding fire combustion characteristics and available safe egress time in underground metro trains: A simulation approach

Due to insufficient oxygen supply in the tunnel, incomplete combustion of the underground metro train fire easily produces toxic gases and smoke dust, causing difficulty in breathing for passengers and rescue. The experimental study of the fire combustion characteristics of metro trains in the tunnel is of great significance for designing metro fire extinguishing and fire prevention systems and providing reliable guidance for emergency evacuation in fire scenarios. A train fire model is established to study the effects of various factors on fire combustion characteristics and calculate the available safe egress time (ASET). The smoke spread characteristics under different conditions such as fire source power, fire source location, carriage layout, and train location are simulated. The simulation results show that the fire source power, location, and seat arrangement have a significant impact on the smoke spread characteristics of carriage fires and ASET.

Performance Optimization and Injury Mitigation for Air Force Student Fighter Pilots.

Military fighter aircrew report high rates of cervical pain and injury. There is currently no consensus regarding the best training methods for this population. Eglin Air Force Base (AFB) and Luke AFB have multidisciplinary teams specializing in aircrew training, performance, and injury mitigation. All student pilots (SPs) completing Basic Course training at these locations engage in an 8-week Spine Training Program (STP). The STP originated at Luke AFB in 2020 and was expanded to Eglin AFB in 2022. The primary aim of this study was to assess whether the STP led to significant changes in the performance measure studied, Cervical Endurance Hold (CEH). Further, this study aimed to determine if the CEH training effect was independent of location of STP administration. We hypothesized that SPs would exhibit statistically significant CEH training adaptations irrespective of base location. Air Force F-16 and F-35 SPs from Luke AFB and Eglin AFB were actively enrolled in the Basic Course and participated in the standardized STP from 2020 to 2023. The CEH test was administered prior to (intake) and following (exit) the 8-week STP. SPSS for Windows version 29 software (IBM, Armonk, NY) was used to retrospectively analyze the data from this study. Participants were excluded if they were unable to perform the CEH test at intake or exit. The study was approved by the Air Force Research Laboratory Institutional Review Board and was performed in accordance with the ethical standards of the Declaration of Helsinki. One hundred and ninety-eight SPs (Luke AFB, males n = 170, females n = 12; Eglin AFB, males n = 16) completed the STP program. There was no significant difference between intake and exit concerning age, height, weight, % body fat, and fat-free mass at Luke AFB or Eglin AFB (P < 0.05). Statistically significant improvements in CEH were observed within all groups from intake to exit (P < 0.001). When considering all participants collectively, there was a notable33.6% increase in CEH from intake to exit (P < 0.001) with an overall effect size of d = 1.14. When analyzing specific subgroups, females from Luke AFB experienced a significant 20.4% increase in CEH (P < 0.001, d = 1.14), males from Luke AFB exhibited a significant 34.5% increase (P < 0.001, d = 1.09), and males from Eglin AFB demonstrated a significant increase of 55.7% in CEH (P < 0.001, d = 1.97). This retrospective analysis showed significant improvements in the CEH across all groups following the completion of the STP. Furthermore, CEH results from both bases exhibited a large effect size indicating a meaningful change was found between intake and exit regardless of training location. These preliminary study results should be interpreted with caution as a control group was unable to be established. In the future, a randomized control trial should be performed to test the STP used in this study against other STP programs. This may better inform experts on the best spine training methods for fighter aircrew.

Project Safe Guard: Evaluating a Lethal Means Safety Intervention to Reduce Firearm Suicide in the National Guard.

The purpose of this paper is to examine a scalable secure firearm storage intervention in the U.S. National Guard (NG) in preventing firearm injury and suicide. A study among firearm-owning members of the Mississippi NG testing Project Safe Guard (PSG), a 10 to 15 min lethal means counseling intervention, found that PSG increased self-reported secure firearm storage practices. Here, we sought to examine a "real world" rollout of a modified PSG program in the NG in which NG members were trained to understand the importance of lethal means safety and to deliver PSG to Guardsmen peers within their units. The PSG team collaborated with the NG to identify 4 states for the rollout; for each state, the NG was responsible for identifying key personnel ("facilitators") who would receive the training. Team members provided in-person training at 5 locations across 4 states (AZ, GA, IA, and NV) from January to April 2023. Attendees were provided with combination trigger locks or cable locks and evaluation instructions. Questionnaires were administered to training attendees via REDCap at pre-training and post-training. We conducted descriptive and comparison statistics of questionnaire data. A total of 186 facilitators were trained at 5 in-person training locations across 4 states (AZ, GA, IA, and NV) from January to April 2023; data collection concluded in August 2023. There were 137 pre-training responses (74% pre-survey response rate) and 88 post-training responses (64% response rate from those who took the pre-training survey). Findings demonstrate increases in self-reported knowledge, attitudes, and beliefs regarding firearm injury and suicide and a reported desire to store personal firearms more securely. The adapted version of PSG shows promise as a relevant and acceptable intervention among Guardsmen to enhance knowledge and attitudes regarding firearm suicide, increase secure firearm storage practices, and normalize conversations about firearm suicide prevention among peers. This intervention seeks to frame firearm suicide prevention within a culture of safety, complementary to the existing prevention methods and training within the NG.