Emergency pre-hospital disaster response training. What's the state of play?

Study/Objective This study examines the current state of disaster response education for Australian paramedics from a national and international perspective and identifies both potential gaps in content and challenges to the sustainability of knowledge acquired through occasional training. Background As demands for domestic and international disaster response increase, experience in the field has begun to challenge traditional assumptions that response to mass casualty events requires little specialist training. The need for a “streamlined process of safe medical team deployment into disaster regions”1 is generally accepted and, in Australia, the emergence of national humanitarian aid training has begun to respond to this gap. However, calls for a national framework for disaster health education2 haven’t received much traction. Methods A critical analysis of the peer reviewed and grey literature on the core components/competencies and training methods required to prepare Australian paramedics to contribute to effective health disaster response has been conducted. Research from the past 10 years has been examined along with federal and state policy with regard to paramedic disaster education. Results The literature shows that education and training for disaster response is variable and that an evidence based study specifically designed to outline sets of core competencies for Australian health care professionals has never been undertaken. While such competencies in disaster response have been developed for the American paradigm it is suggested that disaster response within the Australian context is somewhat different to that of the US, and therefore a gap in the current knowledge base exists. Conclusion Further research is needed to develop core competencies specific to Australian paramedics in order to standardise teaching in the area of health disaster management. Until this occurs the task of evaluating or creating disaster curricula that adequately prepares and maintains paramedics for an effective all hazards disaster response is seen as largely unattainable.

virtX - Ein rechnergestütztes System zum Training des intraoperativen Einsatzes eines mobilen Bildverstärkers

Hintergrund und Fragestellung: Die korrekte intraoperative Positionierung und Einstellung eines mobilen Bildverstärkers (auch C-Bogen) kann zurzeit theoretisch mit Hilfe von Lehrbüchern erlernt, am Gerät selbst aber nur ohne visuelle Rückmeldung, d.h. ohne ein zur Ausrichtung korrespondierendes Röntgenbild, trainiert werden. Hieraus ergibt sich die Fragestellung, inwiefern das Training der Handhabung und richtigen Einstellung des C-Bogens in verschiedenen Operationsszenarien durch ein C-Bogen Simulationssystem als Teil eines CBT-Systems (Computer Based Training) unterstützt werden kann. Methoden: In Kooperation mit Ärzten aus Unfallchirurgie und Radiologie wurde das computer-basierte Trainingssystem virtX entwickelt. virtX kann dem Nutzer verschiedene Aufgaben zur Einstellung eines C-Bogens stellen und die Ausführung und das Ergebnis bewerten. Die Aufgaben können mit Hilfe eines Autorensystems erstellt und vom Trainierenden in verschiedenen Modi erfüllt werden: im rein virtuellen Modus oder im kombinierten virtuell-realen Modus. Im rein virtuellen Modus steuert der Nutzer den virtuellen C-Bogen in einem virtuellen OP-Saal mittels einer grafisch-interaktiven Benutzungsoberfläche. Im virtuell-realen Modus hingegen wird die Ausrichtung eines realen C-Bogens erfasst und auf den virtuellen C-Bogen übertragen. Während der Aufgabenerfüllung kann der Benutzer zu jeder Zeit ein realitätsnahes, virtuelles Röntgenbild erzeugen und dabei alle Parameter wie Blendenstellung, Röntgenintensität, etc. wie bei einem realen C-Bogen steuern. virtX wurde auf einem dreitägigen Kurs für OP-Personal mit 120 Teilnehmern eingesetzt und auf der Basis von Fragebögen evaluiert. Ergebnisse: Von den Teilnehmern gaben 79 einen ausgefüllten Evaluations-Fragebogen ab. Das Durchschnittsalter der 62 weiblichen und 15 männlichen Teilnehmer (zwei o.A.) lag bei 34 ± 9 Jahren, die Berufserfahrung bei 8,3 ± 7,6 Jahren. 18 Personen (23%) gaben an, gelegentlich mit einem C-Bogen zu arbeiten, 61 (77%) arbeiteten regelmäßig damit. Über 83% der befragten Teilnehmer empfanden virtX als eine sinnvolle Ergänzung zur herkömmlichen Ausbildung am C-Bogen. Das virtuelle Röntgen wurde mit einer Zustimmung von 91% der befragten Teilnehmer als besonders wichtig für das Verständnis der Arbeitsweise eines C-Bogens beurteilt. Ebenso erhielt der kombinierte virtuell-reale Modus mit 84% Zustimmung einen vergleichsweise hohen Stellenwert. Schlussfolgerung: Die Befragung zeichnet ein positives Bild der Akzeptanz des virtX-System als substanzielle Ergänzung zur herkömmlichen Ausbildung am C-Bogen.

Canadian Society for Exercise Physiology Position Paper: Resistance Training in Children and Adolescents

Many position stands and review papers have refuted the myths associated with resistance training (RT) in children and adolescents. With proper training methods, RT for children and adolescents can be relatively safe and improve overall health. The objective of this position paper and review is to highlight research and provide recommendations in aspects of RT that have not been extensively reported in the pediatric literature. In addition to the well-documented increases in muscular strength and endurance, RT has been used to improve function in pediatric patients with cystic fibrosis, cerebral palsy and burn victims. Increases in children’s muscular strength have been attributed primarily to neurological adaptations due to the disproportionately higher increase in muscle strength than in muscle size. Although most studies using anthropometric measures have not shown significant muscle hypertrophy in children, more sensitive measures such as magnetic resonance imaging and ultrasound have suggested hypertrophy may occur. There is no minimum age for RT for children. However the training and instruction must be appropriate for children and adolescents involving a proper warm-up, cool-down and an appropriate choice of exercises. It is recommended that low-to-moderate intensity resistance should be utilized 2-3 times per week on non-consecutive days, with 1-2 sets initially, progressing to 4 sets of 8-15 repetitions for 8-12 exercises. These exercises can include more advanced movements such as Olympic style lifting, plyometrics and balance training, which can enhance strength, power, co-ordination and balance. However specific guidelines for these more advanced techniques need to be established for youth. In conclusion, a RT program that is within a child’s or adolescent’s capacity, involves gradual progression under qualified instruction and supervision with appropriately sized equipment can involve more advanced or intense RT exercises which can lead to functional (i.e. muscular strength, endurance, power, balance and co-ordination) and health benefits.

Exercise and Training at Altitudes: Physiological Effects and Protocols

An increase in altitude leads to a proportional fall in the barometric pressure, and a decrease in atmospheric oxygen pressure, producing hypobaric hypoxia that affects, in different degrees, all body organs, systems and functions. The chronically reduced partial pressure of oxygen causes that individuals adapt and adjust to physiological stress. These adaptations are modulated by many factors, including the degree of hypoxia related to altitude, time of exposure, exercise intensity and individual conditions. It has been established that exposure to high altitude is an environmental stressor that elicits a response that contributes to many adjustments and adaptations that influence exercise capacity and endurance performance. These adaptations include in crease in hemoglobin concentration, ventilation, capillary density and tissue myoglobin concentration. However, a negative effect in strength and power is related to a decrease in muscle fiber size and body mass due to the decrease in the training intensity. Many researches aim at establishing how training or living at high altitudes affects performance in athletes. Training methods, such as living in high altitudes training low, and training high-living in low altitudes have been used to research the changes in the physical condition in athletes and how the physiological adaptations to hypoxia can enhanceperformance at sea level. This review analyzes the literature related to altitude training focused on how physiological adaptations to hypoxic environments influence performance, and which protocols are most frequently used to train in high altitudes.

Training pharmacists to deliver a complex information technology intervention (PINCER) using the principles of educational outreach and root cause analysis

Objective: To describe the training undertaken by pharmacists employed in a pharmacist-led information technology-based intervention study to reduce medication errors in primary care (PINCER Trial), evaluate pharmacists’ assessment of the training, and the time implications of undertaking the training. Methods: Six pharmacists received training, which included training on root cause analysis and educational outreach, to enable them to deliver the PINCER Trial intervention. This was evaluated using self-report questionnaires at the end of each training session. The time taken to complete each session was recorded. Data from the evaluation forms were entered onto a Microsoft Excel spreadsheet, independently checked and the summary of results further verified. Frequencies were calculated for responses to the three-point Likert scale questions. Free-text comments from the evaluation forms and pharmacists’ diaries were analysed thematically. Key findings: All six pharmacists received 22 hours of training over five sessions. In four out of the five sessions, the pharmacists who completed an evaluation form (27 out of 30 were completed) stated they were satisfied or very satisfied with the various elements of the training package. Analysis of free-text comments and the pharmacists’ diaries showed that the principles of root cause analysis and educational outreach were viewed as useful tools to help pharmacists conduct pharmaceutical interventions in both the study and other pharmacy roles that they undertook. The opportunity to undertake role play was a valuable part of the training received. Conclusions: Findings presented in this paper suggest that providing the PINCER pharmacists with training in root cause analysis and educational outreach contributed to the successful delivery of PINCER interventions and could potentially be utilised by other pharmacists based in general practice to deliver pharmaceutical interventions to improve patient safety.

Endurance training modulates lymphocyte function in rats with post-MI CHF

Purpose: Exercise training restores innate immune system cell function in post-myocardial infarction (post-MI) rats. However, studies of the involvement of lymphocyte (Ly) in the setting of the congestive heart failure (CHF) are few. To address this issue, we investigated the function of Ly obtained from cervical lymph nodes from post-MI CHF rats submitted to treadmill running training. Methods: Twenty-five male Wistar rats were randomly assigned to the following groups: rats submitted to ligation of the left coronary artery, which were sedentary (MI-S, N= 7, only limited activity) or trained (MI-T, N= 6, on a treadmill (0% grade at 13-20 m.m(-1)) for 60 min.d(-1), 5 d.wk(-1), for 8-10 wk); or sham-operated rats, which were sedentary (sham-S, N = 6) or trained (sham-T, N = 6). The incorporation of [2-C-14]-thymidine by Ly cultivated in the presence of concanavalin A (Con A) and lipopolysaccharide (LPS), cytokine production by Ly cultivated in the presence of phytohemagglutinin (PHA), and plasma concentration of glutamine were assessed in all groups, 48 h after the last exercise session. Results: Proliferative capacity was increased, following incubation with Con-A in the MI groups, when compared with the sham counterparts. When incubated in the presence of PHA, MI-S produced more IL-4 (96%) than sham-S (P < 0.001). The training protocol induced a 2.2-fold increase in the production of interleukin-2 (P < 0.001) of the cells obtained from the cervical lymph nodes of MI-T, compared with MI-S. Conclusion: The moderate endurance training protocol caused an increase in IL-2 production, and a trend toward the reversion of the Th-1/Th-2 imbalance associated with IL-4 production increased in the post-MI CHF animal model.

`Modern` learning methods : rhetoric and reality - further to Sadler-Smith et al

Working in the UK, Sadler-Smith, Down and Lean, in their article “‘Modern’ learning methods: rhetoric and reality”, Personnel Review, Vol. 29 No. 4, 2000, pp. 474-90, have shown that distance learning methods are neither favoured nor perceived as effective by enterprises pursuing training that yields a competitive edge. They have suggested that these methods need to be integrated with other more conventional on-job training methods. This paper, based on Australian research, shows a tension between the requirements of flexible training methods based on distance learning methods, and the characteristics that typify learners and their workplaces. That identified tension is used to suggest how an integration of training methods may be effected in workplaces.

The design and implementation of a novel method for quantifying training loads in elite rowing: the T2minute method

Introduction: A systematic approach to managing the training of elite athletes is supported by accurate training load measurement. However, quantifying the training of elite Australian rowers is complex due to unique challenges: 1) the multi-centre, multi-state structure of the national program; 2) the variety of training undertaken, incorporating rowing-specific and non-specific modalities, with continuous and interval efforts that span the full intensity spectrum; and 3) the limitations of existing quantification methods for capturing total training loads undertaken from varied training. These challenges highlighted a need to create a consistent, location-independent framework for prescribing training in elite rowing, with a capacity to account for varied training. Methods: An in-house proprietary measure (the T2minute method) was developed at the National Rowing Centre of Excellence (NRCE), as a collaborative project between sport scientists and national squad coaches. The design phase was informed by assessments of the existing training measures, and built upon standardised intensity zones established at the Australian Institute of Sport. A common measurement unit was chosen: one T2minute equates to one minute of on-water single scull rowing at T2 intensity (∼60–72% VO2max). Each intensity zone was assigned a weighting factor according to the curvilinear relationship between power output, intensity, and blood lactate response. Each training mode was assigned a weighting factor based on whether coaches perceived it to be “harder” or “easier” than onwater rowing. With coaches’ feedback, the method was refined over a period of five months. The T2minute method was implemented as the core framework for prescribing training for elite Australian rowers throughout the 2009–2012 Olympic cycle. Results: The implementation of the T2minute method successfully established consistency with training prescription and monitoring practices within the NRCE high performance program. The national roll out this method has influenced rowing training methodology at elite and sub-elite levels in Australia. Since implementation, the method has undergone scientific validation. Further research is underway, utilising the method to explore complex relationships between rowers’ training and performance outcomes. Conclusion: The T2minute method is a novel approach that allows rowing coaches and sport scientists to utilise one consistent system to quantify load from varied training. Its implementation represents a considerable achievement in establishing a common framework for managing the training process within a complex organisational structure. This collaborative approach used to develop the T2minute method provides unique insight into the important considerations and practical challenges of applying training science to enhance elite sport performance.

Eliciting personal constructs to distinguish prevailing D/discourse in police training

This paper describes the application of the rank-order repertory grid technique to elicit personal constructs in order to distinguish prevailing D/discourse in police training. Traditionally, the repertory grid has been used as a quantitative method for data collection, correlation, and analysis, however, in recent years it has been applied as a qualitative method. This research combines the use of the repertory grid as a quantitative method for data collection and initial statistical analysis with a discourse analytic framework for final theoretical analysis. This research is in informed by a literature review of police culture, police training, gender, “Othering”, and inherent D/discourses in police organisations, and inspired by the researcher’s professional experiences in a police organisation. Anecdotal evidence and studies reveal that pedagogical training methods are predominantly used in police training with concerns identified as to their educative value. These concerns are supported by Australian and international studies into police management education which reveal a ‘resistant anti-intellectual subculture’ and a set of unconscious and unchallengeable assumptions regarding police work, conduct, and leadership which prevents critical thinking. An examination of D/discourse in police training is timely and pertinent given the Australasian agenda for policing to become a profession.

A participatory workplace health and safety training program for ethylene oxide

The Occupational Safety and Health Administration (OSHA) has regulated ethylene oxide (EtO) on the basis of its acute toxicity and its potential carcinogenic and reproductive effects since 1971. OSHA's 1984 EtO standard and its 1988 revisions focused new attention on health and safety training and other preventive measures. An EtO health and safety training program for hospital sterilization workers was developed by the staff of an independent occupational and environmental health clinic. Participatory and empowerment training methods were central to the approach. Also included were hands-on, demonstration, interactive presentation, and other methods. An EtO Health and Safety Training Manual was developed based on the training experiences. This paper presents the challenges, benefits, and limitations of incorporating participatory and empowerment approaches in the design, implementation, and evaluation of EtO health and safety training.

Vitamin C and E supplementation prevents some of the cellular adaptations to endurance-training in humans

BACKGROUND: It is clear that reactive oxygen species (ROS) produced during skeletal muscle contraction have a regulatory role in skeletal muscle adaptation to endurance exercise. However, there is much controversy in the literature regarding whether attenuation of ROS by antioxidant supplementation can prevent these cellular adaptations. Therefore, the aim of this study was to determine whether vitamin C and E supplementation attenuates performance and cellular adaptations following acute endurance exercise and endurance training. METHODS: A double-blinded, placebo-controlled randomized control trial was conducted in eleven healthy young males. Participants were matched for peak oxygen consumption (VO2peak) and randomly allocated to placebo or antioxidant (vitamin C (2×500mg/day) and E (400IU/day)) groups. Following a four-week supplement loading period, participants completed acute exercise (10×4min cycling at 90% VO2peak, 2min active recovery). Vastus lateralis muscle samples were collected pre-, immediately-post- and 3h-post-exercise. Participants then completed four weeks of training (3 days/week) using the aforementioned exercise protocol while continuing supplementation. Following exercise training, participants again completed an acute exercise bout with muscle biopsies. RESULTS: Acute exercise tended to increase skeletal muscle oxidative stress as measured by oxidized glutathione (GSSG) (P=0.058) and F2-isoprostanes (P=0.056), with no significant effect of supplementation. Acute exercise significantly increased mRNA levels of peroxisome proliferator-activated receptor gamma coactivator 1α (PGC-1α), mitochondrial transcription factor A (TFAM) and PGC related coactivator (PRC), with no effect of supplementation. Following endurance training, supplementation did not prevent significantly increased VO2peak, skeletal muscle levels of citrate synthase activity or mRNA or protein abundance of cytochrome oxidase subunit 4 (COX IV) (P<0.05). However, following training, vitamin C and E supplementation significantly attenuated increased skeletal muscle superoxide dismutase (SOD) activity and protein abundance of SOD2 and TFAM. CONCLUSION: Following acute exercise, supplementation with vitamin C and E did not attenuate skeletal muscle oxidative stress or increased gene expression of mitochondrial biogenesis markers. However, supplementation attenuated some (SOD, TFAM) of the increased skeletal muscle adaptations following training in healthy young men.

Interval training at 95% and 100% of the velocity at VO2 max: effects on aerobic physiological indexes and running performance

The objective of this study was to analyze the effect of two different high-intensity interval training (HIT) programs on selected aerobic physiological indices and 1500 and 5000 m running performance in well-trained runners. The following tests were completed (n = 17): (i) incremental treadmill test to determine maximal oxygen uptake (VO2max), running velocity associated with VO2 max (VVO2max), and the velocity corresponding to 3.5 mmol/L of blood lactate concentration (vOBLA); (ii) submaximal constant-intensity test to determine running economy (RE); and (iii) 1500 and 5000 m time trials on a 400 m track. Runners were then randomized into 95% vVO(2max) or 100% vVO(2max) groups, and undertook a 4 week training program consisting of 2 HIT sessions (performed at 95% or 100% vVO(2max), respectively) and 4 submaximal run sessions per week. Runners were retested on all parameters at the completion of the training program. The VO2 max values were not different after training for both groups. There was a significant increase in post-training vVO(2 max), RE, and 1500 in running performance in the 100% vVO(2 max) group. The vOBLA and 5000 m running performance were significantly higher after the training period for both groups. We conclude that vOBLA and 5000 m running performance can be significantly improved in well-trained runners using a 4 week training program consisting of 2 HIT sessions (performed at 95% or 100% vVO(2max)) and 4 submaximal run sessions per week. However, the improvement in vVO(2 max), RE, and 1500 in running performance seems to be dependent on the HIT program at 100% vVO(2 max).

Effects of Strength Training on Running Economy

The objective of this study was to compare the effect of different strength training protocols added to endurance training on running economy (RE). Sixteen well-trained runners (27.4 +/- 4.4 years; 62.7 +/- 4.3 kg; 166.1 +/- 5.0 cm), were randomized into two groups: explosive strength training (EST) (n = 9) and heavy weight strength training (HWT) (n = 7) group. They performed the following tests before and after 4 weeks of training: 1) incremental treadmill test to exhaustion to determine of peak oxygen uptake and the velocity corresponding to 3.5 mM of blood lactate concentration; 2) submaximal constant-intensity test to determine RE; 3) maximal countermovernent jump test and; 4) one repetition maximal strength test in leg press. After the training period, there was an improvement in RE only in the HWT group (HWT = 47.3 +/- 6.8 vs. 44.3 +/- 4.9 ml.kg(-1) -min(-1); EST = 46.4 +/- 4.1 vs. 45.5 +/- 4.1 ml.kg(-1) .min(-1)). In conclusion, a short period of traditional strength training can improve RE in well-trained runners, but this improvement can be dependent on the strength training characteristics. When comparing to explosive training performed in the same equipment, heavy weight training seems to be more efficient for the improvement of RE.

Modulation of insulin secretion by physical training during recovery from protein malnutrition in rats

Objective: The purpose of the present study was to examine insulin secretion in rats submitted to protein restriction and nutritional recovery associated or not to physical training. Methods: The experiment was designed in two sets of five weeks each. In the first set the rats were fed a nonnal-protein diet(17%-control group) or a low-protein diet (6%-malnourished group) for five weeks. After this, all animals were fed the 17% protein diet and separated into four groups: sedentary control(SC); trained eontrol(TC); sedentary recovered(SR) and trained recovered(TR). TC and TR rats performed swimming exercise. Results: The results indicated efficiency of the 6% protein diet in producing signs of malnutrition, as reduction in body weight gain and serum albumin levels, as well as liver fat. Serum insulin in the fed state and insulin secretion by isolated pancreatic islets in response to glucose were Keduced,but peripheral sensitivity to insulin was increased and glucose tolerance was not changed in the protein deficient rats, indicating adaptation to malnutrition. Diet protocol for nutritional recovery was efficient in repairing body weight gain, serum albumin and liver fat levels of the previously malnourished rats. Glucose induced insulin release by pancreatic islets remained low after nutritional recovery. Insulin secretion by the islets isolated from rats submitted to exercise training during nutritional recovery was improved when compared with the sedentary animals. Conclusion: This indicates that exercise training may be useful in the treatment of protein calorie malnutrition, concerning to glucose induced insulip secretion.

Endurance swimming periodized training in rats

The aim of this study was to develop an experimental protocol for endurance swimming periodization training in rats similar to high performance training in humans, and compare it to continuous training. Three groups of male Wistar rats (90 days old) were allocated to Sedentary Control (SC); Continuous Training (CT); and Periodized Experimental Training (PET) groups. PET and CT trained 5 days/week, over five weeks, CT: continuous training supporting a 5% body mass (bm) load for 40 min/day; PET: training subdivided into basic, specific, and taper periods, with overload changed daily (volume-intensity, continuous, and interval training). Total training overload was quantified (% bm X exercise time in training session) and equalized for the two trained groups. Glucose ([ 3H]2-deoxyglucose) uptake, incorporation to glycogen (synthesis), glucose oxidation (CO 2 production), and lactate production from [U- 14C]glucose by soleus muscle strips incubated in presence of insulin (100μU/mL) were evaluated 48h after the last training session. The load equivalent at 5.5mM blood lactate concentration ([La-5.5]) was determined in the incremental test. Lactate production was similar in all groups. PET presented higher glucose uptake (59%) than SC, and higher glycogen synthesis (51 and 22%) and glucose oxidation (147 and 178%) than SC and CT, respectively. CT presented higher glycogen synthesis rates (23%) than SC. Load [La-5.5] was similar between trained groups and higher than SC. PET presented higher values for glucose metabolism than CT and SC. These results open up new perspectives for studying training methods used in high performance sport through swimming exercise in rats.