Impact of patient training patterns on peritonitis rates in a large national cohort study

Background. Ideal training methods that could ensure best peritoneal dialysis (PD) outcome have not been defined in previous reports. The aim of the present study was to evaluate the impact of training characteristics on peritonitis rates in a large Brazilian cohort.Methods. Incident patients with valid data on training recruited in the Brazilian Peritoneal Dialysis Multicenter Study (BRAZPD II) from January 2008 to January 2011 were included. Peritonitis was diagnosed according to International Society for Peritoneal Dialysis guidelines; incidence rate of peritonitis (episodes/patient-months) and time to the first peritonitis were used as end points.Results. Two thousand two hundred and forty-three adult patients were included in the analysis: 59 +/- 16 years old, 51.8% female, 64.7% with <= 4 years of education. The median training time was 15 h (IQI 10-20 h). Patients were followed for a median of 11.2 months (range 3-36.5). The overall peritonitis rate was 0.29 per year at risk (1 episode/41 patient-months). The mean number of hours of training per day was 1.8 +/- 2.4. Less than 1 h of training/day was associated with higher incidence rate when compared with the intervals of 1-2 h/day (P = 0.03) and > 2 h/day (P = 0.02). Patients who received a cumulative training of > 15 h had significantly lower incidence of peritonitis compared with < 15 h (0.26 per year at risk versus 0.32 per year at risk, P = 0.01). The presence of a caregiver and the number of people trained were not significantly associated with peritonitis incidence rate. Training in the immediate 10 days after implantation of the catheter was associated with the highest peritonitis rate (0.32 per year), compared with training prior to catheter implantation (0.28 per year) or > 10 days after implantation (0.23 per year). More experienced centers had a lower risk for the first peritonitis (P = 0.003).Conclusions. This is the first study to analyze the association between training characteristics and outcomes in a large cohort of PD patients. Low training time (particularly < 15 h), smaller center size and the timing of training in relation to catheter implantation were associated with a higher incidence of peritonitis. These results support the recommendation of a minimum amount of training hours to reduce peritonitis incidence regardless of the number of hours trained per day.

The determination of a basic management system for small construction firms within the Western region with recommendations for education and training patterns

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Training patterns of German companies in India, China, Japan and the USA: What really works?

The transfer of vocational education and training (VET) systems is currently the subject of lively international debate, but there has so far been very little documentation of the process or analysis of how such transfers are achieved in practical terms. This paper therefore considers the potential for transferring Germany’s ‘dual’ vocational training system to German subsidiaries abroad, specifically in China, India, Japan and the USA. Using the EPRG typology as a theoretical framework, the paper systematises the range of training strategies deployed by German subsidiaries. It analyses the findings of interviews with training officers and Directors of Human Resources in more than 40 German subsidiaries abroad. These interviews show clearly that local factors in the host country exert such a strong influence that it is not possible completely to transfer the German VET system to another country. What is more likely is that an accommodation is reached with local VET structures, local labour market conditions and other socio-cultural features. The findings suggest that policy borrowing in the area of VET is likely to be only partial and will be strongly influenced by the national characteristics of the host country. (DIPF/Orig.)

A forced running wheel system with a microcontroller that provides high-intensity exercise training in an animal ischemic stroke model

We developed a forced non-electric-shock running wheel (FNESRW) system that provides rats with high-intensity exercise training using automatic exercise training patterns that are controlled by a microcontroller. The proposed system successfully makes a breakthrough in the traditional motorized running wheel to allow rats to perform high-intensity training and to enable comparisons with the treadmill at the same exercise intensity without any electric shock. A polyvinyl chloride runway with a rough rubber surface was coated on the periphery of the wheel so as to permit automatic acceleration training, and which allowed the rats to run consistently at high speeds (30 m/min for 1 h). An animal ischemic stroke model was used to validate the proposed system. FNESRW, treadmill, control, and sham groups were studied. The FNESRW and treadmill groups underwent 3 weeks of endurance running training. After 3 weeks, the experiments of middle cerebral artery occlusion, the modified neurological severity score (mNSS), an inclined plane test, and triphenyltetrazolium chloride were performed to evaluate the effectiveness of the proposed platform. The proposed platform showed that enhancement of motor function, mNSS, and infarct volumes was significantly stronger in the FNESRW group than the control group (P<0.05) and similar to the treadmill group. The experimental data demonstrated that the proposed platform can be applied to test the benefit of exercise-preconditioning-induced neuroprotection using the animal stroke model. Additional advantages of the FNESRW system include stand-alone capability, independence of subjective human adjustment, and ease of use.

AN ARTIFICIAL NEURAL NETWORK FOR SONAR TARGET DETECTION

Neural Network has emerged as the topic of the day. The spectrum of its application is as wide as from ECG noise filtering to seismic data analysis and from elementary particle detection to electronic music composition. The focal point of the proposed work is an application of a massively parallel connectionist model network for detection of a sonar target. This task is segmented into: (i) generation of training patterns from sea noise that contains radiated noise of a target, for teaching the network;(ii) selection of suitable network topology and learning algorithm and (iii) training of the network and its subsequent testing where the network detects, in unknown patterns applied to it, the presence of the features it has already learned in. A three-layer perceptron using backpropagation learning is initially subjected to a recursive training with example patterns (derived from sea ambient noise with and without the radiated noise of a target). On every presentation, the error in the output of the network is propagated back and the weights and the bias associated with each neuron in the network are modified in proportion to this error measure. During this iterative process, the network converges and extracts the target features which get encoded into its generalized weights and biases.In every unknown pattern that the converged network subsequently confronts with, it searches for the features already learned and outputs an indication for their presence or absence. This capability for target detection is exhibited by the response of the network to various test patterns presented to it.Three network topologies are tried with two variants of backpropagation learning and a grading of the performance of each combination is subsequently made.

Uma contribuição ao estudo das categorias internas e de sua proliferação em redes ARTMAP

ART networks present some advantages: online learning; convergence in a few epochs of training; incremental learning, etc. Even though, some problems exist, such as: categories proliferation, sensitivity to the presentation order of training patterns, the choice of a good vigilance parameter, etc. Among the problems, the most important is the category proliferation that is probably the most critical. This problem makes the network create too many categories, consuming resources to store unnecessarily a large number of categories, impacting negatively or even making the processing time unfeasible, without contributing to the quality of the representation problem, i. e., in many cases, the excessive amount of categories generated by ART networks makes the quality of generation inferior to the one it could reach. Another factor that leads to the category proliferation of ART networks is the difficulty of approximating regions that have non-rectangular geometry, causing a generalization inferior to the one obtained by other methods of classification. From the observation of these problems, three methodologies were proposed, being two of them focused on using a most flexible geometry than the one used by traditional ART networks, which minimize the problem of categories proliferation. The third methodology minimizes the problem of the presentation order of training patterns. To validate these new approaches, many tests were performed, where these results demonstrate that these new methodologies can improve the quality of generalization for ART networks

Intrusion detection system using optimum-path forest

Intrusion detection systems that make use of artificial intelligence techniques in order to improve effectiveness have been actively pursued in the last decade. Neural networks and Support Vector Machines have been also extensively applied to this task. However, their complexity to learn new attacks has become very expensive, making them inviable for a real time retraining. In this research, we introduce a new pattern classifier named Optimum-Path Forest (OPF) to this task, which has demonstrated to be similar to the state-of-the-art pattern recognition techniques, but extremely more efficient for training patterns. Experiments on public datasets showed that OPF classifier may be a suitable tool to detect intrusions on computer networks, as well as allow the algorithm to learn new attacks faster than the other techniques. © 2011 IEEE.

Learning real-world stimuli in a neural network with spike-driven synaptic dynamics

We present a model of spike-driven synaptic plasticity inspired by experimental observations and motivated by the desire to build an electronic hardware device that can learn to classify complex stimuli in a semisupervised fashion. During training, patterns of activity are sequentially imposed on the input neurons, and an additional instructor signal drives the output neurons toward the desired activity. The network is made of integrate-and-fire neurons with constant leak and a floor. The synapses are bistable, and they are modified by the arrival of presynaptic spikes. The sign of the change is determined by both the depolarization and the state of a variable that integrates the postsynaptic action potentials. Following the training phase, the instructor signal is removed, and the output neurons are driven purely by the activity of the input neurons weighted by the plastic synapses. In the absence of stimulation, the synapses preserve their internal state indefinitely. Memories are also very robust to the disruptive action of spontaneous activity. A network of 2000 input neurons is shown to be able to classify correctly a large number (thousands) of highly overlapping patterns (300 classes of preprocessed Latex characters, 30 patterns per class, and a subset of the NIST characters data set) and to generalize with performances that are better than or comparable to those of artificial neural networks. Finally we show that the synaptic dynamics is compatible with many of the experimental observations on the induction of long-term modifications (spike-timing-dependent plasticity and its dependence on both the postsynaptic depolarization and the frequency of pre- and postsynaptic neurons).

Social work and the Bologna Process

As social work training in Europe is characterized by progressive 'academisation' it is directly affected by the changes in university structures triggered by the Bologna Process. This means, however, simultaneously that all the ambiguities surrounding social work education, such as the level and rank it has achieved as an independent academic discipline, the relationship between theory and practice and the duality of training patterns at university and non-university institutions, are becoming more starkly apparent and need to be addressed with renewed urgency in practically all countries that have subscribed to the transformation initiative.

Offensive zones in beach volleyball: differences by gender

Gender differences in anthropometric and athletic properties (e.g. strength) as well as the different net heights (2.24 vs. 2.43 m) on the same field size (8x16 m) would be reflected in the game. The literature about differences between male and female playing characteristics in beach volleyball is scarce. Therefore, the aim of this study was to analyse the differences by gender in the use of offensive zones. Study participants were 20 players (10 female and 10 male) who took part in the European Beach Volleyball Championship 2005 and 2006. Video recordings were made of the 659 points in eight matches played. The beach volleyball court was divided into six zones (z1 to z6). The results showed that men and women use different offensive zones and also were different in the percentages of ball out (15.53 and 27.38% respectively). Concretely, men players used more 1, 2, 4 and 5 zones and women 1 and 5 zones. A few differences were observed in the percentage the ball to the net (7.73 and 5.35% respectively). An understanding of the use of offensive zones is relevant to establish specific tactical training patterns for beach volleyball.

Poder y exclusiones formativas en Ciencias de la Salud. Propuestas de mejora en la atención al paciente desde la complementariedad

Introducción: La importancia de los procesos de salud-enfermedad-atención es un hecho universal ejecutado a través de diferentes modelos. Occidente propone el modelo Biomédico, cuyos logros se ven limitados por la exclusión que realiza a las variables socio-culturales del enfermar. Objetivo: Una reflexión sobre las posibilidades de mejora que permitan una asistencia cercana al holismo, determinante no sólo de una mayor profesionalidad sino también de la conformación de una auténtica identidad enfermera, constituye el objetivo esencial. Metodología: Para intentar dar una respuesta sólida nos aventuraremos a la lectura de dos autores clásicos de la talla de Foucault y Gramsci, largamente referenciados en el ámbito de la Antropología médica, permitiéndonos sugerir una línea en la búsqueda de motivos y soluciones sobre la problemática que nos envuelve. Desarrollo: Una vía razonable se vislumbra en el aporte que las formas de atención complementarias posibilitan. En este sentido, la Enfermería actual debe buscar una vuelta a su ethos del cuidado, alejándose así de los preceptos deterministas que la han condenado a la subalternidad. Conclusiones: Un cambio en los patrones formativos se constituye como eje básico que determine una mejora real en los procesos de atención y permitan el derecho básico de una atención de calidad.

Understanding Dropout and Prolonged Engagement in Adolescent Competitive Sport

Objectives: The purpose of this study is to gain understanding of training patterns and roles of significant others (i.e. coaches, parents, peers, and siblings) in adolescent swimmers’ sport participation patterns. Design: The developmental model of sport participation [Côté, J., Baker, J., & Abernethy, B. (2003). From play to practice: A developmental framework for the acquisition of expertise in team sport. In J. Starkes, & K. A. Ericsson (Eds.), Recent advances in research on sport expertise (pp. 89–114). Champaign, IL: Human Kinetics; Côté, J., & Fraser-Thomas, J. (2007). Youth involvement in sport. In P. R. E. Crocker (Ed.), Introduction to sport psychology: A Canadian perspective (pp. 266–294). Toronto: Pearson Prentice Hall] was used as a framework. Method: Ten dropout and 10 engaged swimmers, matched on key demographic variables participated in a semi-structured qualitative interview. Results: Groups had many similar experiences (e.g. early training, supportive and unsupportive coaches, involved parents). However, only dropouts spoke of early peak performances, limited one-on-one coaching, pressuring parents during adolescence, lack of swimming peers during adolescence, and sibling rivalries. In contrast, only engaged athletes spoke of clubs’ developmental philosophies, coaches’ and parents’ open communication, school friends’ support, and siblings’ general positive influences. Conclusions: Findings highlight the importance of appropriately structured programs and the fragility of athletes’ relationships with significant others during the adolescent years. Implications for sport programmers, coaches, and parents are discussed.

The dynamics of a genetic algorithm for a simple learning problem

A formalism for describing the dynamics of Genetic Algorithms (GAs) using method s from statistical mechanics is applied to the problem of generalization in a perceptron with binary weights. The dynamics are solved for the case where a new batch of training patterns is presented to each population member each generation, which considerably simplifies the calculation. The theory is shown to agree closely to simulations of a real GA averaged over many runs, accurately predicting the mean best solution found. For weak selection and large problem size the difference equations describing the dynamics can be expressed analytically and we find that the effects of noise due to the finite size of each training batch can be removed by increasing the population size appropriately. If this population resizing is used, one can deduce the most computationally efficient size of training batch each generation. For independent patterns this choice also gives the minimum total number of training patterns used. Although using independent patterns is a very inefficient use of training patterns in general, this work may also prove useful for determining the optimum batch size in the case where patterns are recycled.

Changes in prescribing patterns of benzodiazepines after training of general practitioners

RESUMO: Introdução: As benzodiazepinas são os fármacos ansiolíticos e hipnóticos mais utilizados. O elevado consumo destes fármacos tem representado uma preocupação devido aos efeitos secundários do seu uso prolongado e dependência. Portugal tem a maior utilização de benzodiazepinas na Europa. Este estudo pretende analisar a alteração do padrão de prescrição de benzodiazepinas após uma intervenção com clínicos gerais. Métodos: A intervenção consistiu numa sessão educacional a um grupo de clínicos gerais. Foi comparado o padrão de prescrição de benzodiazepinas dos médicos intervencionados com o de um grupo de médicos não intervencionado da mesma região e com o de um grupo de médicos não intervencionados de outra região. Analisaram-­‐se as prescrições de 12 meses antes e depois da intervenção. A análise do padrão de prescrição utilizou como metodologia a Dose Diária Definida (DDD) e a Dose Diária Definida por 1000 pacientes por dia (DHD). A análise estatística recorreu a métodos de regressão segmentada. Resultados: Houve uma diminuição no padrão de prescrição de benzodiazepinas no grupo intervencionado após a intervenção (p=0.005). Houve também uma redução no padrão de prescrição no grupo não intervencionada da mesma região (p=0.037) e no grupo não-intervencionado da região diferente (p=0.010). Analisando por género, prescritores do género feminino prescrevem uma quantidade maior de benzodiazepinas. Os clínicos gerais do género feminino intervencionados tiveram a maior redução na prescrição após a intervenção (p=0.008). Discussão: Os dados demonstraram que a intervenção reduziu a prescrição de benzodiazepinas após a intervenção. A diminuição geral do padrão de prescrição poderá ser explicada pelo efeito de Hawthorne ou pela contaminação entre os três grupos de clínicos gerais. Os dados disponíveis não explicam as diferenças nos padrões de prescrição por género. Conclusão: Este estudo demonstra como uma única intervenção tem um impacto positivo na melhoria dos padrões de prescrição. A replicação desta intervenção poderá representar uma oportunidade para alterar a prescrição de benzodiazepinas em Portugal. -----------------------------ABSTRACT: Introduction: Benzodiazepines are the most utilized anxiolytic and hypnotic drugs. The high consumption of benzodiazepines has been a concern due to the reported side effects of long-­‐term use and dependence. Portugal has the highest benzodiazepine utilisation in Europe. This study aims to analyse the change in General Practitioners’ (GPs) benzodiazepine prescription pattern after na intervention period. Methods: An educational session was delivered to a group of intervened GPs. The benzodiazepine prescription pattern of the intervened group was compared to the pattern of a non-­‐intervened matched group from the same region, and to the pattern of another non-­‐intervened matched group from a diferente region. The research time frame was 12 month before and after intervention. The analysis of the prescription trends used the Defined Daily Dose (DDD) and Defined Daily Dose per 1000 patients per day (DHD) methodology. The statistical methods consisted of segmented regression analysis. Results: There was a decrease in benzodiazepine prescription pattern of intervened GPs after intervention (p=0.005). There was also a decrease in benzodiazepine prescription pattern for the non-­‐intervened group from the same region (p=0.037) and for the non-­‐ intervened group from a diferente region (p=0.010). Concerningthe analysis by gender, female gender prescribed a higher amount of benzodiazepines. The intervened female gender prescribers presented the highest decrease in prescription trend after intervention (p=0.008). Discussion: The data demonstrated that the intervention was effective in reducing benzodiazepine prescription after intervention. The general decrease in prescription trend might be explained by a Hawthorne effect or a contamination effect between the three groups of GPs. The available data couldn´t explain the diferences in prescription patterns by gender. Conclusion: This study demonstrates how a single intervention has a positive impact on improving prescription trends. The replication of this intervention might be an opportunity to changing the worrying benzodiazepine utilisation in Portugal.

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.