Implementing the Objective Structured Clinical Examination in a Geriatrics Fellowship Program-A 3-Year Experience

The Objective Structured Clinical Examination (OSCE) appears to be an effective alternative for assessing not only medical knowledge, but also clinical skills, including effective communication and physical examination skills. The purpose of the current study was to implement an OSCE model in a geriatrics fellowship program and to compare the instrument with traditional essay examination. Seventy first- and second-year geriatric fellows were initially submitted to a traditional essay examination and scored from 0 to 10 by a faculty member. The same fellows subsequently underwent an OSCE with eight 10-minute stations covering a wide range of essential aspects of geriatric knowledge. Each OSCE station had an examiner responsible for its evaluation according to a predefined checklist. Checklist items were classified for analysis purposes as clinical knowledge items (CKI) and communication skills items (CSI); fellow responses were scored from 0 to 10.Although essay examinations took from 30 to 45 minutes to complete, 180200 minutes were required to evaluate fellows using the proposed OSCE method. Fellows scored an average of 6.2 +/- 1.2 on the traditional essay examination and 6.6 +/- 1.0 on the OSCE (P < .001). Subanalyses of OSCE scores indicated that average performance on CKI was lower than the average on CSI (6.4 +/- 1.1 vs. 8.4 +/- 1.1; P < .001). Fellow performance on the essay examination was similar to their performance on CKI (P = .13). Second-year fellows performed better than first-year fellows on the essay examination (P < .001) and CKI (P = .05), but not on CSI (P = .25).The OSCE was successfully implemented as an educational strategy during a geriatrics fellowship program. Combining different testing modalities may provide the best assessment of competence for various domains of knowledge, skills, and behavior.

Effects of Positive End-expiratory Pressure Titration and Recruitment Maneuver on Lung Inflammation and Hyperinflation in Experimental Acid Aspiration-induced Lung Injury

Background: In acute lung injury positive end-expiratory pressure (PEEP) and recruitment maneuver are proposed to optimize arterial oxygenation. The aim of the study was to evaluate the impact of such a strategy on lung histological inflammation and hyperinflation in pigs with acid aspiration-induced lung injury. Methods: Forty-seven pigs were randomly allocated in seven groups: (1) controls spontaneously breathing; (2) without lung injury, PEEP 5 cm H2O; (3) without lung injury, PEEP titration; (4) without lung injury, PEEP titration + recruitment maneuver; (5) with lung injury, PEEP 5 cm H2O; (6) with lung injury, PEEP titration; and (7) with lung injury, PEEP titration + recruitment maneuver. Acute lung injury was induced by intratracheal instillation of hydrochloric acid. PEEP titration was performed by incremental and decremental PEEP from 5 to 20 cm H2O for optimizing arterial oxygenation. Three recruitment maneuvers (pressure of 40 cm H2O maintained for 20 s) were applied to the assigned groups at each PEEP level. Proportion of lung inflammation, hemorrhage, edema, and alveolar wall disruption were recorded on each histological field. Mean alveolar area was measured in the aerated lung regions. Results: Acid aspiration increased mean alveolar area and produced alveolar wall disruption, lung edema, alveolar hemorrhage, and lung inflammation. PEEP titration significantly improved arterial oxygenation but simultaneously increased lung inflammation in juxta-diaphragmatic lung regions. Recruitment maneuver during PEEP titration did not induce additional increase in lung inflammation and alveolar hyperinflation. Conclusion: In a porcine model of acid aspiration-induced lung injury, PEEP titration aimed at optimizing arterial oxygenation, substantially increased lung inflammation. Recruitment maneuvers further improved arterial oxygenation without additional effects on inflammation and hyperinflation.

Carbono em agregados do solo sob vegetação nativa, pastagem e sistemas agrícolas no bioma Cerrado

A matéria orgânica do solo (MOS) é responsável pela fertilidade, ciclagem de nutrientes e estabilidade da estrutura, possuindo estreita relação com a agregação do solo. No entanto, ainda não é clara a relação entre as classes de agregados na dinâmica de acúmulo ou perda de MOS em função do uso e manejo do solo. Este trabalho teve como objetivo avaliar os teores de carbono (C) em agregados do solo sob quatro usos e manejos: Cerrado nativo (CE), sistema plantio direto (SPD), sistema plantio convencional (SPC) e pastagem (PA). As áreas de estudo estão localizadas no município de Rio Verde (GO), em solo classificado como Latossolo Vermelho distrófico de textura argilosa. Em amostras de solo coletadas em fevereiro de 2007 nas camadas de 0-5, 5-10 e 10-20 cm de profundidade, foram determinados: a quantidade de macroagregados (maiores que 2,0 mm), mesoagregados (maiores que 0,25 e menores que 2,00 mm) e microagregados (maiores que 0,05 e menores que 0,25 mm) estáveis em água, os índices de agregação diâmetro médio ponderado (DMP) e geométrico (DMG) e os teores de C nas classes de agregados estabelecidas. No solo avaliado observou-se predominância de macroagregados, com maior quantidade sob CE e PA, em comparação ao solo sob SPD e SPC, indicando efeito negativo do cultivo do solo na conservação de macroagregados. Contudo, os teores de C nos agregados do solo na camada de 0-20 cm foram maiores no CE e SPD em relação a PA e SPC, sugerindo que o não revolvimento e a manutenção dos resíduos culturais na superfície do solo favorecem o acúmulo de C. Com isso, foi verificado que os macro e mesoagregados podem ser mais sensíveis ao tipo de uso e manejo do solo, quando comparados aos microagregados. A agregação do solo sob PA é semelhante à do CE, embora com menores teores de C, sugerindo dinâmica de agregação diferenciada, o que merece a atenção de novas pesquisas.

Spectroscopic investigation and heat generation of Yb3+/Ho3+ codoped aluminosilicate glasses looking for the emission at 2 μm

Energy transfer (ET) and heat generation processes in Yb3+/Ho3+-codoped low-silica calcium aluminosilicate glasses were investigated using thermal lens (TL) and photoluminescence measurements looking for the emission around 2.0 μm. Stepwise ET processes from Yb3+ to Ho3+, upon excitation at 0.976 μm, produced highly efficient emission in the mid-infrared range at around 2.0 μm, with high fluorescence quantum efficiency (η1 ∼ 0.85 and independent of Ho3+ concentration) and relatively very low thermal loading (<0.4) for concentration up to 1.5% of Ho2O3. An equation was deduced for the description of the TL results that provided the absolute value of η1 and the number of emitted photons at 2.0 μm per absorbed pump photon by the Yb3+ ions, the latter reaching 60% for the highest Ho3+ concentration. These results suggest that the studied codoped system would be a promising candidate for the construction of photonic devices, especially for medical applications.