Assessment of critical resource gaps in pediatric injury care in Mozambique's four largest Hospitals.

BACKGROUND: Hospitals from resource-scarce countries encounter significant barriers to the provision of injury care, particularly for children. Shortages in material and human resources are seldom documented, not least in African settings. This study analyzed pediatric injury care resources in Mozambique hospital settings. METHODS: We undertook a cross-sectional study, encompassing the country's four largest hospitals. Data was collected in November 2020 at the pediatric emergency units. Assessment of the resources available was made with standardized WHO emergency equipment and medication checklists, and direct observation of premises and procedures. The potential impact of unavailable equipment and medications in pediatric wards was assessed considering the provisions of injury care. RESULTS: There were significant amounts of not available equipment and medications in all hospitals (ranging from 20% to 49%) and two central hospitals stood out in that regard. The top categories of not available equipment pertained to diagnosis and monitoring, safety for health care personnel, and airway management. Medications to treat infections and poisonings were those most frequently not available. There were several noteworthy and life-threatening shortcomings in how well the facilities were equipped for treating pediatric patients. The staff regarded lack of equipment and skills as the main obstacles to delivering quality injury care. Further, they prioritized the implementation of trauma courses and the establishment of trauma centers to strengthen pediatric injury care. CONCLUSION: The country's four largest hospitals had substantial quality-care threatening shortages due to lack of equipment and medications for pediatric injury care. All four hospitals face issues that put at risk staff safety and impede the implementation of essential care interventions for injured children. Staff wishes for better training, working environments adequately equipped and well-organized. The room for improvement is considerable, the study results may help to set priorities, to benefit better outcomes in child injuries.

Assessment of asymmetry at different intensities between conventional and paralympic powerlifting athletes.

Powerlifting competitions require consistent and symmetric lifting of heavy loads and maximal effort, in which, asymmetric lifting results in trial invalidation. Symmetry during this very high intensity movement is determinant to athletes' performance and success in competitions. This study aimed to compare the asymmetry between Conventional Powerlifting athletes (CP) and Paralympic (PP) athletes at intensities of 45 and 80% 1RM before and after a training session. Twenty-two male athletes (11 CP: 29.84 ± 4.21 and 11 PP: 30.81 ± 8.05 years old) participated in this study. Mean Propulsive Velocity (MPV), Maximum Velocity (Vmax) and Power during the concentric and eccentric phases were evaluated at 45%-1RM before and after a training session. For the intensity of 80%-1RM, MPV, Vmax and Power were measured in the first and last series (5 series of 5 repetitions: 5X5) of a training session. PP athletes demonstrated lower velocity and greater symmetry at 45%-1RM, but higher velocity and less asymmetry at 80%-1RM, when compared to CP. The data indicated that PP athletes tend to be slower at lower intensities, faster at higher intensities in absolute values, and have greater symmetry than CP.

Ongoing Bidirectional Feedback between Planning and Assessment in Educational Contexts: A Narrative Review.

Quality in education is one of the 17 goals in the United Nations' sustainable agenda for 2030, presupposing careful planning and assessment of learning. Traditional planning in sports education (either in training or school settings) largely adopts pre-determined learning sequences and temporal milestones that, in theory, enhance the learning process. However, learning is a context-dependent, non-linear process with considerable intra- and interindividual variability, whereby planning and assessment should also be non-linear. In this narrative review, the main findings suggest that the specific teaching or training contents and their relative (i.e., ordering or sequencing) and absolute timing (i.e., the specific time point where certain learning or adaptations are expected) should vary depending on the learners and the context. In a process-oriented perspective, this requires flexible planning and the establishment of ongoing bidirectional links between planning and assessment. In this framework, assessment should be a flexible, evolving, and daily pedagogical tool instead of a set of formal checkpoints. We further explored how planning and assessment could be linked to provide an ongoing feedback loop that respects the individuality of each learner and its context, and therefore hope this review helps bring about a change in current planning and assessment paradigms in sports education.

Day-to-day Variation of The Heart Rate, Heart Rate Variability, and Energy Expenditure During FIFA 11+ and Dynamic Warm-up Exercises.

There seems to be a scarcity in literature investigating day-to-day warm-up (WU) variations. We investigated day-to-day variation of psychophysiological responses during Fédération Internationale de Football Association (FIFA) 11+ and dynamic warm-up (DWU) exercises. Twenty-one male collegiate soccer players were randomly assigned to the FIFA 11+ (n = 10) or DWU group (n = 11). Each group performed the assigned WU protocol on three different occasions with a 48-h interval in between. The inter-day variation of the heart rate (HR), time distribution of HR zones, heart rate variability (HRV), estimated energy expenditure (EE), blood lactate (BL) concentration, and the Borg rating of perceived exertion (RPE) were recorded. A two-way repeated measures of analysis of variance was used to compare the differences in chosen variables [group (2) × day (3)]. The coefficient of variation was used to determine the dispersion of the variables over the sessions. The interclass correlation coefficient (ICC) with a two-way random model and a single measure (ICC2,1) was used to determine inter-day reliability. There were no significant differences in time spent at particular HR zones and EE in both groups. The FIFA 11+ exercises showed high reliability of exercise duration, average HR (HRaverage), minimal HR (HRmin), peak HR (HRpeak), and post-exercise RPE. In the DWU group, high reliability was found only in HRaverage, HRpeak, and post-exercise RPE. The FIFA 11+ exercises showed similar EE, exercise HR patterns, BL, and RPE compared to the DWU. The FIFA 11+ program is an intense WU protocol with a characteristically low variation of day-to-day exercise HR and RPE responses.

Flexible Training Planning Coupled with Flexible Assessment: A 12-Week Randomized Feasibility Study in a Youth Female Volleyball Team.

According to the Quality Education and Gender Equality ambitions established at the 2030 Agenda for Sustainable Development Goals, we aimed to test the feasibility of a flexible planning and assessment process, using ongoing, bidirectional feedback between planning and assessment. Eighteen players (11.5 ± 0.5 years of age) from a U13 female volleyball team were randomized into an experimental group (in which the plan could be changed daily) or a contrast group (pre-defined planning, adjusted monthly). The pedagogical intervention lasted three months. Besides ongoing daily assessments from the training practices, the Game Performance Assessment Instrument was adopted as a starting point for the weekly assessments in 4 vs. 4 game-forms (i.e., the instrument was modified monthly based on feedback from the training process). Information from daily and weekly formal assessment was used in the planning of the experimental group, and monthly in the contrast group. Data suggested that pre-established and strict planning (even updated monthly) failed to fit current learner needs. Over 12 weeks, the pre-established planning suffered regular modifications in the experimental group, and the assessment tool changed monthly. In conclusion, both planning and assessment should be open and flexible to exchange information mutually, and support the design of tailor-made learning environments.

Wearables and Internet of Things (IoT) Technologies for Fitness Assessment: A Systematic Review.

Wearable and Internet of Things (IoT) technologies in sports open a new era in athlete's training, not only for performance monitoring and evaluation but also for fitness assessment. These technologies rely on sensor systems that collect, process and transmit relevant data, such as biomarkers and/or other performance indicators that are crucial to evaluate the evolution of the athlete's condition, and therefore potentiate their performance. This work aims to identify and summarize recent studies that have used wearables and IoT technologies and discuss its applicability for fitness assessment. A systematic review of electronic databases (WOS, CCC, DIIDW, KJD, MEDLINE, RSCI, SCIELO, IEEEXplore, PubMed, SPORTDiscus, Cochrane and Web of Science) was undertaken according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. From the 280 studies initially identified, 20 were fully examined in terms of hardware and software and their applicability for fitness assessment. Results have shown that wearable and IoT technologies have been used in sports not only for fitness assessment but also for monitoring the athlete's internal and external workloads, employing physiological status monitoring and activity recognition and tracking techniques. However, the maturity level of such technologies is still low, particularly with the need for the acquisition of more-and more effective-biomarkers regarding the athlete's internal workload, which limits its wider adoption by the sports community.

Match Fatigue Time-Course Assessment Over Four Days: Usefulness of the Hooper Index and Heart Rate Variability in Professional Soccer Players.

The aims of the present study were to (a) examine recovery time-course and (b) analyze the usefulness of the Hooper-Index (wellness index) and resting heart rate variability (HRV) in professional soccer players during an in-season phase. The Hooper-Index and resting HRV were collected on matchday and on the four following days in three consecutive in-season weeks in nine players (25.2 ± 4.3-years). The usefulness of monitoring variables was assessed by (a) comparing noise (typical error, TE) to the smallest worthwhile change (SWC) (TE/SWC) and (b) comparing match-related changes (i.e., signal) to TE (i.e., signal-to-noise ratio). Between-days standardized differences in the changes of Hooper-Index and HRV were compared to the SWC using magnitude-based inferences. The magnitudes of TE were small and moderate for the Hooper-Index and HRV, respectively. The Hooper-Index showed to be more useful than HRV for monitoring match-induced fatigue as having a lower TE/SWC (3.1 versus 4.4) and a higher signal-to-noise ratio (5.5 versus 1.5). Small-to-very large [range of effect sizes, 0.48; 2.43, confidence limits (0.22; 2.91)] and moderate-to-large [-1.71; -0.61 (-2.44; -0.03)] detrimental changes in Hooper-Index and HRV, respectively, were observed on the days following matchday. While group analyses showed a similar pattern for recovery time-course, more individual players responded, similarly when tracked using the Hooper -Index compared to when they were tracked using HRV. An inverse moderate within-individual relationship was observed between changes in the Hooper index and HRV [r = -0.41, (-0.60, 0.18)]. The Hooper index is an easy-to-use, no-cost, and non-invasive monitoring tool and seems promising for tracking match-induced fatigue during in the season in professional soccer.

Body Composition Evaluation Issue among Young Elite Football Players: DXA Assessment.

Accurate assessment of body composition is an important issue among athletes. Different methodologies generate controversial results, leading to a deep uncertainty on individual exercise prescriptions. Thus, this study aims to identify the differences between field methods, such as bioelectrical impedance (BIA) and skinfold assessment, with a clinical method, highly accurate, dual-energy X-ray absorptiometry (DXA), among elite young football players. Thirty-eight male football players with a mean (sd) age of 16.7 (0.87) years, involved in the Portuguese national competition of U16 (n = 13) and U19 (n = 25), were evaluated and objective measures of body composition, muscle strength and football skills were collected by trained specialists. Body composition was assessed using BIA (Tanita BC-418, Tanita Corp., Tokyo, Japan), in agreement with all the evaluation premises. Additionally, all athletes were evaluated using the clinical method DXA (Hologic Inc., Waltham, MA, USA). Among the U19 athletes, three skinfold sites (SKF) were assessed: chest, abdomin and thigh. The Spearman correlation coefficients and the mean difference between methods were calculated. The agreement between both methods was analyzed using Bland-Altman plots. Among the evaluated athletes, lower mean values of body fat % were found using BIA as a method of body composition assessment compared with DXA (12.05 vs. 15.58 for U16; 11.97 vs. 14.16 for U19). Despite the moderate correlation between methods (r = 0.33) to estimate the percentage of total fat, the median of the difference (DXA vs. BIA) was relevant in clinical terms, with 2.90% and 1.47% for U16 and U19 athletes, respectively. Stronger correlations were found between the sum of the SKF and DXA fat estimation (r = 0.68). The Bland-Altman plots showed a clear underestimation in the evaluations using the BIA, namely among athletes with better body composition profiles (8%⁻12% of fat). Using BIA, an underestimation of body fat assessment was observed among 94.5% of the athletes with less than 12% body fat mass. Among the evaluated athletes, fat mass was underestimated at a median value of 2.21% using BIA in comparison with DXA. The sum of the SKF showed a stronger correlation with the reference method (DXA) (r = 0.68) than BIA.

Tactical expertise assessment in youth football using representative tasks.

Specific football drills improve the development of technical/tactical and physical variables in players. Based on this principle, in recent years it has been possible to observe in daily training a growing volume of small-sided and conditioned games. These games are smaller and modified forms of formal games that augment players' perception of specific tactics. Despite this approach, the assessment of players' knowledge and tactical execution has not been well documented, due mainly to the difficulty in measuring tactical behavior. For that reason, this study aims to provide a narrative review about the tactical assessment of football training by using representative tasks to measure the tactical expertise of youth football players during small-sided and conditioned games. This study gives an overview of the ecological approach to training and the principles used for representative task design, providing relevant contribution and direction for future research into the assessment of tactical expertise in youth football.