Untrained Cohort Research Articles

Assessment of training-associated changes of the lumbar back muscle using a multiparametric MRI protocol.

Adaptations in muscle physiology due to long-term physical training have been monitored using various methods: ranging from invasive techniques, such as biopsy, to less invasive approaches, such as electromyography (EMG), to various quantitative magnetic resonance imaging (qMRI) parameters. Typically, these latter parameters are assessed immediately after exercise. In contrast, this work assesses such adaptations in a set of qMRI parameters obtained at rest in the lumbar spine muscles of volunteers. To this end, we developed a multiparametric measurement protocol to extract quantitative values of (water) T2, fat fraction, T1, and Intra Voxel Incoherent Motion (IVIM) diffusion parameters in the lumbar back muscle. The protocol was applied to 31 healthy subjects divided into three differently trained cohorts: two groups of athletes (endurance athletes and powerlifters) and a control group with a sedentary lifestyle. Significant differences in muscle water T2, fat fraction, and pseudo-diffusion coefficient linked to microcirculatory blood flow in muscle tissue were found between the trained and untrained cohorts. At the same time, diffusion coefficients (resolved along different directions) provided additional differentiation between the two groups of athletes. Specifically, the strength-trained athletes showed lower axial and higher radial diffusion components compared to the endurance-trained cohort, which may indicate muscle hypertrophy. In conclusion, utilizing multiparametric information revealed new insights into the potential of quantitative MR parameters to detect and quantify long-term effects associated with training in differently trained cohorts, even at rest.

Adaptation of Left Ventricular Twist Mechanics in Exercise-Trained Children Is Only Evident after the Adolescent Growth Spurt

The extent of structural cardiac remodeling in response to endurance training is maturity dependent. In adults, this structural adaptation is often associated with the adaptation of left ventricular (LV) twist mechanics. For example, an increase in LV twist often follows an expansion in end-diastolic volume, whereas a reduction in twist may follow a thickening of the LV walls. While structural cardiac remodeling has been shown to be more prominent post-peak height velocity (PHV), it remains to be determined how this maturation-dependent structural remodeling influences LV twist. Therefore, we aimed to (1) compare LV twist mechanics between trained and untrained children pre- and post-PHV and (2) investigate how LV structural variables relate to LV twist mechanics pre- and post-PHV. Left ventricular function and morphology were assessed (echocardiography) in endurance-trained and untrained boys (n=38 and n=28, respectively) and girls (n=39 and n=34, respectively). Participants were categorized as either pre- or post-PHV using maturity offset to estimate somatic maturation. Pre-PHV, there were no differences in LV twist or torsion between trained and untrained boys (twist: P=.630; torsion: P=.382) or girls (twist: P=.502; torsion: P=.316), and LV twist mechanics were not related with any LV structural variables (P>.05). Post-PHV, LV twist was lower in trained versus untrained boys (P=.004), with torsion lower in trained groups, irrespective of sex (boys: P<.001; girls: P=.017). Moreover, LV torsion was inversely related to LV mass (boys: r=-0.55, P=.001; girls: r=-0.46, P=.003) and end-diastolic volume (boys: r=-0.64, P<.001; girls: r=-0.36, P=.025) in both sexes. A difference in LV twist mechanics between endurance-trained and untrained cohorts is only apparent post-PHV, where structural and functional remodeling were related.

OP144 Impact Of A Training Program For The General Population On Knowledge Of Aortic Valve Stenosis

IntroductionLimited knowledge of the symptomatology of aortic stenosis (AS) among the general population may delay diagnosis and have a major impact on morbidity and resource use. Training programs have often been advocated by the scientific community. The present study reported the results of an assessment of a training program for the general population.MethodsPatients who attended healthcare centers were asked to answer a questionnaire on their level of knowledge around AS. A cohort of patients without training (n=681) answered the questionnaire and a second cohort answered the questionnaire via phone 24 hours after training (n=197). Propensity score matching by sex and age was used to obtain a balanced sample between the two cohorts, giving a total study sample of 394 individuals (197 without training and 197 with training). A descriptive analysis was performed to compare differences in the level of knowledge between the two cohorts. Predictors of AS symptomatology were identified using multivariate logistic regression.ResultsThe trained cohort was more aware of AS disease than the untrained cohort (79% versus 31%, 95% confidence interval [CI]: 0.39, 0.56; p&lt;0.001). They were also better at distinguishing the symptoms associated with AS (80% versus 43%, 95% CI: 0.28, 0.48, p&lt;0.001) and were more aware of its severity (36% versus 12%; 95% CI: 0.16, 0.32, p&lt;0.001). Moreover, the trained cohort were better at identifying symptoms that should make them consider visiting a doctor (76% versus 65%; 95% CI 0.02, 0.20, p&lt;0.02). No differences were observed in level of concern regarding AS (8% versus 4%; 95% CI: -0.0046, 0.09, p=0.08).The trained people who were aware of AS (p=0.04) correctly classified AS as a valvular disease (p=0.025), would seek medical consultation when AS symptoms occurred (p=0.04), and were more likely to correctly detect AS symptoms.ConclusionsThe training program significantly improved the knowledge and awareness of AS in the general population. This can improve the timeliness of AS diagnosis, reducing the health and economic burden of AS for the healthcare system.

Remote Exercise Training Intervention During the COVID-19 Pandemic: Randomized Controlled Trial.

Societal measures to contain the spread of COVID-19 (eg, lockdown and contact restrictions) have been associated with decreased health and well-being. A multitude of prepandemic studies identified the beneficial effects of physical exercise on both physical and mental health. We report on the feasibility of a remote physical exercise intervention and its stress-buffering potential in 2 untrained cohorts: a pre-COVID-19 cohort that completed the intervention in 2019 and a lockdown cohort that started the intervention shortly before pandemic-related restrictions were implemented. In a randomized controlled trial, participants were assigned to either an intervention group (IG; pre-COVID-19 cohort: n=7 and lockdown cohort: n=9) or a control group (CG; pre-COVID-19 cohort: n=6 and lockdown cohort: n=6). IG participants received weekly individualized training recommendations delivered via web-based support. The intervention period was initially planned for 8 weeks, which was adhered to in the pre-COVID-19 cohort (mean 8.3, SD 0.5 weeks) but was extended to an average of 17.7 (SD 2.0) weeks in the lockdown cohort. Participants' health parameters were assessed before and after the intervention: aerobic capacity was measured as peak oxygen uptake (VO2peak) via cardiopulmonary exercise testing. Depressive symptoms were scored via the depression subscale of the Brief Symptom Inventory-18. Dropout rates were low in both cohorts in the IG (pre-COVID-19 cohort: n=0, 0% and lockdown cohort: n=2, 16.7%) and the CG (pre-COVID-19 cohort: n=0, 0% and lockdown cohort: n=2, 20%). The mean adherence to the training sessions of the IG for both cohorts was 84% (pre-COVID-19 cohort: SD 5.5% and lockdown cohort: SD 11.6%). Aligned rank transform ANOVAs in the lockdown cohort indicated deterioration of VO2peak and depressive symptoms from before to after the intervention in the CG but no longitudinal changes in the IG. Analyses in the pre-COVID-19 cohort revealed significant increases in VO2peak for the IG compared to the CG (P=.04) but no intervention effects on depressive symptoms. With low dropout rates and high adherence, the remote intervention was feasible for healthy adults under regular conditions and in the face of pandemic-related stressors. Moreover, our results hint at a stress-buffering effect as well as a buffering of a lockdown-induced deconditioning of remote physical exercise interventions in the pandemic scenario, which can be used in future studies to overcome equally stressful periods of life. However, due to limited statistical power, these findings should be replicated in similar scenarios. German Clinical Trials Register DRKS00018078; https://drks.de/search/en/trial/DRKS00018078.

Eye of the Carpenter: How Well do Orthopaedic Surgeons Estimate Angular Measurements in Derotational Osteotomies?

Femoral derotational osteotomies are used by orthopaedic surgeons to decrease version in a variety of pathologies. Intraoperatively, the goal of the surgery is to decrease the rotation of the femur to within physiological range. Surgeons generally visually estimate the angle of correction based on bone markers at the rotating cylindrical portion of the femur. This study sought first to assess the accuracy and inter-rater reliability of surgeons with respect to angle creation, and then to implement a training intervention. A rotational femur model was constructed and tested among surgeons and nonsurgeons. Surgeons were then randomized into an experimental and control cohort with training on the model as the intervention. Subjects were asked to create target angles of 15, 30, 45, and 60 degrees using only Kirschner wires and then only bone marks for reference. Independent and paired t -tests were performed to determine variability between cohorts. The mean angle creation error and range of the surgeon cohort were significantly lower than those of the nonsurgeon cohort. Within the nonsurgeon cohort, the mean angle creation error and range of the wire modality were significantly lower than that of the mark modality. The mean angle creation error and range of the trained cohort were significantly lower than the untrained cohort. The considerable inter-subject range within the surgeon cohort highlights a need for the reinforcement of basic geometric principles within orthopaedic instruction. This model allows for immediate, accurate feedback on angle creation, and training appears to be both time and cost-effective. The physiological range allows for a level of variability between surgical outcomes without consequence. However, the more than 20 degree range determined by this study does not fall within those bounds and should be addressed. Moving forward, rotational estimation as a surgical skill should increase in prominence within orthopaedic instruction to maximize future joint health, and additional emphasis should be placed on fundamental spatial orientation during training.

A pilot study to assess radiographer preliminary clinical evaluation (PCE) introduced for emergency department adult appendicular X-ray examinations: Comparison of trained and untrained radiographers

IntroductionRadiographers are transitioning from using “Red Dot” annotations to flag abnormal emergency X-ray images, to providing written preliminary clinical evaluation (PCE) diagnostic comments. This study explored the impact of local training on radiographers’ PCE participation and accuracy performance during a trial period. MethodsTen radiographers provided PCE comments for adult appendicular trauma X-ray examinations performed in the Emergency Department of an English public hospital over a 19 week trial period. Five senior radiographers who had received local PCE training and five more recently qualified radiographers, without this local training, participated in the trial. PCE participation rates were recorded and the PCE comments were scored for accuracy compared to the formal radiology report. ResultsThere were 796 eligible examinations, of which 528 (66%) had PCE comments. PCE participation was significantly higher (p < 0.001) for the radiographer group who received the training (80%, 253/316) compared to the untrained group (57%, 275/480). Similar levels of PCE accuracy (90% vs. 89%), sensitivity (86% vs. 82%) and specificity (91% vs. 93%) were found for the trained and untrained cohorts respectively, with no statistically significance difference between these scores. ConclusionLocal PCE training was associated with more frequent PCE participation but did not appear to influence PCE accuracy. The accuracy results suggest that radiographers are well equipped to provide PCE comments for adult appendicular X-ray examinations. Implications for practiceLocal PCE training is likely to be important for consistent PCE scheme participation. Both experienced and recently qualified radiographers appear well equipped to provide accurate PCE for adult appendicular trauma X-ray examinations.

High-protein Milk Ingestion During A Resistance Training Program Improves Muscular Regulatory Markers In Trained Males

It is well established that the rate of muscle protein synthesis is augmented after resistance training (RT) sessions when dietary proteins are ingested in young adults. Dairy milk (DM) has a high Digestible Indispensable Amino Acid Score and contains a complement of whey and casein proteins which have both been shown to stimulate the mammalian target of rapamycin signaling pathway involved in protein translation. Studies have suggested that regular DM can augment some of the adaptations from RT in young untrained cohorts. However, the effects of high-protein DM ingestion in young resistance- trained populations are unknown. PURPOSE: To evaluate the effects of high-protein DM ingestion on changes in body composition, strength and skeletal muscle regulatory markers following 6 weeks of RT in trained young males. METHODS: Thirty resistance-trained young males (age: 27 ± 3 years; training experience: 15 ± 2 months) were randomly assigned to one of two groups: high-protein DM + RT (MR; n = 15) or isoenergetic carbohydrate (placebo) + RT (PR; n = 15). Milk and placebo were ingested immediately post-exercise (250 mL; 30 g protein) and 30-minutes before sleep (250 mL; 30 g protein). Participants performed linear periodized RT 4 x week. Body composition, muscular strength and serum concentrations of skeletal muscle regulatory markers (Insulin-like growth factor 1 [IGF-1], growth hormone [GH], testosterone, cortisol, follistatin, myostatin) were assessed before and after 6 weeks. RESULTS: Lean mass (MR: 1.3 ± 0.3 vs. PR: 0.2 ± 0.1 kg), bench press (MR: 4.2 ± 0.8 vs. PR: 1.9 ± 0.7 kg) and squat (MR: 4.9 ± 0.9 vs. PR: 2.2 ± 0.8 kg) strength significantly increased in the MR (P < 0.05) compared to the improvements in the PR group (p < 0.05). Further, IGF-1 (MR: 0.3 ± 0.2 vs. PR: 0.07 ± 0.09 ng/ml), GH (MR: 3.3 ± 2.2 vs. PR: 1.4 ± 2.6 pg/ml), testosterone (MR: 0.3 ± 0.1 vs. PR: 0.1 ± 0.2 ng/ml), cortisol (MR: -0.6 ± 0.5 vs. PR: -0.08 ± 0.1 ng/ml), follistatin (MR: 0.1 ± 0.1 vs. PR: 0.02 ± 0.03 ng/ml) and myostatin (MR: -0.2 ± 0.1 vs. PR: -0.01 ± 0.04 ng/ml) were also significantly improved in the MR compared to the PR group (p < 0.05). CONCLUSIONS: The strategic ingestion of high-protein DM (post-exercise and pre-sleep) during 6 weeks of RT improved lean mass, strength and serum concentrations of skeletal muscle regulatory markers in trained young males.

Natural language processing of radiology reports for the identification of patients with fracture.

Fracture liaison services address the post-fracture treatment gap in osteoporosis (OP). Natural language processing (NLP) is able to identify previously unrecognized patients by screening large volumes of radiology reports. The aim of this study was to compare an NLP software tool, XRAIT (X-Ray Artificial Intelligence Tool), with a traditional fracture liaison service at its development site (Prince of Wales Hospital [POWH], Sydney) and externally validate it in an adjudicated cohort from the Dubbo Osteoporosis Epidemiology Study (DOES). XRAIT searches radiology reports for fracture-related terms. At the development site (POWH), XRAIT and a blinded fracture liaison clinician (FLC) reviewed 5,089 reports and 224 presentations, respectively, of people 50 years or over during a simultaneous 3-month period. In the external cohort of DOES, XRAIT was used without modification to analyse digitally readable radiology reports (n = 327) to calculate its sensitivity and specificity. XRAIT flagged 433 fractures after searching 5,089 reports (421 true fractures, positive predictive value of 97%). It identified more than a threefold higher number of fractures (421 fractures/339 individuals) compared with manual case finding (98 individuals). Unadjusted for the local reporting style in an external cohort (DOES), XRAIT had a sensitivity of 70% and specificity of 92%. XRAIT identifies significantly more clinically significant fractures than manual case finding. High specificity in an untrained cohort suggests that it could be used at other sites. Automated methods of fracture identification may assist fracture liaison services so that limited resources can be spent on treatment rather than case finding.

Training Decay Selection for Usability Validation: Pilot Study Methodology and Results for an FDA Research Grant

As medical devices become more technologically advanced, patients risk forgetting their training and missing critical steps. Existing literature explores ways to train patients on medical devices but does not quantify how long information is retained, which is essential for valid medical device testing before approval. The aim of the research presented is to validate a robust method of quantifying training decay research across multiple periods. Some participants were trained on an insulin pump and assigned to decay periods of one hour, one day, or one week. Additionally, an untrained cohort represented a theoretical maximum decay. Although results are not statistically significant due to a small sample size, task performance shows possible differences between time points and task types. Improvements and considerations translating this pilot study into a more extensive main study are also discussed.

OR29-02 Natural Language Processing of Radiology Reports Improves Identification of Patients with Fracture

Fracture liaison services (FLS) address the treatment gap for those with osteoporosis (OP) who fracture and are not treated. Given the limited human resources in FLS, screening high volumes of radiology reports for fractures with Natural Language Processing (NLP) could identify patients that have not been recognized or treated. This study is an analytical and clinical validation of X-Ray Artificial Intelligence Tool software (XRAIT) at its development site (a tertiary hospital) and external validation in an adjudicated cohort from the Dubbo Osteoporosis Epidemiology Study (DOES).Methods: XRAIT uses NLP to perform a Boolean search of radiology reports for fracture and related terms. It can be trained for site-specific reporting styles and use rules to refine identification (e.g. age>50y; bone involved; etc). At the development site, XRAIT was used to search the emergency patient presentations of people over 50 years of age and compared to referrals to FLS (usual care) during the same 3-month period. XRAIT analyzed all plain radiographs and CT scans (n = 5089) while n = 224 were referred to FLS for usual care. External validation: XRAIT was used to analyze digitally readable radiology reports in an untrained cohort from DOES (n = 327) to calculate sensitivity and specificity.Results: XRAIT identified a 5-fold higher number of potential significant fractures (349/5089) compared to manual case finding (70/224). 339/349 were confirmed fractures (97.1%). Only 29% of those eligible were started or recommended anti-resorptive therapy, including those seen by the fracture liaison service. XRAIT unadjusted for the local radiology reporting styles in DOES had a sensitivity of 69.6% and specificity of 95%. Conclusion: XRAIT identifies clinically significant fractures efficiently with minimal additional human resources. Its high specificity in an untrained cohort suggests it could be used at other sites. Automated methods of patient identification may assist fracture liaison services to identify fractures that still remain largely untreated.

Strengthening teamwork capability in allied health: implementation of a team development program in a metropolitan health service.

Objective Collaborative practice is critical to optimising patient outcomes in contemporary healthcare settings. Evidence suggests interprofessional learning is an effective way to develop teamwork capabilities, yet these skills are traditionally developed in professional silos, or not at all. This study evaluated the implementation of a team development program, the Team Management Systems (TMS) program, for allied health staff within a large metropolitan health service. Methods A mixed-methods audit-quality improvement study was conducted, using Kirkpatrick's four-level evaluation model to structure evaluation of the program. Semistructured questionnaire and workforce survey data were retrieved immediately, 6 months and 1-2 years after training and applied to each level of the model (Reaction, Learning, Behaviour, Results). Results In all, 886 staff participated in the TMS program from 2014 to 2018. High satisfaction with the program was observed. Knowledge of what constitutes effective teamwork improved significantly (P=0.008) in TMS participants compared with a matched untrained cohort. Participants reported positive behaviour change and continued engagement with TMS principles 6 months after training. Perceived impact of the program on patient and/or organisational outcomes was evident, although less compelling than the changes to knowledge and behaviour. Conclusions The TMS program yielded positive effects on staff satisfaction, knowledge, team dynamics and team behaviours. These findings demonstrate the significant value of such initiatives to enhance the capability and effectiveness of interdisciplinary healthcare teams. What is known about the topic? Complex conditions, increasing comorbidities, specialisation and scarcity of resources mean healthcare workers need to work effectively in teams to achieve quality, safe, person centred patient care. There is some evidence of the effect of teamwork initiatives on knowledge or behaviour in specific clinical specialities, single services or single professions, but limited research is available regarding the effects of teamwork programs across multiple professions, including allied health professions, and on patient and organisational outcomes. What does this paper add? This paper describes the effect of a large-scale teamwork program implemented across multiple professions, including enablers and barriers. It presents outcomes at all four levels of Kirkpatrick's evaluation model, including the less studied behaviour and results levels. What are the implications for practitioners? This paper supports health service leaders to consider developing and implementing interprofessional teamwork programs to foster essential teamwork capabilities. Learning together about teamwork, across professional silos, will lead to collaborative, patient-centred care, which leads to safe, quality patient outcomes.

Preoperative Educational Intervention Decreases Unplanned Gastrostomy-Related Health Care Utilization

Apprehension in taking independent care of children with medical devices may lead to unnecessary visits to the ED and/or acute clinic (AC). To address these concerns, our institution implemented a gastrostomy tube (GT) class in 2011 for caretakers. We hypothesized that inappropriate GT-related ED/AC visits would be lower in preoperatively educated caregivers. We performed a retrospective cohort study of all patients aged 0 to 18 who received GT (surgical or percutaneous) at our institution between 2006 and 2015 (n = 1340). Class attendance (trained vs untrained) and unscheduled GT-related ED/AC visits one year after GT placement were reviewed. Gastrostomy-related ED/AC visits were classified as appropriate (hospital-based intervention) or inappropriate (site care and education/reassurance). Occurrence of ED/AC visits was compared between trained and untrained cohorts. We found that 59 per cent of patients had an unscheduled GT-related ED/AC visit within one year of placement. The trained cohort had 27 per cent less unplanned ED/AC visits within one year (mean 1.21 (SD 1.82) vs untrained 1.65 (2.24), P < 0.001). On multivariate analysis, GT education independently decreased one-year GT-related health care utilization (Odds Ratio 0.75, 95% Confidence Interval 0.59-0.95). Formal education seems to decrease GT-related health care utilization within one year of placement and should be integrated into a comprehensive care plan to improve caregiver self-efficacy.

Variability and Reliability of Punching Impact Kinetics in Untrained Participants and Experienced Boxers.

Lenetsky, S, Brughelli, M, Nates, RJ, Cross, MR, and Lormier, AV. Variability and reliability of punching impact kinetics in untrained participants and experienced boxers. J Strength Cond Res 32(7): 1838-1842, 2017-Striking impact kinetics are central to performance in combat sports. Despite a multitude of assessment, few in the literature have explored the variability and reliability of punching force assessment. Consequently, this study assessed the variability and reliability of measured punching impact kinetics in untrained and experienced boxers using a recently developed and validated method of striking dynamometry. Intrasession (both cohorts) and intersession (untrained only) measures of impulse, peak, and mean force were determined across 4 punch types (jabs, crosses, lead, and rear hand hooks) using coefficient of variation (CV), intraclass correlation coefficients (ICCs), and typical error of measurement (TEM). Moderate (ICC <0.67 or CV >10%) to small (ICC >0.67 and CV <10%) variability was found for intrasession results of both groups, the majority having small variability. Intersession findings of the untrained cohort had a similar spread of variability, but with the majority exhibiting moderate variability. All variables except for mean force of the cross in the experienced boxer cohort were found to exhibit a "moderated" magnitude of reliability determined by standardized TEM scores (TEM = 0.60-1.19) during intrasession testing. All variables had moderate reliability during intersession. This method was found to have acceptable variability and reliability when monitoring punching impact kinetics.

Skin Protection Seminars to Prevent Occupational Skin Diseases: Results of a Prospective Longitudinal Study in Apprentices of High-risk Professions.

BackgroundOccupational skin diseases (OSDs) are frequent in professions with exposure to skin hazards. Thus, a health educational intervention for apprentices of high-risk professions was conducted. It was the aim of this study to gain insight into possible effects of this intervention.MethodsA one-time skin protection seminar was conducted in 140 apprentices of health-related and non-health–related professions [trained cohort (TC)]. In addition, 134 apprentices of the same occupations were monitored [untrained cohort (UTC)]. The OSD-specific knowledge and the skin condition of the hands were assessed at baseline (T0), after the seminar (T1), and after 6 (T2) and 12 months (T3).ResultsThe OSD-specific knowledge increased in all cohorts from T0 to T3, but we found a significantly higher knowledge in the TC at T2 (p < 0.001, t = 3.6, df = 196, 95% confidence interval = 0.9, 3.3) and T3 (p < 0.001, t = 3.8, df = 196, 95% confidence interval = 1.0, 3.2) compared to the UTC. Our results indicated a better skin condition of the hands in the TC of the health-related professions but not in the non-health–related professions.ConclusionThe study indicates that an educational intervention may positively influence the disease-specific knowledge and the prevalence of OSD in apprentices. However, definite conclusions cannot be drawn because of the heterogeneous study cohorts and the study design. Future research should aim at tailoring primary prevention to specific target groups, e.g., in view of the duration and frequency of skin protection education, different professions, and gender-specific prevention approaches.

Equine skeletal muscle adaptations to exercise and training: evidence of differential regulation of autophagosomal and mitochondrial components

BackgroundA single bout of exercise induces changes in gene expression in skeletal muscle. Regular exercise results in an adaptive response involving changes in muscle architecture and biochemistry, and is an effective way to manage and prevent common human diseases such as obesity, cardiovascular disorders and type II diabetes. However, the biomolecular mechanisms underlying such responses still need to be fully elucidated. Here we performed a transcriptome-wide analysis of skeletal muscle tissue in a large cohort of untrained Thoroughbred horses (n = 51) before and after a bout of high-intensity exercise and again after an extended period of training. We hypothesized that regular high-intensity exercise training primes the transcriptome for the demands of high-intensity exercise.ResultsAn extensive set of genes was observed to be significantly differentially regulated in response to a single bout of high-intensity exercise in the untrained cohort (3241 genes) and following multiple bouts of high-intensity exercise training over a six-month period (3405 genes). Approximately one-third of these genes (1025) and several biological processes related to energy metabolism were common to both the exercise and training responses. We then developed a novel network-based computational analysis pipeline to test the hypothesis that these transcriptional changes also influence the contextual molecular interactome and its dynamics in response to exercise and training. The contextual network analysis identified several important hub genes, including the autophagosomal-related gene GABARAPL1, and dynamic functional modules, including those enriched for mitochondrial respiratory chain complexes I and V, that were differentially regulated and had their putative interactions ‘re-wired’ in the exercise and/or training responses.ConclusionHere we have generated for the first time, a comprehensive set of genes that are differentially expressed in Thoroughbred skeletal muscle in response to both exercise and training. These data indicate that consecutive bouts of high-intensity exercise result in a priming of the skeletal muscle transcriptome for the demands of the next exercise bout. Furthermore, this may also lead to an extensive ‘re-wiring’ of the molecular interactome in both exercise and training and include key genes and functional modules related to autophagy and the mitochondrion.

Impact of competency-based and target-oriented training on employee performance

Some firms have applied different in-house training models to keep up with new technological innovations in their specific fields. This study investigated how a target-oriented in-house training programme should be developed and how it should be evaluated for effectiveness. The aim of the study was to develop, implement and evaluate a competency-based and target-oriented training programme with the cooperation of both the academic and the automotive industrial sectors. During this process, 124 employees of Bosch Rexroth Company were trained via a specific target-oriented programme. The effectiveness of the training was assessed using pre- and post-tests, a course evaluation survey and peer evaluation performance analyses. At the end of the study, the success rate of the participants, according to the pre- and post-tests, had increased by 54 points on a 100-point scale. Furthermore, in a participant feedback survey, 93% of the respondents said that the programme had contributed positively to their working life. The most important result was that, according to performance analyses, 26% of the participants had improved their performance relative to an untrained cohort. The goals and outcomes proved to be encouraging for future programmes.

PTU-023 Sedation In The Endoscopy Department – Do We Need More Training?

IntroductionThe 2004 report of the National Confidential Enquiry into Patient Outcome and Death (NCEPOD) highlighted that only 35% of endoscopists surveyed were known to have attended courses on safe sedation....

Differences in Safety Climate Among Hospital Anesthesia Departments and the Effect of a Realistic Simulation-Based Training Program

Safety climate is often measured via surveys to identify appropriate patient safety interventions. The introduction of an insurance premium incentive for simulation-based anesthesia crisis resource management (CRM) training motivated our naturalistic experiment to compare the safety climates of several departments and to assess the impact of the training. We administered a 59-item survey to anesthesia providers in six academic anesthesia programs (Phase 1). Faculty in four of the programs subsequently participated in a CRM program using simulation. The survey was readministered 3 yr later (Phase 2). Factor analysis was used to create scales regarding common safety themes. Positive safety climate (% of respondents with positive safety attitudes) was computed for the scales to indicate the safety climate levels. The usable response rate was 44% (309/708) and 38% (293/772) in Phases 1 and 2 respectively. There was wide variation in response rates among hospitals and providers. Eight scales were identified. There were significantly different climate scores among hospitals but no difference between the trained and untrained cohorts. The positive safety climate scores varied from 6% to 94% on specific survey questions. Faculty and residents had significantly different perceptions of the degree to which residents are debriefed about their difficult clinical situations. Safety climate indicators can vary substantially among anesthesia practice groups. Scale scores and responses to specific questions can suggest practices for improvement. Overall safety climate is probably not a good criterion for assessing the impact of simulation-based CRM training. Training alone was insufficient to alter engrained behaviors in the absence of further reinforcing actions.

A prevocational training project for emotionally disturbed adolescents

Adult inpatient populations, trained to develop a repertoire of work-related skills such as tracking and following directions, utilizing emotional controls, relating to the world in a realistic manner, as well as acceptance of supervision, grooming, punctuality, and attendance. These skills eased their transition to the community and assisted in a more positive existence once within that community as compared to their untrained cohort. Additionally, the process of vocational training has been demonstrated to have therapeutic benefits. This project used many of the same adult training principles but applied them to an adolescent inpatient population. A vocational training project using specific behavioral interventions resulted in comparable improvement for adolescent subjects otherwise evidenced in adult patients' work-related skills and abilities. This training project was conducted yearly, 32 h per week for 10 weeks for 4 years. The project combined actual work experience, classroom time and behavioral interventions and rewards. A 16 × 10 analysis of variance was computed to assess improvement in work-related skills and abilities. The analysis yielded and F = 2.57, p < 0.01, suggesting the efficacy of the behavioral interventions when applied to adolescent inpatient populations. © 1997 John Wiley & Sons, Ltd.

Return of auditory function following structural regeneration after acoustic trauma: Behavioral measures from quail

After measuring baseline behavioral audiograms, three of four behaviorally trained quail and fifteen untrained cohorts were exposed to a 1.5-kHz octave-band noise at 116-dB SPL for 4 h. The trained birds were tested daily following the exposure and showed a steady recovery of absolute sensitivity with a return to normal absolute thresholds by post-exposure days 8–10. Thirteen untrained cohorts were sacrificed after various survival times to evaluate the structural condition of the car. The cohorts all showed regeneration of sensory cells similar to that seen in chicks. The effects of repeated acoustic trauma on recovery of sensitivity were evaluated by re-exposing the three trained birds and two untrained cohorts 106 days after the first exposure. One of the trained birds was exposed a third time, 113 days following the second exposure. The findings demonstrate that, following acoustic trauma, normal sensitivity returns prior to complete structural regeneration of the sensory epithelium and that repeated acoustic trauma may increase the time course of recovery of normal hearing sensitivity.