A new training set-up for trans-apical aortic valve replacement.

Trans-apical aortic valve replacement (AVR) is a new and rapidly growing therapy. However, there are only few training opportunities. The objective of our work is to build an appropriate artificial model of the heart that can replace the use of animals for surgical training in trans-apical AVR procedures. To reduce the necessity for fluoroscopy, we pursued the goal of building a translucent model of the heart that has nature-like dimensions. A simplified 3D model of a human heart with its aortic root was created in silico using the SolidWorks Computer-Aided Design (CAD) program. This heart model was printed using a rapid prototyping system developed by the Fab@Home project and dip-coated two times with dispersion silicone. The translucency of the heart model allows the perception of the deployment area of the valved-stent without using heavy imaging support. The final model was then placed in a human manikin for surgical training on trans-apical AVR procedure. Trans-apical AVR with all the necessary steps (puncture, wiring, catheterization, ballooning etc.) can be realized repeatedly in this setting.

Unison or cacophony: postgraduate training in pathology in Europe.

With the free movement of people in the European Union, medical mobility has increased significantly. This is notably the case for disciplines for which shortage of well-trained staff has occurred. Pathology is among those specialties and effectively the discipline is confronted with a striking increase in mobility among trainees and qualified specialists. The presumption underlying unlimited mobility is that the competencies of the medical specialists in the European countries are more or less equal, including significant similarities in the postgraduate training programs. In order to assess whether reality corresponds with this presumption, we conducted a survey of the content and practice requirements of the curricula in the EU and affiliated countries. The results indicate a striking heterogeneity in the training program content and practice requirements. To name a few elements: duration of the training program varied between 4 and 6 years; the number of autopsies required varied between none at all and 300; the number of biopsies required varied between none at all and 15,000. We conclude that harmonization of training outcomes in Europe is a goal that needs to be pursued. This will be difficult to reach through harmonization of training programs, as these are co-determined by political, cultural, and administrative factors, difficult to influence. Harmonization might be attained by defining the general and specific competencies at the end of training and subsequent testing them through a test to which all trainees in Europe are subjected.

Musical training intensity yields opposite effects on grey matter density in cognitive versus sensorimotor networks.

Using optimized voxel-based morphometry, we performed grey matter density analyses on 59 age-, sex- and intelligence-matched young adults with three distinct, progressive levels of musical training intensity or expertise. Structural brain adaptations in musicians have been repeatedly demonstrated in areas involved in auditory perception and motor skills. However, musical activities are not confined to auditory perception and motor performance, but are entangled with higher-order cognitive processes. In consequence, neuronal systems involved in such higher-order processing may also be shaped by experience-driven plasticity. We modelled expertise as a three-level regressor to study possible linear relationships of expertise with grey matter density. The key finding of this study resides in a functional dissimilarity between areas exhibiting increase versus decrease of grey matter as a function of musical expertise. Grey matter density increased with expertise in areas known for their involvement in higher-order cognitive processing: right fusiform gyrus (visual pattern recognition), right mid orbital gyrus (tonal sensitivity), left inferior frontal gyrus (syntactic processing, executive function, working memory), left intraparietal sulcus (visuo-motor coordination) and bilateral posterior cerebellar Crus II (executive function, working memory) and in auditory processing: left Heschl's gyrus. Conversely, grey matter density decreased with expertise in bilateral perirolandic and striatal areas that are related to sensorimotor function, possibly reflecting high automation of motor skills. Moreover, a multiple regression analysis evidenced that grey matter density in the right mid orbital area and the inferior frontal gyrus predicted accuracy in detecting fine-grained incongruities in tonal music.

El blog y otras herramientas comunicativas de la biblioteca del Área de Gestión Sanitaria Este de Málaga - Axarquía

In 2006 the Library of the Andalusian Public Health System (BVSSPA) is constituted as a Virtual Library which provides Resources and Services that are accessed through inter-hospital local area network (corporate intranet) and Internet. On the other hand, the Hospital de la Axarquia still did not have any institutional or self-presence on the Internet and the librarian ask the need to create a space for communication with the "digital users" of the Library of the area through a website. MATERIALS AND METHODS. The reasons why we opted for a blog were: -It was necessary to make no financial outlay for its establishment. It allowed for great versatility, both in its administration and in its management by users. -The ability to compile on the same platform different Web 2.0 communication tools. Between different options available we chose Blogger Google Inc. The blog allowed entry to the 2.0 services or Social Web in the library. The benefits offered were many, especially the visibility of the service and communication with the user. 2.0 tools that have been incorporated into the library are: content syndication (RSS) which allowed users to stay informed about updates to the blog. Share documents and other multimedia as presentations through SlideShare, images through Flickr or Picasa, or videos (YouTube). And the presence on social network like Facebook and Twitter. RESULTS. The analysis of the activity we has been traking by Google Analytics tool, helping to determine the number of blog visits. Since its stablishment, on November 17th 2006, until November 29th 2010 the blog has received 15,787 visitors, 38,422 page views were consulted, at each visit on average 2.4 pages were consulted and each visit has an average stay at the site of 4'31''. DISCUSSION. The blog has served as a communication and information tool with the user. Since the creation of the blog we have incorporated technologies and tools to interact with the user. With all the tools used we have applied the concept of "open source" and the contents were generated from the activities organized in the Knowledge Management Unit from the anatomo-clinical sessions, the training activities, dissemination events, etc. The result has been the customization of library services, contextualized in the Knowledge Management Unit - Axarquia. In social networks we have shared information and files with the professionals and the community. CONCLUSIONS. The blog has allowed us to explore technologies that allow us to communicate with the user and the community, disseminate information and documents with the participation of users and become the "Interactive Library" we aspire to be.

Effect of an overground walking training on gait performance in healthy 65- to 80-year-olds.

The aim of this study was to examine the effect of an individualized overground walking interval training on gait performance [i.e., speed and energy cost (C(w))] in healthy elderly individuals. Twenty-two older adults were assigned to either a training group (TG; n=12, 73.4+/-3.9yr) or a non-training control group (CG; n=10, 70.9+/-9.6yr). TG participated in a 7-week individualized walking interval training at intensities progressing from 50 to 100% of ventilatory threshold (T (VE)). Aerobic fitness [maximal oxygen uptake (V O(2max)) and T (VE)], preferred walking speed (PWS), gross and net C(w) (GC(w) and NC(w), respectively) and relative effort (%V O(2max)) at PWS measured before training (PWS(1)) were assessed prior and following the intervention. All outcomes were measured on a treadmill. Significant improvements in GC(w) (-8%; P=0.007), NC(w) (-12%; P=0.003), relative effort (%V O(2max): -12%; P<0.001) and PWS (+12%; P<0.001) were observed in TG but not in CG (P>0.71). V O(2max) and T (VE) remained unchanged in both groups (P>0.57). Changes in GC(w) at PWS(1) (difference between GC(w) at PWS(1) measured pre and post intervention) were inversely correlated with changes in PWS (difference between pre and post PWS; r=-0.67; P=0.02). The decreased C(w) at PWS(1), with no concomitant improvement in aerobic fitness, represents the main contributing factor for the reduction of the relative effort at this speed. This also allows elderly people to increase their PWS post training. Therefore, the present walking training may be an effective way to improve walking performance and delay mobility impairment in older adults.

Functional multidisciplinary rehabilitation versus outpatient physiotherapy for non specific low back pain: randomized controlled trial.

INTRODUCTION: In recent decades the treatment of non-specific low back pain has turned to active modalities, some of which were based on cognitive-behavioural principles. Non-randomised studies clearly favour functional multidisciplinary rehabilitation over outpatient physiotherapy. However, systematic reviews and meta-analysis provide contradictory evidence regarding the effects on return to work and functional status. The aim of the present randomised study was to compare long-term functional and work status after 3-week functional multidisciplinary rehabilitation or 18 supervised outpatient physiotherapy sessions. METHODS: 109 patients with non-specific low back pain were randomised to either a 3-week functional multidisciplinary rehabilitation programme, including physical and ergonomic training, psychological pain management, back school and information, or 18 sessions of active outpatient physiotherapy over 9 weeks. Primary outcomes were functional disability (Oswestry) and work status. Secondary outcomes were lifting capacity (Spinal Function Sort and PILE test), lumbar range-of-motion (modified-modified Schöber and fingertip-to-floor tests), trunk muscle endurance (Shirado and Biering-Sörensen tests) and aerobic capacity (modified Bruce test). RESULTS: Oswestry disability index was improved to a significantly greater extent after functional multidisciplinary rehabilitation compared to outpatient physiotherapy at follow-up of 9 weeks (P = 0.012), 9 months (P = 0.023) and 12 months (P = 0.011). Work status was significantly improved after functional multidisciplinary rehabilitation only (P = 0.012), resulting in a significant difference compared to outpatient physiotherapy at 12 months' follow-up (P = 0.012). Secondary outcome results were more contrasted. CONCLUSIONS: Functional multidisciplinary rehabilitation was better than outpatient physiotherapy in improving functional and work status. From an economic point of view, these results should be backed up by a cost-effectiveness study.

Training effects with the observer-rated cognitive errors and the coping action patterns scales

The use of observer-rated scales requires that raters be trained until they have become reliable in using the scales. However, few studies properly report how training in using a given rating scale is conducted or indeed how it should be conducted. This study examined progress in interrater reliability over 6 months of training with two observer-rated scales, the Cognitive Errors Rating Scale and the Coping Action Patterns Rating Scale. The evolution of the intraclass correlation coefficients was modeled using hierarchical linear modeling. Results showed an overall training effect as well as effects of the basic training phase and of the rater calibration phase, the latter being smaller than the former. The results are discussed in terms of implications for rater training in psychotherapy research.

Metacognitive training for adolescents with psychosis: A multiple case study

Cognitive biases may be one of the explaining factor underlying psychotic symptoms like delusions and hallucinations. Metacognitive training (MCT) was demonstrated, in adults with schizophrenia, to reduce these cognitive biases. However, to the best of our knowledge, there has been no research on adolescents with psychosis. The current study aimed at assessing the feasibility, treatment adherence and its benefi cial effects on psychotic symptoms, depression, social functioning and self-esteem of a MCT. Participants were fi ve psychotic adolescents with psychosis, aged 16-18, who attended the Day Care Unit for Adolescents (DCUA). The MCT, delivered in group, corresponds to 2x8 modules, lasting between 45 and 60 minutes once a week. To measure MCT's effi ciency, the Positive And Negative Syndrome Scale (PANSS), the Social and Occupational Functioning Assessment Scale (SOFAS), the Health of Nation Outcome Scale for Children and Adolescent (HoNOSCA), the depression scale of Calgary and the self-esteem scale of Rosenberg have been used. The results of the 5 patients indicate that MCT is feasible and the treatment adherence is moderate. The schedule of the MCT needs to be adapted to the availability of the participants. At a descriptive level, the MCT allows to reduce psychotic and depressive symptoms (PANSS & Calgary) as well as to improve the social functioning (SOFAS & HoNOSCA) and self-esteem (Rosenberg). To sum up, MCT seem to be an interesting alternative and/or a good additional treatment to reduce cognitive bias, psychotic symptoms as well as improving social functioning

Regional fat mobilization and training type on sedentary, premenopausal overweight and obese women.

OBJECTIVE: Little is known about the influence of different training types on relative fat mobilization with exercise. The purpose of this study was to analyze the changes induced by aerobic training (AT), resistance (RT) or a combination of both (AT+RT) on total fat mass (TFM) and regional fat mass (RFM). Further, the relative contribution of different regions, upper limbs (UL), lower limbs (LL), and trunk (Tr), were compared. DESIGN AND METHODS: Forty-five overweight and premenopausal women were randomized in either AT, RT or AT+RT. All training groups exercised for the same duration (60 min), 3 times per week for 5 months. Body composition was estimated using dual energy X-ray absorptiometry. RESULTS: TFM decreased significantly in all groups (-4.6 ± 1.9 kg; -3.8 ± 2.6 kg, and -4.7 ± 3.0 kg in AT, RT, and AT+RT groups respectively; P < 0.001). The relative contribution of FM into each segment changed significantly: TrFM represented 46.6% ± 5.8% of TFM at baseline and reduced to 43.1% ± 5.5% (P < 0.001); LLFM was 39.7% ± 5.8% vs. 41.6% ± 5.7% (P < 0.01); ULFM was 11.3% ± 1.3% vs. 12.2% ± 1.4% (P < 0.01). CONCLUSION: Training type did not influence changes of TFM and RFM. Fat mobilization came predominantly from Tr in all training protocols. These findings suggest that overweight and obese women can reduce TFM and RFM, independently of training type.

Workforce - Iowa's Employee Training Programs, 2002

Manual for employee training.