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Abstract Trauma teams handle severely injured patients under high temporal demands and need to coordinate and achieve collaborative decision-making and task execution through communication. Specific coordination and communication behaviours are taught in simulation training to enhance team performance. An examination of the role and nature of communication could increase the understanding of educational possibilities and assess the validity of in situ simulation on behalf of communication. Our study aim was to describe the relative use of communication within information and task management, the use of coordinating behaviours, and the use of talking to the room and closed-loop communication in in-real-life trauma assessment and in the simulated domain. We video-recorded all verbal communicative events in four real-world trauma teams and four teams during simulation training. The analysis showed that although the teamwork was task-oriented, information management dominated task management at 64% of all the utterances in-real-life and 68% during simulation. In-real-life, information management was dominated by the codes “request information” (24%) and “confirmation” (21%), whereas “task distribution” (43%) was most frequently used for task management. The only difference between domains was that “give information after request” represented a smaller proportion of the utterances in-real-life compared to simulation (p ≤ 0.001). Talking to the room was primarily used by the teams in both domains to provide information without request and to delegate tasks. Closed-loop communication was used at a low frequency, 3.6% in-real-life, but was significantly higher, 7.7%, in simulation training. We suspect that this outcome reflects the Hawthorne effect. In the simulations, greater information delivery was provided in response to questions, probably accounting for instructor information. Our results may be valuable for research on trauma team behaviour in a simulated environment to draw conclusions about similar activities in-real-life.

IntroductionWhile there is agreement on the positive link between psychological resilience and athletic performance, conclusive findings regarding the association between psychological resilience and other variables of interest (for example, age, gender, type of sport, or competitive level) remain elusive.ObjectiveThe study aimed to assess psychological resilience levels among judokas and explore potential associations with demographic factors, judo experience and competitive level.MethodsA total of 702 judokas (469 men and 233 women) participated in the study, of whom 194 (27.6%) were classified as TOP by their competitive level. Psychological resilience was evaluated using the Spanish version of the 10 item Connor-Davidson Resilience Scale (CD-RISC 10), with a score range from 0 to 40. Independent T-test and Pearson’s coefficient were used for bivariate analysis. A two-way non-parametric ANCOVA was carried out to analyse the impact of gender and competitive level on psychological resilience.ResultsThe judokas showed total mean scores in the CD-RISC 10 of 33.08 points (SD = 4.79), considered high. Levels of psychological resilience were significantly higher among men (33.36 ± 4.76) than women (32.53 ± 4.80) and were positively correlated with age and number of years practicing and competing in Judo (p = 0.019). Judokas with a higher competitive level (TOP judokas) showed significantly higher levels of resilience than the others (non-TOP judokas) (p

BackgroundPrograms that aim to improve the detection hypoxic-ischemic encephalopathy (HIE) should establish which neonates suffering from perinatal asphyxia need to be monitored within the first 6 h of life.MethodAn observational prospective cohort study of infants with gestational age ≥35 weeks, and above 1,800g, were included according to their arterial cord pH value (ApH): ≤7.00 vs. 7.01–7.10. Data was collected including obstetrical history, as well as neonatal comorbidities, including the presence of HIE, that happened within 6 h of life. A standardized neurological exam was performed at discharge.ResultsThere were 9,537 births; 176 infants with ApH 7.01–7.10 and 117 infants with ApH ≤7.00. All 9 cases with moderate-to-severe HIE occurred among infants with ApH ≤7.00. The incidence of global and moderate-severe HIE was 3/1,000 and 1/1,000 births, respectively. Outcome at discharge (abnormal exam or death) showed an OR 12.03 (95% CI 1.53, 94.96) in infants with ApH ≤7.00 compared to ApH 7.01–7.10 cohort. Ventilation support was 5.1 times (95% CI 2.87, 9.03) more likely to be needed by those with cord ApH ≤7.00 compared to those with ApH 7.01–7.10, as well as hypoglycemia (37% vs. 25%; p = 0.026). In 55%, hypoglycemia occurred despite oral and/or intravenous glucose administration had been already initiated.ConclusionsCord pH 7.00 might be a safe pH cut-off point when developing protocols to monitor infants born with acidemia in order to identify infants with moderate or severe HIE early on. There is non-negligible comorbidity in the ApH ≤7.00 cohort, but also in the 7.01–7.10 cohort.

[This corrects the article DOI: 10.1371/journal.pone.0230010.].

Purpose. Basal cell carcinoma (BCC) is the most frequent malignant periocular tumor. It is associated with exposure to ultraviolet radiation, and its incidence is gradually increasing. It may occasionally display more aggressive behavior and result in orbital or intracranial invasion. Mortality from periocular BBC with orbital invasion is very low, but the associated morbidity can be significant, from disfigurement to blindness. Traditionally, these cases have been treated with orbital exenteration or with radiotherapy (RT), but in recent years, hedgehog pathway inhibitors (HPIs) have emerged, are effective in more serious cases, and are used primarily or combined with surgery, changing our perspective on the management of these patients. Methods. We studied 24 cases of periocular BCC with orbital invasion, some primary and others recurrent, which were treated between 2011 and 2021 in the same hospital. All patients had clinical or radiological evidence of orbital invasion. Orbital exenteration was performed on 9/24 of the patients (1 received vismodegib after surgery), and 12/24 were treated, surgically preserving the eyeball, with 3 of them receiving adjuvant vismodegib. Three of the twenty-four patients were treated exclusively with vismodegib (Erivedge®, Genentech). Results. One patient died due to poor tumor evolution, but the rest evolved favorably and they have had no recurrences. Vismodegib was generally well tolerated, except for in one patient who discontinued treatment due to the side effects. Conclusions. In advanced BBC with orbital invasion, mutilating surgical treatments such as exenteration or potentially vision-threatening treatments such as RT remain as options. In recent years, however, very promising new medical therapies have emerged, such as HPI, which can be used effectively instead of surgery or in combination with it, preserving the eye and vision, which implies a new approach to treatment.

Cherry is a fruit which contains elevated amounts of antioxidant compounds, such as anthocyanins, pigments, and vitamins. Furthermore, it possesses high water, sugar, mineral, and indolamine contents. The general objective of this study was to characterise a cherry-based fermented beverage (the ‘sweetheart’ variety) and analyse the effects of its ingestion on (i) circulating serum levels of melatonin and serotonin, (ii) inflammatory response, and iii) serum total antioxidant capacity in rats (Rattus norvegicus). For cherry-based fermented beverage manufacturing, the cherries were washed, the stems and woody endocarps were removed, and ascorbic acid was added (to avoid enzymatic browning). After the homogenisation of the cherry fruit, lactic acid bacteria were inoculated, and the fermentation process was conducted for 36 h. The main bioactive compounds in the cherry beverage were characterised, as well as their total antioxidant capacity. Moreover, an in vivo assay was developed, in which rats ingested the fermented beverage ad libitum for seven days. The inflammatory mediators, the total antioxidant capacity, and the serum levels of melatonin and serotonin were measured. Based on these results, the intake of the cherry-based fermented beverage assayed in this study increased the total antioxidant status of rats, elevated the melatonin and serotonin levels in the serum, and improved the regulation of the inflammatory systemic processes.

Introdução: O interesse por estudos na área de Avaliação de Tecnologia em Saúde (ATS) vem crescendo devido à sua importância no adequado direcionamento das políticas no que se refere à incorporação de novas tecnologias na atenção à saúde. A incorporação de tecnologias responde por cerca de um terço do aumento dos gastos com saúde no mundo, comprometendo a sustentabilidade dos sistemas de saúde. Na Secretaria da Saúde do Estado da Bahia (SESAB), a Diretoria de Ciência, Tecnologia e Inovação em Saúde (DITEC) atua na área de desenvolvimento de base científica, tecnológica e de inovação em saúde. A Coordenação de Avaliação de Tecnologia em Saúde (COATS) foi criada em abril de 2016, vinculada à DITEC, com o objetivo de institucionalizar o uso dos métodos de ATS na tomada de decisão no âmbito estadual do SUS e como missão subsidiar a tomada de decisão sobre incorporação, alteração ou exclusão de tecnologias em saúde e difundir o uso da ATS no âmbito do SUS/Ba. Objetivo: Relatar a experiência da estruturação de uma coordenação de avaliação de tecnologia em uma secretaria estadual de saúde. Métodos: Trata-se de um relato de experiência acerca da estruturação da COATS, com foco nos resultados obtidos no período de um ano de implantação do serviço. Os dados primários referem-se ao período compreendido entre abril de 2016 e abril 2017 e foram coletados a partir da análise documental dos relatórios de gestão e de atividade da equipe técnica, do banco de dados do Sistema Integrado de Material, Patrimônio e Serviços (SIMPAS) e outros documentos produzidos no setor. Resultados: Nesse período, a COATS acumulou resultados relevantes: construção de documentos norteadores como fluxo de incorporação de tecnologias em saúde no SUS estadual, formulário de solicitação de descritivos de novas tecnologias pelas unidades da rede da SESAB e procedimentos operacionais padrão para elaboração de descritivos; elaboração da minuta da portaria da Comissão Estadual de ATS; condução de Grupo de Trabalho de Padronização de Descritivos de Medicamentos para o SIMPAS; elaboração/ revisão de cerca de 209 descritivos; atendimento de aproximadamente 31 fornecedores de tecnologias em saúde, elaboração de 03 notas técnicas e 05 informes técnicos. Conclusão: Considerando que até abril de 2016 inexistia na SESAB uma coordenação de ATS, a criação da COATS representou um avanço na disseminação da cultura, consolidação e institucionalização da metodologia de ATS no Estado da Bahia. A partir dos resultados apresentados, conclui-se que a centralização das ações de ATS na COATS favorece o acompanhamento, avaliação e monitoramento de seus impactos e resultados.

Introdução: O Diabetes mellitus (DM) é uma doença crônica, cujo controle glicêmico inadequado resulta no aparecimento de graves complicações que reduzem a expectativa de vida e comprometem a qualidade de vida do portador desta doença. Entre os insumos disponibilizados pelo SUS, em cumprimento da contrapartida do Componente Básico da Assistência Farmacêutica (Portaria MS/GM 1.555, de 30/07/2013), estão as tiras reagentes utilizadas para o controle glicêmico de usuários do SUS portadores de DM. As tiras funcionam em conjunto com glicosímetros que são aparelhos portáteis que medem a glicemia capilar com precisão satisfatória em pouco tempo em comparação com os métodos laboratoriais. A Secretaria de Saúde do Estado da Bahia (SESAB) enfrentava problemas em suas licitações para compra de tiras de glicemia pois as especificações técnicas estavam sempre direcionadas para os métodos fotométrico ou amperométrico dos glicosímetros. Objetivos: Correlacionar os métodos amperométrico e fotométrico dos glicosímetros quanto às semelhanças nos resultados apresentados de glicemia capilar; revisar o descritivo técnico das tiras de glicemia para evitar impugnações em licitações futuras e garantir o princípio da ampla concorrência nos processos licitatórios. Métodos: Trata-se de um trabalho de revisão técnica de descritivo de tiras reagentes realizado pela Coordenação de Avaliação de Tecnologias em Saúde (COATS) motivado pelos direcionamentos provocados por conta dos métodos amperométrico ou fotométrico. Buscou-se verificar quais as diferenças entre eles em termos de acurácia. Foi realizada busca quanto a alertas de tecnovigilância nas agências regulatórias e evidências na literatura para análise de resultados apresentados pelos dois métodos. Resultados: Foi identificado que os dois métodos de leitura dos glicosímetros não interferem nos resultados de acurácia do teste. Dessa forma, foi elaborado um novo descritivo técnico para as tiras, possibilitando que diferentes fabricantes pudessem participar das licitações. Essa mudança permitiu a redução do preço unitário da tira de R$ 0,4430 para R$0,3090, gerando uma economia de 30,2% provocada pela maior concorrência. Conclusão: Na análise técnica dos descritivos anteriores, identificou-se que apenas poucas empresas poderiam concorrer ao edital, ocasionando processos licitatórios com número limitado de participantes, além de impugnações subsequentes. Este trabalho garantiu ampla concorrência nos pregões e economia para o estado. Considerando uma estimativa mínima de 35 milhões de tiras reagentes compradas, o Estado chegou a um montante economizado de R$4,5 milhões em recursos.

The influence of the oceanic medium on the underwater optical wireless communication (UOWC) highlights the need for an accurate mathematical channel characterization that models the properties of realistic oceanic environments, significantly optimizing the development of practical UOWC system designs. However, a need remains to provide a deeper insight into the behavior of air bubbles in turbid waters. This article presents an analysis and a statistical characterization of the received optical power fluctuations when considering different air bubble sizes and levels of particle-induced scattering. Experimental measurements were conducted in a water tank, manipulating water turbidity levels by dissolving a commercial antacid. Afterward, some evaluation metrics, such as the scintillation index, the average outage duration, and the coherence time, are calculated to provide an analytical framework of the air bubbles-induced fading in turbid environments. Additionally, the statistical behavior of small and large air bubbles are analytically described through the generalized Gamma distribution and a mixture of two generalized Gamma distributions, respectively, and validated with a coefficient of determination above 0.95 for all the considered turbid waters. Results demonstrate that water turbidity dramatically affects the stochastic behavior of the underwater channel in the presence of air bubbles, resulting in a significant reduction in light blockage due to the collection of scattered photons. As a result, the scintillation index and the average outage duration are noticeably reduced for more turbid water.