Teaching elliptical excision skills to novice medical students: a randomized controlled study comparing low- and high-fidelity bench models

Background: The search for alternative and effective forms of training simulation is needed due to ethical and medico-legal aspects involved in training surgical skills on living patients, human cadavers and living animals. Aims : To evaluate if the bench model fidelity interferes in the acquisition of elliptical excision skills by novice medical students. Materials and Methods: Forty novice medical students were randomly assigned to 5 practice conditions with instructor-directed elliptical excision skills' training (n = 8): didactic materials (control); organic bench model (low-fidelity); ethylene-vinyl acetate bench model (low-fidelity); chicken legs' skin bench model (high-fidelity); or pig foot skin bench model (high-fidelity). Pre- and post-tests were applied. Global rating scale, effect size, and self-perceived confidence based on Likert scale were used to evaluate all elliptical excision performances. Results : The analysis showed that after training, the students practicing on bench models had better performance based on Global rating scale (all P < 0.0000) and felt more confident to perform elliptical excision skills (all P < 0.0000) when compared to the control. There was no significant difference (all P > 0.05) between the groups that trained on bench models. The magnitude of the effect (basic cutaneous surgery skills' training) was considered large (>0.80) in all measurements. Conclusion : The acquisition of elliptical excision skills after instructor-directed training on low-fidelity bench models was similar to the training on high-fidelity bench models; and there was a more substantial increase in elliptical excision performances of students that trained on all simulators compared to the learning on didactic materials.

Does bench model fidelity interfere in the acquisition of suture skills by novice medical students?

OBJETIVO: Embora vários modelos de bancada inanimados tenham sido descritos para o treinamento de habilidades de sutura, até o momento, não existe um método ideal para esse ensino e aprendizagem durante a formação médica. O objetivo foi avaliar se a fidelidade dos modelos de bancada interfere na aquisição de habilidades de sutura em estudantes de medicina iniciantes na prática cirúrgica. MÉTODOS: 36 estudantes de medicina sem exposição prévia a habilidades cirúrgicas foram randomizados em três grupos (n = 12): treinamento de suturas baseado em materiais didáticos (controle); treinamento de suturas em modelo de baixa-fidelidade (modelo de bancada de etileno vinil acetato); ou treinamento de suturas em modelo de alta-fidelidade (modelo de bancada de pele de pata de porco). Foram aplicados pré e pós-testes (realização de pontos simples e pontos subdérmicos invertidos em língua de boi). Três ferramentas (Global Rating Scale com avaliação cega, tamanho do efeito e autopercepção da confiança baseada em uma escala de Likert) foram utilizadas para mensurar todas as performances de sutura. RESULTADOS: A análise após o treinamento demonstrou que os estudantes que treinaram nos modelos tiveram um melhor (p < 0.0000) desempenho na avaliação pela Global Rating Scale, quando comparados com o controle, independente da fidelidade do modelo. A magnitude do efeito (treinamento) foi considerada grande (> 0.80) em todas as mensurações. Após o treinamento os alunos sentiram-se mais confiantes (p < 0.0000) para executarem os dois tipos de suturas. CONCLUSÃO: A aquisição de habilidades de suturas no modelo de baixa fidelidade foi semelhante à prática no modelo de alta fidelidade, sendo que a melhora no desempenho dos participantes que treinaram nesses dois modelos foi superior à aprendizagem baseada em materiais didáticos.

High incidences of DNA ploidy abnormalities in tongue squamous cell carcinoma of young patients: an international collaborative study

Aims: This multi-centre analysis assessed the DNA content of TSCC in 37 young patients (<40 years) and 28 old patients (>50 years) and determined the correlation of DNA ploidy findings with clinicopathological data.Methods and results: Image cytometry was carried out using an automated cellular imaging system on Feulgen-stained histological sections to obtain high-fidelity DNA histograms. Among young patients, 37.8% were females compared to 18.7% in the older group (P = 0.002). In total, 48.6% patients were non-smokers and 40.5% were non-drinkers compared to 10.7% non-smokers and non-drinkers in the older group (P < 0.0001). TNM, clinical stage of disease and histological grade of differentiation did not differ between groups. Tumour aneuploidy was detected in 86.5% and tetraploidy in 24.3% young patients; this was significantly greater than in the older group where 64.3% were aneuploid (P < 0.0001) and 7.2% tetraploid (P < 0.0001). The mean values of DNA index (DI) and DNA heterogeneity index as well as the percentage of cells with DI exceeding 5N were higher in young patients (P < 0.0001).Conclusions: Young patients with TSCC represent a distinct clinical entity. The high incidence of DNA ploidy abnormalities suggest that they may have increased genomic instability and indicates underlying genetic differences between TSCC in young and older patients.

A framework for learning in humanoid simulated robots

One of the most important characteristics of intelligent activity is the ability to change behaviour according to many forms of feedback. Through learning an agent can interact with its environment to improve its performance over time. However, most of the techniques known that involves learning are time expensive, i.e., once the agent is supposed to learn over time by experimentation, the task has to be executed many times. Hence, high fidelity simulators can save a lot of time. In this context, this paper describes the framework designed to allow a team of real RoboNova-I humanoids robots to be simulated under USARSim environment. Details about the complete process of modeling and programming the robot are given, as well as the learning methodology proposed to improve robot's performance. Due to the use of a high fidelity model, the learning algorithms can be widely explored in simulation before adapted to real robots. © 2008 Springer-Verlag Berlin Heidelberg.

Artificial neural network model of discharge lamps in the power quality context

This paper presents a methodology for modeling high intensity discharge lamps based on artificial neural networks. The methodology provides a model which is able to represent the device operating in the frequency of distribution systems, facing events related to power quality. With the aid of a data acquisition system to monitor the laboratory experiment, and using $$\text{ MATLAB }^{\textregistered }$$ software, data was obtained for the training of two neural networks. These neural networks, working together, were able to represent with high fidelity the behavior of a discharge lamp. The excellent performance obtained by these models allowed the simulation of a group of lamps in a distribution system with shorter simulation time when compared to mathematical models. This fact justified the application of this family of loads in electric power systems. The representation of the device facing power quality disturbances also proved to be a useful tool for more complex studies in distribution systems. © 2013 Brazilian Society for Automatics - SBA.

Compressible modes in a square lid-driven cavity

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

Aplicativo computacional para obtenção de probabilidades a priori de classificação errônea em experimentos agronômicos

Pós-graduação em Agronomia (Energia na Agricultura) - FCA

Aplicação da genética molecular no manejo e conservação de tubarões

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Hesitações em início de enunciados de crianças em aquisição de linguagem

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Metodologia de design mediada por protótipos

Pós-graduação em Design - FAAC

Assessment of a high-order finite difference upwind scheme for the simulation of convection-diffusion problems

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Generalized linear mixed models for the genetic evaluation of binary reproductive traits: a simulation study

The objective of this study was to evaluate the use of probit and logit link functions for the genetic evaluation of early pregnancy using simulated data. The following simulation/analysis structures were constructed: logit/logit, logit/probit, probit/logit, and probit/probit. The percentages of precocious females were 5, 10, 15, 20, 25 and 30% and were adjusted based on a change in the mean of the latent variable. The parametric heritability (h²) was 0.40. Simulation and genetic evaluation were implemented in the R software. Heritability estimates (ĥ²) were compared with h² using the mean squared error. Pearson correlations between predicted and true breeding values and the percentage of coincidence between true and predicted ranking, considering the 10% of bulls with the highest breeding values (TOP10) were calculated. The mean ĥ² values were under- and overestimated for all percentages of precocious females when logit/probit and probit/logit models used. In addition, the mean squared errors of these models were high when compared with those obtained with the probit/probit and logit/logit models. Considering ĥ², probit/probit and logit/logit were also superior to logit/probit and probit/logit, providing values close to the parametric heritability. Logit/probit and probit/logit presented low Pearson correlations, whereas the correlations obtained with probit/probit and logit/logit ranged from moderate to high. With respect to the TOP10 bulls, logit/probit and probit/logit presented much lower percentages than probit/probit and logit/logit. The genetic parameter estimates and predictions of breeding values of the animals obtained with the logit/logit and probit/probit models were similar. In contrast, the results obtained with probit/logit and logit/probit were not satisfactory. There is need to compare the estimation and prediction ability of logit and probit link functions.

MIGRATION MEASUREMENTS FROM PLASTIC PACKAGING: A SIMULATION STUDY ON INFLUENCE OF INITIAL CONCENTRATION PROFILE

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

On developing efficient applications using conservative distributed simulation paradigm

This paper aims to present, using a set of guidelines, how to apply the conservative distributed simulation paradigm (CMB protocol) to develop efficient applications. Using these guidelines, even a user with little experience on distributed simulation and computer architecture can have good performance on distributed simulations using conservative synchronization protocols for parallel processes.The set of guidelines is focus on a specific application domain, the performance evaluation of computer systems, considering models with coarse granularity and few logical processes and running over two platforms: parallel (high performance communication environment) and distributed (low performance communication environment).

A continuously differentiable upwinding scheme for the simulation of fluid flow problems

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)