Simulation-based ultrasound-guided central venous cannulation training program

PURPOSE: To propose a simulation-based ultrasound-guided central venous cannulation skills' training program, during residency.METHODS: This study describes the strategies for learning the ultrasound-guided central venous cannulation on low-fidelity bench models. The preparation of bench models, educational goals, processes of skill acquisition, feedback and evaluation methods were also outlined. The training program was based on key references to the subject.RESULTS: It was formulated a simulation-based ultrasound-guided central venous cannulation teaching program on low-fidelity bench models.CONCLUSION: A simulation-based inexpensive, low-stress, no-risk learning program on low-fidelity bench models was proposed to facilitate acquisition of ultrasound-guided central venous cannulation skills by residents-in-training before exposure to the living patient.

Ethical Care of the Self and the Teacher in the Pedagogical Relationship: Reflections Based on the Latest Foucault

Our conception of education is that it is the responsible action whereby man becomes human, trains and faces the challenges that life and the world present, as man enters a larger, shared cultural tradition and thus joins the world. However such sharing implies that we must not just rely on tradition, but remain open to new ideas. It is essential for schooling to preserve a field where the art of living intersects with the world for which future generations are being prepared. It is in this field of intersection that this essay seeks to discuss Michel Foucault's thought, care of the self and the role played by others in the acquisition of ethical attitudes pertaining to one's conduct in life. Through reconstructing Foucault's ideas, we elaborate on the hypothesis that, before morally shaping students, teaching them values, or aiding in their skill acquisition in the sense prevailing in schooling today, it is important to understand the notion of care of the self (and how the notion implies interaction with others for effective care of the self). Care of the self is vital for thoroughly understanding the relationships between ethics and education in school. We particularly examine how Foucault's ideas and his analysis of the teacher's role in shaping the student's life conduct can help educators rethink pedagogical action in an ethical sense and find within it a certain openness to the formation of attitudes in educators and students

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.

Evidence for Reductive Genome Evolution and Lateral Acquisition of Virulence Functions in Two Corynebacterium pseudotuberculosis Strains

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

LEARNING A COMPLEX MOTOR SKILL FROM VIDEO and POINT-LIGHT DEMONSTRATIONS

The aim of this Study was to compare the learning process of a highly complex ballet skill following demonstrations of point light and video models 16 participants divided into point light and video groups (ns = 8) performed 160 trials of a pirouette equally distributed in blocks of 20 trials alternating periods of demonstration and practice with a retention test a day later Measures of head and trunk oscillation coordination d1 parity from the model and movement time difference showed similarities between video and point light groups ballet experts evaluations indicated superiority of performance in the video over the point light group Results are discussed in terms of the task requirements of dissociation between head and trunk rotations focusing on the hypothesis of sufficiency and higher relevance of information contained in biological motion models applied to learning of complex motor skills

Structural FRF acquisition via electric impedance measurement applied to damage location

Continuing development of new materials makes systems lighter and stronger permitting more complex systems to provide more functionality and flexibility that demands a more effective evaluation of their structural health. Smart material technology has become an area of increasing interest in this field. The combination of smart materials and artificial neural networks can be used as an excellent tool for pattern recognition, turning their application adequate for monitoring and fault classification of equipment and structures. In order to identify the fault, the neural network must be trained using a set of solutions to its corresponding forward Variational problem. After the training process, the net can successfully solve the inverse variational problem in the context of monitoring and fault detection because of their pattern recognition and interpolation capabilities. The use of structural frequency response function is a fundamental portion of structural dynamic analysis, and it can be extracted from measured electric impedance through the electromechanical interaction of a piezoceramic and a structure. In this paper we use the FRF obtained by a mathematical model (FEM) in order to generate the training data for the neural networks, and the identification of damage can be done by measuring electric impedance, since suitable data normalization correlates FRF and electrical impedance.

Risk factors for acquisition of Methicillin-resistant Staphylococcus aureus among patients from a burn unit in Brazil

Methicillin-resistant Staphylococcus aureus (MRSA) is an important agent of colonization and infection in burn units. in order to identify risk factors for MRSA acquisition in a Brazilian burn unit, we performed two retrospective studies. In the first ("cohort" study), 175 patients who were not colonized with MRSA on admission were followed to assess risk factors for MRSA acquisition. in the second ("case-case-control" study), 143 individuals from the previous study who were negative for both MRSA and Methicillin-susceptible S. aureus (MSSA) on admission were followed. Case-control studies were performed to investigate risk factors for MRSA and MSSA acquisition. MRSA and MSSA were recovered from 75 and 23 patients, respectively. In the "cohort" study, only the number of wound excisions (Odds Ratio [OR] = 1.55, 95% Confidence Interval [CI] = 1.21-1.98, P = 0.001) was associated with MRSA acquisition. in the "case-case-control" study, burns involving head (OR=3.43, 95%CI = 1.50-7.81, P = 0.003) and the number of wound excisions (OR = 1.83, 95%CI = 1.27-2.63, P = 0.001) were significant risk factors for MRSA. Burns involving perineum were negatively associated with MSSA acquisition (OR = 0.16, 95%CI = 0.03-0.75, P = 0.02). In conclusion, the acquisition of MRSA was related to the site of the burn and to the surgical manipulation of tissues, but not to the use of antimicrobials. (C) 2009 Elsevier Ltd and ISBI. All rights reserved.

Acquisition of motor abilities up to independent walking in very low birth weight preterm infants

Objective: To determine chronological and corrected ages at acquisition of motor abilities up to independent walking in very low birth weight preterms and to determine up to what point it is necessary to use corrected age.Methods: This was a longitudinal study of preterms with birth weight < 1,500 g and gestational age <= 34 weeks, free from neurosensory sequelae, selected at the high-risk infants follow-up clinic at the Hospital das Clinicas, Faculdade de Medicine de Botucatu, Universidade Estadual Paulista (UNESP) in Botucatu, Brazil, between 1998 to 2003, and assessed every 2 months until acquisition of independent walking.Results: Nine percent of the 155 preterms recruited were excluded from the study, leaving a total of 143 patients. The mean gestational age was 30 +/- 2 weeks, birth weight was 1,130 +/- 222 g, 59% were female and 44% were small for gestational age. Preterms achieved head control in their second month, could sit independent at 7 months and walked at 12.8 months' corrected age, corresponding to the 4th, 9th and 15th months of chronological age. There were significant differences between chronological age and corrected age for all motor abilities. Preterms who were small for their gestational age acquired motor abilities later, but still within expected limits.Conclusions: Very low birth weight preterms, free from neurosensory disorders, acquired their motor abilities within the ranges expected for their corrected ages. Corrected age should be used until independent walking is achieved.

Follicular deviation and acquisition of ovulatory capacity in bovine follicles

Selection of dominant follicles in cattle is associated with a deviation in growth rate between the dominant and largest subordinate follicle of a wave (diameter deviation). To determine whether acquisition of ovulatory capacity is temporally associated with diameter deviation, cows were challenged with purified LH at known times after a GnRH-induced LH surge (experiment 1) or at known follicular diameters (experiments 2 and 3). A 4-mg dose of LH induced ovulation in all cows when the largest follicle was greater than or equal to 12 mm (16 of 16), in 17% (1 of 6) when it was 11 mm, and no ovulation when it was less than or equal to 10 mm (0 of 19). To determine the effect of LH dose on ovulatory capacity, follicular dynamics were monitored every 12 h, and cows received either 4 or 24 mg of LH when the largest follicle first achieved 10 mm in diameter (experiment 2). The proportion of cows ovulating was greater (P < 0.05) for the 24-mg (9 of 13; 69.2%) compared with the 4-mg (1 of 13; 7.7%) LH dose. To determine the effect of a higher LH dose on follicles near diameter deviation, follicular dynamics were monitored every 8 h, and cows received 40 mg of LH when the largest follicle first achieved 7.0, 8.5, or 10.0 mm (experiment 3). No cows with a follicle of 7 mm (0 of 9) or 8.5 mm (0 of 9) ovulated, compared with 80% (8 of 10) of cows with 10-mm follicles. Thus, follicles acquired ovulatory capacity at about 10 mm, corresponding to about 1 day after the start of follicular deviation, but they required a greater LH dose to induce ovulation compared with larger follicles. We speculate that acquisition of ovulatory capacity may involve an increased expression of LH receptors on granulosa cells of the dominant follicle and that this change may also be important for further growth of the dominant follicle.

Ultrasonographic and endocrine aspects of follicle deviation, and acquisition of ovulatory capacity in buffalo (Bubalus bubalis) heifers

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

Tissue changes in senescent gerbil prostate after hormone deprivation leads to acquisition of androgen insensitivity

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

Formação de classes ordinais após a aprendizagem de seqüências independentes

A aquisição de relações ordinais entre estímulos arbitrários é uma importante habilidade comportamental, requisito para a aprendizagem de comportamentos acadêmicos, especialmente a alfabetização. O propósito deste estudo foi investigar o efeito do ensino de seqüências de dois termos com sobreposição na emergência de relações ordinais com mais de dois estímulos. A sobreposição ocorre quando o último estímulo em uma seqüência de dois estímulos é o primeiro de outra seqüência (e.g., S1 -> S2 e S2 ->S3, onde S2 é o estímulo sobreposto). Nas Etapas 1 e 2 de um experimento conduzido com cinco estudantes do ensino fundamental foram ensinadas seqüências de dois termos com os cinco estímulos de um conjunto A (A1 -> A2, A2 -> A3, A3 -> A4, A4 ->A5) e os cinco de um conjunto B (B1 -> B2, B2 ->B3, B3 -> B4, B4 -> B5). Estabelecida essa linha de base, foram conduzidos testes da emergência de relações ordinais com três, quatro e cinco termos dos conjuntos A e B, separadamente. A Etapa 3 avaliou se estímulos das seqüências ensinadas eram mutuamente substituíveis, com base na mesma função ordinal (primeiro, secundo, etc.). Os estudantes compuseram as relações ordinais ensinadas e apresentaram relações ordinais emergentes com estímulos dos conjuntos A e B, separadamente. Três estudantes também realizaram a substituição mútua entre estímulos dos conjuntos A e B na Etapa 3. Esses resultados sugerem a formação de cinco classes de estímulos (A1B1, A2B2, etc.), cada uma consistindo de estímulos que ocuparam a mesma função ordinal em diferentes seqüências. Os resultados têm implicações para a análise de comportamento simbólico complexo. Merecem consideração, também, aspectos metodológicos que favoreceram a aprendizagem relacional e a emergência de comportamento novo.

The use of somatosensory information during the acquisition of independent upright stance

This study investigated developmental changes in the use of a contact surface during the acquisition of upright posture. Standing infants were longitudinally examined at four developmental epochs: pulling to stand (PS); standing alone (SA); walking onset (WO); and 1.5 months post-walking (PW). The results revealed that as standing experience increased the force applied to the contact surface by the hand and the body sway decreased. Applied force and body sway were consistently related in the anterior-posterior direction (r approximate to 0.65). Temporally, body sway led applied force (approximate to 45 ms) at the PS, SA, and WO developmental periods. However, at PW, the temporal relationship reversed and applied force led body sway (approximate to 140 ms). These results indicate that initially infants use surface contact for mechanical purposes but later for orientation information that affords prospective control of posture.

Acquisition and transmission of Hepatozoon canis (Apicomplexa: Hepatozoidae) by the tick Amblyomma ovale (Acari: Ixodidae)

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