A Survey on Sensor Failures in Autonomous Vehicles: Challenges and Solutions.

Autonomous vehicles (AVs) rely heavily on sensors to perceive their surrounding environment and then make decisions and act on them. However, these sensors have weaknesses, and are prone to failure, resulting in decision errors by vehicle controllers that pose significant challenges to their safe operation. To mitigate sensor failures, it is necessary to understand how they occur and how they affect the vehicle's behavior so that fault-tolerant and fault-masking strategies can be applied. This survey covers 108 publications and presents an overview of the sensors used in AVs today, categorizes the sensor's failures that can occur, such as radar interferences, ambiguities detection, or camera image failures, and provides an overview of mitigation strategies such as sensor fusion, redundancy, and sensor calibration. It also provides insights into research areas critical to improving safety in the autonomous vehicle industry, so that new or more in-depth research may emerge.

Development and validation of a multi-substance method for routine analysis of pesticides in post-mortem samples by Ultra-High Performance Liquid Chromatography-Tandem Mass Spectrometry.

Pesticides play an important role in forensic toxicology and are usually classified as a single class of chemicals. Despite their commonly perceived unity, pesticides encompass a spectrum of compounds, including organophosphates, carbamates, pyrethroids or organochlorines, among others, each with varying degrees of toxicity. Pesticide analysis in post-mortem samples can be difficult due to the complexity of the samples and to the high toxicity of these compounds. The aim of this study was to develop and validate an easy to use, sensitive, and robust method, using ultra-performance liquid chromatography-tandem mass spectrometry to be incorporated in the routine flow for pesticide analysis in post-mortem blood samples. Described herein is a streamlined, expeditious, yet highly efficient method facilitating the screening, qualitative assessment, and quantitative confirmation of 15 pesticides, including acetamiprid, azinphos-ethyl, bendiocarb, carbofuran, chlorfenvinphos, dimethoate, imidaclopride, malathion, methiocarb, methomyl, parathion, pirimicarb, strychnine, tetrachlorvinphos, and thiacloprid in post-mortem blood, recognizing the pivotal role blood plays in forensic investigations. The developed method was linear from 10 to 200 ng/mL; limits of detection were between 1 and 10 ng/mL, depending on the compound; it was successfully evaluated a dilution ratio of 1-2, 5 and 10; and 8 substances showed maximum stability for the time interval studied. This UHPLC-MS/MS method is useful and a powerful tool in a toxicology lab because it is fast, simple, effective, and trustworthy. The results of this validation highlight the robustness of the analytical method, providing a valuable tool for the accurate and sensitive detection of pesticides in post-mortem blood. Poised for routine implementation, this method has already found success in suspected intoxication cases, promising to elevate the standards of forensic pesticide analysis.

Global consensus statement on simulation-based practice in healthcare.

Simulation plays a pivotal role in addressing universal healthcare challenges, reducing education inequities, and improving mortality, morbidity and patient experiences. It enhances healthcare processes and systems, contributing significantly to the development of a safety culture within organizations. It has proven to be cost-effective and successful in enhancing team performance, fostering workforce resilience and improving patient outcomes.Through an international collaborative effort, an iterative consultation process was conducted with 50 societies operating across 67 countries within six continents. This process revealed common healthcare challenges and simulation practices worldwide. The intended audience for this statement includes policymakers, healthcare organization leaders, health education institutions, and simulation practitioners. It aims to establish a consensus on the key priorities for the broad adoption of exemplary simulation practice that benefits patients and healthcare workforces globally.Key recommendations Advocating for the benefits that simulation provides to patients, staff and organizations is crucial, as well as promoting its adoption and integration into daily learning and practice throughout the healthcare spectrum. Low-cost, high-impact simulation methods should be leveraged to expand global accessibility and integrate into system improvement processes as well as undergraduate and postgraduate curricula. Support at institutional and governmental level is essential, necessitating a unified and concerted approach in terms of political, strategic and financial commitment.It is imperative that simulation is used appropriately, employing evidence-based quality assurance approaches that adhere to recognized standards of best practice. These standards include faculty development, evaluation, accrediting, credentialing, and certification.We must endeavor to provide equitable and sustainable access to high-quality, contextually relevant simulation-based learning opportunities, firmly upholding the principles of equity, diversity and inclusion. This should be complemented with a renewed emphasis on research and scholarship in this field.Call for action We urge policymakers and leaders to formally acknowledge and embrace the benefits of simulation in healthcare practice and education. This includes a commitment to sustained support and a mandate for the application of simulation within education, training, and clinical environments.We advocate for healthcare systems and education institutions to commit themselves to the goal of high-quality healthcare and improved patient outcomes. This commitment should encompass the promotion and resource support of simulation-based learning opportunities for individuals and interprofessional teams throughout all stages and levels of a caregiver's career, in alignment with best practice standards.We call upon simulation practitioners to champion healthcare simulation as an indispensable learning tool, adhere to best practice standards, maintain a commitment to lifelong learning, and persist in their fervent advocacy for patient safety.This statement, the result of an international collaborative effort, aims to establish a consensus on the key priorities for the broad adoption of exemplary simulation practice that benefits patients and healthcare workforces globally.

The Gut Microbiome Controls Liver Tumors via the Vagus Nerve.

Liver cancer ranks amongst the deadliest cancers. Nerves have emerged as an understudied regulator of tumor progression. The parasympathetic vagus nerve influences systemic immunity via acetylcholine (ACh). Whether cholinergic neuroimmune interactions influence hepatocellular carcinoma (HCC) remains uncertain. Liver denervation via hepatic vagotomy (HV) significantly reduced liver tumor burden, while pharmacological enhancement of parasympathetic tone promoted tumor growth. Cholinergic disruption in Rag1KO mice revealed that cholinergic regulation requires adaptive immunity. Further scRNA-seq and in vitro studies indicated that vagal ACh dampens CD8+ T cell activity via muscarinic ACh receptor (AChR) CHRM3. Depletion of CD8+ T cells abrogated HV outcomes and selective deletion of Chrm3 on CD8 + T cells inhibited liver tumor growth. Beyond tumor-specific outcomes, vagotomy improved cancer-associated fatigue and anxiety-like behavior. As microbiota transplantation from HCC donors was sufficient to impair behavior, we investigated putative microbiota-neuroimmune crosstalk. Tumor, rather than vagotomy, robustly altered fecal bacterial composition, increasing Desulfovibrionales and Clostridial taxa. Strikingly, in tumor-free mice, vagotomy permitted HCC-associated microbiota to activate hepatic CD8+ T cells. These findings reveal that gut bacteria influence behavior and liver anti-tumor immunity via a dynamic and pharmaceutically targetable, vagus-liver axis.

Integration of simulation-based education in anaesthesiology specialist training: Synthesis of results from an Utstein Meeting.

BACKGROUND: Despite its importance in education and patient safety, simulation-based education and training (SBET) is only partially or poorly implemented in many countries, including most European countries. The provision of a roadmap may contribute to the development of SBET for the training of anaesthesiologists. OBJECTIVE: To develop a global agenda for the integration of simulation into anaesthesiology specialist training; identify the learning domains and objectives that are best achieved through SBET; and to provide examples of simulation modalities and evaluation methods for these learning objectives. DESIGN: Utstein-style meeting where an expert consensus was reached after a series of short plenary presentations followed by small group workshops, underpinned by Kern's six-step theoretical approach to curriculum development. SETTING: Utstein-style collaborative meeting. PARTICIPANTS: Twenty-five participants from 22 countries, including 23 international experts in simulation and two anaesthesia trainees. RESULTS: We identified the following ten domains of expertise for which SBET should be used to achieve the desired training outcomes: boot camp/initial training, airway management, regional anaesthesia, point of care ultrasound, obstetrics anaesthesia, paediatric anaesthesia, trauma, intensive care, critical events in our specialty, and professionalism and difficult conversations. For each domain, we developed a course template that defines the learning objectives, instructional strategies (including simulation modalities and simulator types), and assessment methods. Aspects related to the practical implementation, barriers and facilitators of this program were also identified and discussed. CONCLUSIONS: We successfully developed a comprehensive agenda to facilitate the integration of SBET into anaesthesiology specialist training. The combination of the six-step approach with the Utstein-style process proved to be extremely valuable in supporting content validity and representativeness. These results may facilitate the implementation and use of SBET in several countries. TRIAL REGISTRATION: Not applicable.

The COVID-19 Impact on Oral Healthcare Demand and Performance: The Experience of a Clinical and Academic Centre in Portugal (EU).

INTRODUCTION: The SARS-CoV-2 pandemic has reshaped the global landscape as we know it and had a tremendous effect on healthcare systems around the world. However, its impact on oral healthcare is still to be fully assessed. The aim of this study was to understand if and how COVID-19 affected the demand and performance of oral healthcare, taking the Clinical and Academic Centre of Coimbra as an example, more specifically, the Department of Stomatology of the Coimbra Hospital and University Centre and the Dentistry Department of the Faculty of Medicine of the University of Coimbra. MATERIAL AND METHODS: An observational study was designed for collecting the data of a series of key oral healthcare indicators: number of appointments; referrals from primary healthcare; missed appointments; number of surgeries performed in the operating room; number of biopsies; number of patients admitted through the emergency department and epidemiologic parameters over two 18-month periods between September 2018 and August 2021: pre-COVID-19 and during the COVID-19 pandemic, with the latter divided in four stages. A statistical analysis which included descriptive and inferential procedures was then performed, with an established significance level of 5% and the application of parametric tests, t-Student test for a sample and for independent samples and One-Way ANOVA for the variance analysis. RESULTS: There was a general decline in all indicators comparing the pre-COVID-19 with the COVID-19 period, with a reduction of 50.61% in the number of appointments, 44.06% in referrals, 24.41% in surgeries, 26.30% in biopsies and 32.33% in patients seen in the Emergency Room. The number of missed appointments also increased by 181.82%. All variations revealed statistically significant differences (p < 0.05). The individual COVID-19 stage analysis, when compared with the pre-COVID-19 reference, and variance analysis of these different stages also showed statistically significant differences (p < 0.05 and p < 0.001), except for the number of biopsies during the third and fourth stages. CONCLUSION: The results of this study suggest that the SARS-CoV-2 pandemic has had a considerable impact on oral healthcare demand and performance. However, results also show a remarkable adjustment and improvement in the provided care, with a positive evolution throughout the COVID-19 period.

Incidental Discovery of Nonrotation in a Patient With Nonspecific Abdominal Pain: A Surgical Diagnostic Dilemma.

Intestinal nonrotation is a subtype of malrotation occurring when the midgut fails to rotate before returning to the peritoneal cavity between weeks 8-10 of development. Though sometimes presenting as volvulus during the neonatal period, a subset of patients remains asymptomatic and are identified incidentally as adults. When patients with intestinal nonrotation present with abdominal symptoms, there exists a diagnostic dilemma for the treating surgeon. We present the case of a patient who presented with acute abdominal pain and vomiting, with radiographic findings of intestinal nonrotation and no other acute pathology. Symptoms spontaneously resolved with conservative management for likely etiology of viral gastroenteritis. At the one-month follow-up, the patient had no residual or recurrent symptoms, with no further interventions planned.

Addressing the Relationship Between Testosterone Levels and Urethral Stricture: A Case-Control Study.

PURPOSE: Hypoandrogenism may have an association with urethral stricture. This study aimed to identify and quantify the association between testosterone levels and urethral stricture. MATERIALS AND METHODS: A case-control study was conducted from January 2019 to January 2021. The case group included patients diagnosed with anterior urethral stricture who visited our urethral office of the urology department, while the control group included patients who visited our practice due to clinical conditions unrelated to voiding. In both groups, a 10 cc blood sample collection was scheduled between 7:30 and 9:30 a.m. The outcome was case/control status. The exposure variables were total testosterone, free testosterone, bioavailable testosterone, and hypoandrogenism (total testosterone < 300 ng/dL). The adjusted ORs were calculated for each exposure. Age, body mass index, hypertension, diabetes, smoking, and thyroxine levels were considered possible confounding factors. RESULTS: A total of 149 cases (mean age 59.5) were compared to 67 controls (64.3). Urethral stricture cases showed significantly lower mean total testosterone than controls (394 ng/dL vs 488 ng/dL). Similarly, the hypoandrogenism rate was significantly higher in the urethral stricture group (26% vs 7.5%). Each 100 unit increase in total testosterone was related to a 34% decrease in the odds of urethral stricture (adjusted OR 0.66, 95% CI: 0.51-0.86). Similarly, each increase of 1 unit of free testosterone and 10 units of bioavailable testosterone was associated with a decrease of 18% and 10%, respectively. A strong direct relationship was observed between hypoandrogenism and urethral stricture (adjusted OR 4.01, 95% CI: 1.37-11.7). CONCLUSIONS: Our study demonstrates an independent association between hypoandrogenism and anterior urethral stricture.

Potential of FX06 to prevent disease progression in hospitalized non-intubated COVID-19 patients - the randomized, EU-wide, placebo-controlled, phase II study design of IXION.

BACKGROUND: More than 2.7 million hospitalizations of COVID-19-infected patients have occurred in Europe alone since the outbreak of the coronavirus in 2020. Interventions against SARS-CoV-2 are still in high need to prevent admissions to ICUs worldwide. FX06, a naturally occurring peptide in humans and other mammals, has the potential to reduce capillary leak by improving endothelial dysfunction and thus preventing the deterioration of patients. With IXION, we want to investigate the potential of FX06 to prevent disease progression in hospitalized, non-intubated COVID-19 patients. METHODS: IXION is an EU-wide, multicentre, placebo-controlled, double-blinded, parallel, randomized (2:1) phase II clinical study. Patient recruitment will start in September 2022 (to Q2/2023) in Germany, Italy, Lithuania, Spain, Romania, Portugal, and France. A total of 306 hospitalized patients (≥ 18 years and < 75 years) with a positive SARS-CoV-2 PCR test and a COVID-19 severity of 4-6 according to the WHO scale will be enrolled. After randomization to FX06 or placebo, patients will be assessed until day 28 (and followed up until day 60). FX06 (2 × 200 mg per day) or placebo will be administered intravenously for 5 consecutive days. The primary endpoint is to demonstrate a difference in the proportion of patients with progressed/worsened disease state in patients receiving FX06 compared to patients receiving placebo. Secondary endpoints are lung function, oxygen saturation and breathing rate, systemic inflammation, survival, capillary refill time, duration of hospital stay, and drug accountability. DISCUSSION: With IXION, the multidisciplinary consortium aims to deliver a new therapy in addition to standard care against SARS-CoV-2 for the clinical management of COVID-19 during mild and moderate stages. Potential limitations might refer to a lack of recruiting and drop-out due to various possible protocol violations. While we controlled for drop-outs in the same size estimation, recruitment problems may be subject to external problems difficult to control for. TRIAL REGISTRATION: EudraCT 2021-005059-35 . Registered on 12 December 2021. Study Code TMP-2204-2021-47.

Association of the Maternal Folic Acid Supplementation with the Autism Spectrum Disorder: A Systematic Review.

OBJECTIVE: To analyze the scientific production regarding maternal folic acid (FA) supplementation and its relationship with autistic spectrum disorder (ASD). DATA SOURCES: We performed unrestricted electronic searches in the BIREME virtual bank, Virtual Health Library (VHL) and Medical Literature Analysis and Retrieval System Online (MEDLINE/PubMed) databases. SELECTION OF STUDIES: For sample selection, articles that met the proposed objectives were included, published in English, Spanish and Portuguese, the use of Health Sciences Descriptors (DeCS): autistic OR autism AND autism spectrum disorder AND folic acid, AND, with the use of the Medical Subject Headings (MeSH): autistic OR autism AND autistic spectrum disorder AND folic acid. DATA COLLECTION: Data extraction was performed by the reviewers with a preestablished data collection formulary. DATA SYNTHESIS: The Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P) was used based on a checklist with 27 items and a 4-step flowchart. RESULTS: A total of 384 articles was found by the search strategies, of which 17 were eligible following the pre-established criteria. The main findings of the present review point to maternal FA supplementation in the pre-conception period and beginning of pregnancy as a protective effect in relation to ASD, which should be indicated in this period as prevention to the problem. CONCLUSION: According to the research analyzed, more studies are necessary to know its effects on pregnancy, since the consumption of excessive FA may not be innocuous.

OBJETIVO: Analisar a produção científica a respeito da suplementação de ácido fólico (AF) materno e sua relação com o transtorno do espectro autista (TEA). FONTES DE DADOS: Realizamos buscas eletrônicas irrestritas nas bases de dados do banco virtual BIREME, Biblioteca Virtual em Saúde (VHL) e Medical Literature Analysis and Retrieval System Online (MEDLINE / PubMed). SELEçãO DOS ESTUDOS: Incluímos os artigos publicados em inglês, espanhol e português, com o uso dos DeCS: autistic OR autism AND autism spectrum disorder AND folic acid, e com o uso dos Medical Subject Headings (MeSH, na sigla em inglês): autistic OR autism AND Autistic Spectrum Disorder AND folic acid ". COLETA DE DADOS: A extração de dados foi realizada pelos revisores com um formulário de coleta de dados pré-estabelecido. SíNTESE DOS DADOS: Foram usados os itens de relatório preferidos para protocolos de revisão sistemática e meta-análise (PRISMA-P) com base em uma lista de verificação com 27 itens e um fluxograma de 4 etapas. RESULTADOS: Foram encontrados 384 artigos pelas estratégias de busca, dos quais 17 eram elegíveis segundo os critérios pré-estabelecidos. Os principais achados da presente revisão apontam para a suplementação de AF materno no período de preconcepção e início da gravidez como efeito protetor em relação ao TEA, que deve ser indicada neste período como prevenção do problema. CONCLUSãO: De acordo com as pesquisas analisadas, mais estudos são necessários para conhecer seus efeitos sobre a gravidez, uma vez que o consumo excessivo de AF pode não ser inócuo.

Translation of the Debriefing Assessment for Simulation in Healthcare in Portuguese and cross-cultural adaptation for Portugal and Brazil.

BACKGROUND: Debriefing Assessment for Simulation in Healthcare (DASH©) is an instrument to assist in developing and evaluating debriefing skills. The objectives of this study were to translate the DASH from English to Portuguese and to conduct a cross-cultural adaptation of this translated instrument for Portugal and Brazil. METHODS: A forward translation of the DASH score sheets and Rater's Handbook was accomplished and reviewed by authors from both Portuguese-speaking countries to reach the consensus harmonized version. A backward translation was reviewed by the original authors and discussed with the authors to produce the approved harmonized translation. This was then tested through a questionnaire to assess clarity, comprehensiveness, appropriateness, and cultural relevance among 10 simulation specialists from Portugal and Brazil. RESULTS: During the forward translation, 19 discrepancies were detected in the Portuguese DASH. After backward translation, 7 discrepancies were discussed and harmonized. All 10 simulation specialists from both countries reviewed the harmonized translation and made 70 suggestions, 64 of which were incorporated in the instrument after discussion among authors. CONCLUSIONS: The translated DASH has undergone translation to Portuguese and a cross-cultural adaptation across Portugal and Brazil. It may be used to assess debriefings in healthcare settings in these countries.

Meningitis due to Streptococcus suis in Two Patients with Occupational Exposure from Northeastern Brazil.

Streptococcus suis is an emerging zoonotic agent that causes bacterial meningitis. S. suis is an encapsulated Gram-positive, facultative anaerobic bacterium. This infection usually manifests in humans as meningitis, endocarditis, septicemia, and/or arthritis. The primary groups at risk for S. suis infection are individuals occupationally exposed to pigs and/or pork, for example, farmers, butchers, and hunters. Herein, we report two cases of meningitis related to S. suis with occupational exposure from the Ceará state, northeastern Brazil.

Non-technical skills progression during anesthesiology residency in Portugal: the impact of a National Pedagogical Plan.

Background Simulation is known as an important tool for the learning of technical and non-technical skills without endangering patient safety. In Portugal, a National Pedagogical Plan for Anesthesiology Residents was created based on simulation training. This plan was designed according to the objectives set forth by the Portuguese Board of Anesthesiology. This study aimed to evaluate the impact of simulation training courses on the non-technical skills of medical residents in Anesthesiology. Methods Confidential questionnaires, pre- and post-course, were answered by all the residents that attended the different modules of the simulation training program at Centro Hospitalar e Universitário de Coimbra Biomedical Simulation Centre, Portugal, from February 2011 to March 2018. Results A total of 344 questionnaires were answered. In the group of questions regarding the need for help, mistakes, and self-efficacy over time, students recognized an increase over time in the need for support and the self-assessment of the number of mistakes (p < 0.001). Regarding the self-evaluation of safety culture and communication skills, at the end of the residency, almost all the students recognized that they did not feel bad when asking for help or expressing their opinion, even when they disagreed with the consultant anesthesiologist. This was significantly different from the values of the self-assessment at the beginning of residency (p < 0.001). The evolution of preparation, knowledge, and training also showed a positive evolution over the simulation modules (p < 0.001). Finally, the evaluation of the behavioral component in the clinical setting showed a significant positive evolution over time (p < 0.001): in the end, all the students strongly agreed that behavioral competencies are crucial. Conclusions The impact of simulation on anesthesiology non-technical skills during residency is positive and recognized by the students. Moreover, simulation also helps in the recognition of error, enriching the value of self-confidence and the crucial role of behavioral skills. ABBREVIATIONS BSC-CHUC: Biomedical Simulation Centre from Centro Hospitalar e Universitário de Coimbra.

Biomedical Simulation: Evolution, Concepts, Challenges and Future Trends.

Biomedical simulation is an effective educational complement for healthcare training, both at undergraduate and postgraduate level. It enables knowledge, skills and attitudes to be acquired in a safe, educationally orientated and efficient manner. In this context, simulation provides skills and experience that facilitate the transfer of cognitive, psychomotor and proper communication competences, thus changing behavior and attitudes, and ultimately improving patient safety. Beyond the impact on individual and team performance, simulation provides an opportunity to study organizational failures and improve system performance. Over the last decades, simulation in healthcare had a slow but steady growth, with a visible maturation in the last ten years. The simulation community must continue to provide the core leadership in developing standards. There is a need for strategies and policy development to ensure its coordinated and cost-effective implementation, applied to patient safety. This paper reviews the evolutionary movements of biomedical simulation, including a review of the Portuguese initiatives and nationwide programs. For leveling knowledge and standardize terminology, basic but essential concepts in clinical simulation, together with some considerations on assessment, validation and reliability are presented. The final sections discuss the current challenges and future initiatives and strategies, crucial for the integration of simulation programs in the greater movement toward patient safety.

A simulação biomédica é uma ferramenta educativa para a formação nas ciências da saúde, com aplicação nos vários níveis de ensino. Proporciona experiências ativas e sistemáticas de aprendizagem com o treino de conhecimentos, habilidades e atitudes, de forma segura, pedagogicamente orientada e eficiente. Neste contexto, a simulação biomédica proporciona habilidades e experiência que facilitam a transferência de competências cognitivas, psicomotoras e de comunicação, mudando assim o comportamento e atitudes, aumentando, em última instância, a segurança do doente. Para além do impacto sobre o desempenho individual e de equipa, a simulação proporciona o ambiente ideal para o estudo de falhas organizacionais e teste de melhorias nos desempenhos dos sistemas. Nas últimas décadas, a simulação na área da saúde cresceu lentamente, mas de forma constante, com um amadurecimento significativo nos últimos 10 anos. A comunidade de simulação deve continuar a liderar o estabelecimento de standards nesta área, assim como o desenvolvimento de estratégicas e políticas para assegurar a sua implementação coordenada e custo-efetiva, no aumento da segurança do doente. Este artigo apresenta os movimentos evolutivos da simulação biomédica, incluindo uma revisão das iniciativas portuguesas e programas nacionais. Para nivelar o conhecimento e padronizar a terminologia, são apresentados conceitos básicos, mas essenciais, da simulação clínica, juntamente com algumas considerações sobre avaliação, validação e fiabilidade. As seções finais discutem os desafios atuais e as iniciativas e estratégias futuras, cruciais para a integração de programas de simulação no movimento global de promoção da segurança do paciente.

Mixed-realism simulation of adverse event disclosure: an educational methodology and assessment instrument.

INTRODUCTION: Physicians have an ethical duty to disclose adverse events to patients or families. Various strategies have been reported for teaching disclosure, but no instruments have been shown to be reliable for assessing them.The aims of this study were to report a structured method for teaching adverse event disclosure using mixed-realism simulation, develop and begin to validate an instrument for assessing performance, and describe the disclosure practice of anesthesiology trainees. METHODS: Forty-two anesthesiology trainees participated in a 2-part exercise with mixed-realism simulation. The first part took place using a mannequin patient in a simulated operating room where trainees became enmeshed in a clinical episode that led to an adverse event and the second part in a simulated postoperative care unit where the learner is asked to disclose to a standardized patient who systematically moves through epochs of grief response. Two raters scored subjects using an assessment instrument we developed that combines a 4-element behaviorally anchored rating scale (BARS) and a 5-stage objective rating scale. RESULTS: The performance scores for elements within the BARS and the 5-stage instrument showed excellent interrater reliability (Cohen's κ = 0.7), appropriate range (mean range for BARS, 4.20-4.47; mean range for 5-stage instrument, 3.73-4.46), and high internal consistency (P < 0.05). CONCLUSIONS: We have demonstrated a comprehensive methodology using a mixed-realism simulation that engages learners in an adverse event and allows them to practice disclosure to a structured range of patient responses. We have developed a reliable 2-part instrument with strong psychometric properties for assessing disclosure performance.

[The importance of simulation in team training on obstetric emergencies: results of the first phase of the national plan for continuous medical training]. / Importância da Simulação no Treino de Equipa para Eventos Críticos em Obstetrícia: Resultados da Primeira Fase do Plano Nacional de Educação Médica Contínua.

Obstetric emergencies are unexpected and random. The traditional model for medical training of these acute events has included lectures combined with sporadic clinical experiences, but this educational method has inherent limitations. Given the variety of manual skills that must be learned and high-risk environment, Obstetrics is uniquely suited for simulation. New technological educational tools provide an opportunity to learn and master technical skills needed in emergent situations as well as the opportunity to rehearse and learn from mistakes without risks to patients. The goals of this study are to assess which are the factors that trainees associate to human fallibility before and after clinical simulation based training; to compare the confidence level to solve emergent obstetric situations between interns and experts with up to 5 years of experience before and after training, and to determine the value that trainees give to simulation as a teaching tool on emergent events. 31 physicians participated at this course sessions. After the course, we verified changes in the factores that trainees associate to human fallibility, an increase in confidence level to solve emergent obstetric and an increase in the value that trainees give to simulation as a teaching tool.

O oleo essencial de Lippia gracilis Schauer, Verbenaceae, em ratos diabeticos / The essential oil from Lippia gracilis Schauer, Verbenaceae, in diabetic rats

O óleo essencial das folhas de Lippia gracilis Schauer, Verbenaceae, foi examinado por CG e CG-MS. Quinze constituintes foram identificados, onde o carvacrol, p-cimeno e o γ-terpineno foram as substâncias majoritárias. No estudo in vitro, a solução a 5 por cento do óleo de L. gracilis Schauer apresentou atividade antibacteriana para Staphylococcus aureus isolado de úlcera infectada de paciente diabético. O estudo avaliou a atividade antibacteriana da solução a 5 por cento do óleo de L. gracilis Schauer em modelo experimental em diabetes utilizando ratos albinos Wistar machos com membro pélvico infectado com cepa de Staphylococcus aureus. No experimento foram utilizados 28 ratos Wistar distribuídos em quatro grupos (G1-branco, G2-controle negativo, G3-controle positivo, G4-teste) de sete ratos. Quando comparado o grupo G4 com G3, observou-se que a solução a 5 por cento promoveu uma redução nas CFU/mL após 24h da administração do inóculo (S.aureus sem L. gracilis Schauer 10(8) ± 313 versus S.aureus com L. gracilis Schauer 13,28 ± 4,03). Os resultados foram expressos através do cálculo da média±EPM) e análise de variança (ANOVA). A diferença entre a concentração inibitória mínima no estudo in vitro foi determinada pelo teste Turkey (p<0.05). O teste Newman-Keuls com nível de significância (p<0.05) foi utilizado para o cálculo dos resultados obtidos no experimento in vivo. A solução a 5 por cento do óleo essencial de Lippia gracilis Schauer apresentou boa atividade antibacteriana tanto no estudo in vivo como no in vitro.

The essential oil from Lippia gracilis Schauer (Verbenaceae) leaves was examined by GC and GC-MS. Fifteen constituents were identified. Carvacrol, p-cymene and γ-terpinene were found to be the major components. In the in vitro study, 5 percent solution of the Lippia gracilis Schauer oil presented antibacterial activity against Staphylococcus aureus isolated from diabetic patients with infected ulcers. The study evaluated the antibacterial activity of the 5 percent solution of the Lippia gracilis Schauer oil on the experimental model of diabetic adult male albino Wistar rats with leaft pelvic limb infected by Staphylococcus aureus strain. In this experiment, 28 diabetic Wistar rats were used, randomly distributed in four different groups of seven rats, (G1-white; G2-negative control; G3-positive control and G4-test). When comparing group G4 with G3, it was observed that the 5 percent solution presented a reduced CFU/mL level showing the antibacterial effect of the oil 24 hours after the administration of the inoculum (S .aureus without Lippia gracilis Schauer 108 ±313 versus S.aureus with Lippia gracilis Schauer 13.28±4.03). The results were expressed as mean±S.E.M. One-way analysis of the variance (ANOVA) was used. The differences between the minimum inhibitory concentration in vitro test were determined by the Tukey test (p<0.05). The Newman-Keuls test with level of significance (p<0.05) was used to measure the results in vivo. The findings have shown that 5 percent solution of the Lippia gracilis Schauer oil presented antibacterial activity in vitro and in vivo.

Inhibitory effect of 1,8-cineole on guinea-pig airway challenged with ovalbumin involves a preferential action on electromechanical coupling.

1. 1,8-Cineole is a terpenoid constituent of essential oils with anti-inflammatory properties. It reduces the neural excitability, functions as an antinociceptive agent and has myorelaxant actions in guinea-pig airways. The aim of the present study was to investigate the mechanism underlying the myorelaxant effects of 1,8-cineole in guinea-pig isolated trachea from either naïve guinea-pigs or ovalbumin (OVA)-sensitized animals subjected to antigenic challenge. 2. Isometric recordings were made of the tone of isolated tracheal rings. Rings with an intact epithelium relaxed beyond basal tone in the presence of 1,8-cineole (6.5 x 10(-6) to 2 x 10(-2) mol/L) in a concentration-dependent manner (P < 0.001, anova) with a pD(2) value of 2.23 (95% confidence interval 2.10-2.37). Removal of the epithelium or pretreatment of intact tissue for 15 min with 50 micromol/L N(G)-nitro-l-arginine methyl ester, 5 mmol/L tetraethylammonium, 0.5 micromol/L tetrodotoxin or 5 micromol/L propranolol did not alter the potency (pD(2)) or the maximal myorelaxant effect (E(max)) of 1,8-cineole. 3. 1,8-Cineole also significantly decreased the Schultz-Dale contraction induced by OVA, mainly in preparations from OVA-sensitized animals submitted to antigen challenge. 1,8-Cineole decreased tracheal hyperresponsiveness to KCl and carbachol caused by antigen challenge and almost abolished the concentration-response curves to KCl, whereas it had little effect on the concentration-response curves to carbachol. Under Ca(2+)-free conditions and in the presence of 10(-4) mol/L acetylcholine, neither 1,8-cineole (6.5 x 10(-3) mol/L) nor verapamil (1 x 10(-5) mol/L) affected Ca(2+)-induced contractions, but they almost abolished Ba(2+)-induced contractions. 4. In conclusion, the findings of the present study show that 1,8-cineole is a tracheal myorelaxant that acts preferentially on contractile responses elicited electromechanically.

Relaxant effects of the essential oil of Eucalyptus tereticornis and its main constituent 1,8-cineole on guinea-pig tracheal smooth muscle.

The effects of the essential oil of Eucalyptus tereticornis Sm. (EOET) on guinea-pig tracheal smooth muscle were investigated. EOET (10 - 1000 microg/mL) relaxed the tracheal basal tonus with an EC (50) value of 125.3 [52.2 - 300.9] microg/mL. Its maximal relaxation (40 +/- 6 %) was significantly lower than that evoked by aminophylline (209 +/- 34 %). The K (+)-(60 mM)-induced contractions were significantly reduced by both EOET (200 - 1000 microg/mL) and its main constituent 1,8-cineole (600 - 1000 microg/mL). Acetylcholine (1 microgM)-induced contractions were significantly enhanced by 1,8-cineole (10 - 1000 microg/mL). However, they were significantly enhanced and reduced by lower (200 - 400 microg/mL) and higher (800 - 1000 microg/mL) concentrations of EOET, respectively. Electrical field stimulation-induced contractions were significantly increased by EOET (100 - 600 microg/mL). In conclusion, EOET produces myorelaxant effects on guinea-pig isolated trachea, an effect that seems to result from a complex interaction between its monoterpenoid constituents.

Relaxant effects of the essential oil of Ocimum gratissimum on isolated ileum of the guinea pig.

The effects of the essential oil of Ocimum gratissimum L. (Labiatae) (EOOG) on guinea pig ileum were studied. EOOG (0.1-1000 microg/ml) reversibly and concentration-dependently relaxed the basal tone of the ileum and reversed the tonic contractions induced by 60 mM KCl and 10 microM acetylcholine, with IC(50) values of 23.8+/-5.2, 18.6+/-4.0 and 70.0+/-4.6 microg/ml, respectively. Our results show that EOOG exerts relaxant effects on intestinal smooth muscle, consistent with the popular use of the plant to treat gastrointestinal disorders.