Evaluation of Workload in High Complexity Work Place: an Experiment During a Real Situation

Some workplace have been widely changed with regard to their automation process, which has promoted a more complex environment concerning the task performance, demanding to the operator the introducing of new abilities. In the aeronautic activity the workload also has been diversified, as the mental demand has been enhanced. The needs of determining the impact of the workload on the operator due to such work place, evidencing a more complex nature, shows to be more important, mainly when looking at the certification requirements for new aircraft development. Such certification process is responsible for determining the minimum aircrew necessary, based on the distribution of the cabin workload, as well as keeping the situation awareness during the different phases of the flight. This study uses psychological and physiological methods of measurements to evaluate the workload in real situation during the end of the certification process of an aircraft, aiming at to identify potential methods to be implemented during the whole certification process. A protocol of workload evaluation was implemented based on the use of interview, NASA-TLX scale, heart rate (HR) and heart rate variability (HRV). Two pilots participated in the study. The measurements and interviews were conducted during flights performed in the final certification process of an aircraft produced in Brazil. A total of six take-off and six landings performed during three consecutive days were evaluated. Each route was previously determined, which involved some abnormal situations according to an established program for the evaluation of the aircraft in terms of human factor requirements. The data analysis was performed in a descriptive and qualitative basis due to the peculiarity of each task. Preliminary results indicate the landing to be more stressful than take-off, and for such situations, the pilot flying (PF) had the more workload during the tasks than the pilot monitoring (PM). When comparing all flights and their tasks, no important difference between the HR and HRV was observed, but, again, the landing showed a little higher stressful than take-off for the PF, as evidenced by the HR. However, the general results, including those from NASA-TLX, suggested a low workload for all tasks. With regards to the interviews, the more pronounced mental demands reported by the pilots in managing any fault of the aircraft were in those tasks that required anticipation, attention and monitoring procedures. Future studies should be conducted with the whole certification process and other scenarios in order to test the applicability of the methodology employed in the present study

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Summary Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. Methods We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung’s disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. Findings We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung’s disease) from 264 hospitals (89 in high-income countries, 166 in middleincome countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in lowincome countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. Interpretation Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between lowincome, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030