A Wii Bit of Fun: A Novel Platform to Deliver Effective Balance Training to Older Adults

BACKGROUND: Falls and fall-related injuries are symptomatic of an aging population. This study aimed to design, develop, and deliver a novel method of balance training, using an interactive game-based system to promote engagement, with the inclusion of older adults at both high and low risk of experiencing a fall.

STUDY DESIGN: Eighty-two older adults (65 years of age and older) were recruited from sheltered accommodation and local activity groups. Forty volunteers were randomly selected and received 5 weeks of balance game training (5 males, 35 females; mean, 77.18 ± 6.59 years), whereas the remaining control participants recorded levels of physical activity (20 males, 22 females; mean, 76.62 ± 7.28 years). The effect of balance game training was measured on levels of functional balance and balance confidence in individuals with and without quantifiable balance impairments.

RESULTS: Balance game training had a significant effect on levels of functional balance and balance confidence (P < 0.05). This was further demonstrated in participants who were deemed at high risk of falls. The overall pattern of results suggests the training program is effective and suitable for individuals at all levels of ability and may therefore play a role in reducing the risk of falls.

CONCLUSIONS: Commercial hardware can be modified to deliver engaging methods of effective balance assessment and training for the older population.

Principles of fatigue in residency education: a qualitative study

Background: Proposals to implement fatigue-management strategies in residency education assume that medicine shares the view
of other risk-adverse industries that fatigue is hazardous. This view is an essential underpinning of fatigue-management strategies
that other industries have embedded as part of their workplace occupational health and safety programs. We sought to explore how
residents understand fatigue in the context of their training environment.

Methods: We interviewed 21 residents in 7 surgical and nonsurgical programs at Western University in 2014. All participants met the
inclusion criteria of routinely working 24-hour call shifts while enrolled in their training program. Data collection and analysis occurred iteratively in keeping with constructivist grounded theory methodology and informed theoretical sampling to sufficiency.

Results: Four predominant principles of fatigue captured how the social learning environment shaped residents’ perceptions of
fatigue. These included the conceptualization of fatigue as (a) inescapable and therefore accepted, (b) manageable through experience, (c) necessary for future practice and (d) surmountable when required.

Interpretation: This study elaborates our understanding of how principles of fatigue are constructed and reinforced by the training
environment. Whereas fatigue is seen as a collective hazard in other industries, our data showed that, in residency training, fatigue
may be seen as a personal challenge. Consequently, fatigue-management strategies that conceptualize fatigue as an occupational
threat may have a limited impact on resident behaviour and patient safety.

THE TEACHING ABOUT THE CARE OF THE ELDERLY IN NURSING TRAINING: THE SITUATION IN PORTUGAL

This paper aims to look at the teaching situation of the nursing undergraduate degree’s courses about eldercare in Portugal. A documentary research on the teaching programs in 39 nursing schools, 26 schools presented syllabus units related to the topic ‘eldercare’ and in eight of these schools the contents of the units were identified. Using textual analysis and from the categories we concluded that the teaching regarding eldercare for the nurse training in Portugal is focused on hospital care; it is directed to the adult/elderly/family; it explores the definitions related to the aging process; it explores community issues, legislation and research. People responsible for the design/monitoring of teaching programs should include teaching regarding eldercare in the nurse training, considering that the elder population is increasing in Portugal.

Nursing training in Brazil and in Portugal: similarities and specificities

Objective: To identify similarities/specificities in the nursing training in Brazil and in Portugal. This is a documentary research conducted in two higher education institutions, in January 2013. Method: It was focused on the National Curriculum Guidelines and on the Bologna Process. Results: Common points: objectives and profile of the newly-trained nurses grounded on competencies; teaching of education in/for health. Brazilian specificity: universal admission; three disciplines focused on research; mandatory discipline related to elderly care; two optional disciplines: Alternative therapies and Brazilian Language of Signs; insertion of complementary activities, actions in teaching/research/extension; basis of teaching: compliance with the Brazilian Unified Health System. Portuguese Specificity: admission with regionalized medical certificate; grounded on the European Credit Transfer and Accumulation System; compulsory disciplines: Clinical Reasoning in Nursing; Family Nursing; Development throughout life; Rehabilitative Nursing and Prospects of development of the Nursing; two optional disciplines: entrepreneurship and arts; basis of teaching: clinical teaching. Conclusions: There are similarities and specificities between the surveyed courses.

Nursing training in Brazil and in Portugal: similarities and specificities

Objective: To identify similarities/specificities in the nursing training in Brazil and in Portugal. This is a documentary research conducted in two higher education institutions, in January 2013. Method: It was focused on the National Curriculum Guidelines and on the Bologna Process. Results: Common points: objectives and profile of the newly-trained nurses grounded on competencies; teaching of education in/for health. Brazilian specificity: universal admission; three disciplines focused on research; mandatory discipline related to elderly care; two optional disciplines: Alternative therapies and Brazilian Language of Signs; insertion of complementary activities, actions in teaching/research/extension; basis of teaching: compliance with the Brazilian Unified Health System. Portuguese Specificity: admission with regionalized medical certificate; grounded on the European Credit Transfer and Accumulation System; compulsory disciplines: Clinical Reasoning in Nursing; Family Nursing; Development throughout life; Rehabilitative Nursing and Prospects of development of the Nursing; two optional disciplines: entrepreneurship and arts; basis of teaching: clinical teaching. Conclusions: There are similarities and specificities between the surveyed courses.

Diagnostic value of surgical lung biopsy: comparison with clinical and radiological diagnosis

OBJECTIVE: To determine overall and disease-related accuracy of the clinical/imagiological evaluation for pulmonary infiltrates of unknown aetiology, compared with the pathological result of the surgical lung biopsy (SLB) and to evaluate the need for the latter in this setting. METHODS: We conducted a retrospective review of the experiences of SLB in 366 consecutive patients during the past 5 years. The presumptive diagnosis was based on clinical, imagiological and non-invasive or minimally invasive diagnostic procedures and compared with the gold standard of histological diagnosis by SLB. We considered five major pathological groups: diffuse parenchymal lung disease (DPLD), primitive neoplasms, metastases, infectious disease and other lesions. Patients with previous histological diagnosis were excluded. RESULTS: In 56.0% of patients (n=205) clinical evaluation reached a correct diagnosis, in 42.6% a new diagnosis was established (n=156) by the SLB, which was inconclusive in 1.4% (n=5). The pre-test probability for each disease was 85% for DPLD, 75% for infectious disease, 64% for primitive neoplasms and 60% for metastases. Overall sensitivity, specificity, positive and negative predictive values for the clinical/radiological diagnosis were 70%, 90%, 62% and 92%, respectively. For DPLD: 67%, 90%, 76% and 85%; primitive neoplasms: 47%, 90%, 46% and 90%; metastases: 99%, 79%, 60% and 99%; infectious disease 38%, 98%, 53% and 96%. CONCLUSIONS: Despite a high sensitivity and specificity of the clinical and imagiological diagnosis, the positive predictive value was low, particularly in the malignancy group. SLB should be performed in pulmonary infiltrates of unknown aetiology because the clinical/imagiological assessment missed and/or misdiagnosed an important number of patients.

Curricular training report: pharmaceutical industry & spin-off company

O presente relatório expõe as atividades desenvolvidas durante o estágio curricular, frequentado na Bluepharma - Indústria Farmacêutica S.A. e na TREAT U, Lda. uma Spin-off da Universidade de Coimbra, no âmbito do Mestrado em Biomedicina Farmacêutica da Universidade de Aveiro. Esta foi uma experiência de 6 meses que teve duas componentes, uma multidisciplinar e outra monodisciplinar, as quais me permitiram desenvolver os conhecimentos e aptidões adquiridas ao longo do curso de mestrado e de as aplicar ao mundo real. Para além do desenvolvimento de competências profissionais, esta experiência possibilitou também a aquisição e desenvolvimento de várias aptidões, quer a nível pessoal como social. Nos primeiros dois meses desta minha experiência adquiri um conhecimento essencialmente teórico em várias áreas da indústria farmacêutica (financeira, desenvolvimento de negócio, assuntos regulamentares, investigação e desenvolvimento de medicamentos, garantia da qualidade, etc.) através da minha passagem pela Bluepharma. De seguida, na minha experiência de quatro meses na TREAT U, foi-me dada a oportunidade de realizar de forma mais independente, as funções inerentes ao cargo de assistente da gerência, com especial enfoque para atividades de gestão de projeto (incluindo assuntos regulamentares), tais como, apoio na preparação do plano de desenvolvimento não clínico e na preparação do pedido de aconselhamento científico. Este relatório começa assim por descrever os objectivos do estágio e uma breve descrição das instituições que me acolheram para a sua realização. De seguida, os conhecimentos adquiridos na vertente multidisciplinar do estágio e depois as atividades desenvolvidas no âmbito monodisciplinar. Por fim, apresenta uma análise das dificuldades e desafios encontrados bem como os esforços realizados para os ultrapassar.

Impact of exercise training on cancer-induced cardiac dysfunction

Cachexia is a complex syndrome characterized by severe weight loss frequently observed in cancer patients and associated with poor prognosis. Cancer cachexia is also related to modifications in cardiac muscle structure and metabolism leading to cardiac dysfunction. In order to better understand the cardiac remodeling induced by bladder cancer and the impact of exercise training after diagnosis on its regulation, we used an animal model of bladder cancer induced by exposition to N-butyl-N-(4-hydroxybutyl)-nitrosamine (BBN) in the drinking water. Healthy animals and previously BBN exposed animals were submitted to a training program in a treadmill at a speed of 20m/min, 60 min/day, 5 days/week during 13 weeks. At the end of the protocol, animals exposed to BBN presented a significant decrease of body weight, in comparison with control groups, supporting the presence of cancer cachexia. Morphological analysis of the cardiac muscle sections revealed the presence of fibrosis and a significant decrease of cardiomyocyte’s cross-sectional area, suggesting the occurrence of cardiac dysfunction associated with bladder cancer. These modifications were accompanied by heart metabolic remodeling characterized by a decreased fatty acid oxidation given by diminished levels of ETFDH and of complex II subunit  from the respiratory chain. Exercise training promoted an increment of connexin 43, a protein involved in cardioprotection, and of c-kit, a protein present in cardiac stem cells. These results suggest an improved heart regenerative capacity induced by exercise training. In conclusion, endurance training seems an attractive non-pharmacological therapeutic option for the management of cardiac dysfunction in cancer cachexia.

A hybrid training method for B-spline neural networks

Current and past research has brought up new views related to the optimization of neural networks. For a fixed structure, second order methods are seen as the most promising. From previous works we have shown how second order methods are of easy applicability to a neural network. Namely, we have proved how the Levenberg-Marquard possesses not only better convergence but how it can assure the convergence to a local minima. However, as any gradient-based method, the results obtained depend on the startup point. In this work, a reformulated Evolutionary algorithm - the Bacterial Programming for Levenberg-Marquardt is proposed, as an heuristic which can be used to determine the most suitable starting points, therefore achieving, in most cases, the global optimum.

Completely supervised training algorithms for B-spline neural networks and neuro-fuzzy systems

Complete supervised training algorithms for B-spline neural networks and fuzzy rule-based systems are discussed. By interducing the relationship between B-spline neural networks and certain types of fuzzy models, training algorithms developed initially for neural networks can be adapted by fuzzy systems.

Training multilayer perceptrons - an optimization perspective

Multilayer perceptrons (MLPs) (1) are the most common artificial neural networks employed in a large field of applications. In control and signal processing applications, MLPs are mainly used as nonlinear mapping approximators. The most common training algorithm used with MLPs is the error back-propagation (BP) alg. (1).

Training multilayer perceptrons for control systems applications - a comparison of different approaches

Multilayer perceptrons (MLPs) (1) are the most common artificial neural networks employed in a large field of applications. In control and signal processing applications, MLPs are mainly used as nonlinear mapping approximators. The most common training algorithm used with MLPs is the error back-propagation (BP) alg. (1).

Supervised training approach using spiking neural networks

One of the basic aspects of some neural networks is their attempt to approximate as much as possible their biological counterparts. The goal is to achieve a simple and robust network, easy to understand and able of simulating the human brain at a computational level. Recently a third generation of neural networks (NN) [1], called Spiking Neural Networks(SNN) was appeared. This new kind of networks use the time of a electrical pulse, or spike, to encode the information. In the first and second generation of NN analog values are used in the communication between neurons.

Training neuro-fuzzy models using evolution based algorithms

The normal design process for neural networks or fuzzy systems involve two different phases: the determination of the best topology, which can be seen as a system identification problem, and the determination of its parameters, which can be envisaged as a parameter estimation problem. This latter issue, the determination of the model parameters (linear weights and interior knots) is the simplest task and is usually solved using gradient or hybrid schemes. The former issue, the topology determination, is an extremely complex task, especially if dealing with real-world problems.

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.