Clinical reasoning of medical students in a public university in Brazil

The aim of this research was to understand the reasoning developed by medical students in a public university in Brazil. This research on education included semi-structured interviews and film recordings of interns discussing 10 clinical cases. A sample of 16 interns analyzed cases presented on a notebook computer with a webcam. They were instructed to verbalize all their thoughts on the procedures they would use. The film recordings and transcripts of the interviews were analyzed. Quantitative data was evaluated using Yates' chi-squared test and speech analysis was used to evaluate the transcripts. The theme worked on in the practice of reasoning was: the student's perceptions of their clinical practice. Of the 160 diagnoses, 57% were done with analytical reasoning and 43% with non-analytical reasoning. The hypothetical deductive method was employed by 31% of the interns and the inductive method was employed by 69%. The diagnostic accuracy was 81% correct for easy cases and 85% correct for difficult cases. We observed two empirical categories: the cognitive universe of the student and the patient's context.

Os dois métodos e o núcleo duro da teoria econômica

While methodological sciences have no object and are supposed to adopt a hypothetical-deductive method, substantive sciences including economics should use an empirical or historical-deductive method. The great classical economists and Keynes did that and were able to develop open models explaining how equally open economic systems work. Thus, the hard core of relevant economics is formed by the classical microeconomics and the classical theory of capitalist economic growth, and by Keynesian macroeconomics. In contrast, neoclassical economist aiming to build a mathematical science wrongly adopted the hypothetical-deductive method, and came to macroeconomic and growth models that do not have practical use in policymaking. The exception is Marshall's microeconomics that does not provide a model of real economic systems, but is useful to the analysis of markets.

Dois métodos ou duas antropologias?

This is a commentary to a well-known paper of Bresser-Pereira: The two methods and the hard core of economics. Therefore, it target a very suggestive article that seeks to examine the conceptions of man of classical political economy and Keynesian economics in contrast to the reductive conception of man found in positive economic theory, especially in neoclassical theory. It shows that both conceptions at large think with abstracts economic men. However, the first one reasons with individuals who are determined by the historical and social structures of the capitalistic economic system. The second one seeks to present them in a formal way, as if they were mere pieces of a large automaton, i.e., the mercantile system as a large and standardized mechanism. In the end, Marx is distinguished because he does not reflect based on a static anthropological foundation. For him, men are subjects that become because they can realize themselves only in the course of history.

The general equilibrium theory as economic metatheory

Many economists show certain nonconformity relative to the excessive mathematical formalization of economics. This stems from dissatisfaction with the old debate about the lack of correspondence between mainstream theoretical models and reality. Although we do not propose to settle this debate here, this article seeks to associate the mismatch of mathematized models with the reality of the adoption of the hypothetical-deductive method as reproduced by general equilibrium. We begin by defining the main benefits of the mathematization of economics. Secondly, we address traditional criticism leveled against it. We then focus on more recent criticism from Gillies (2005) and Bresser-Pereira (2008). Finally, we attempt to associate the reproduction of the hypothetical-deductive method with a metatheoretical process triggered by Debreu's general equilibrium theory. In this respect, we appropriate the ideas of Weintraub (2002), Punzo (1991), and mainly Woo (1986) to support our hypothesis.

Ciência econômica e modelos de explicação científica: retomando a questão

Economic science and scientific explanation models. Economics was born under the sign of methodological vagueness. The first author who tried to solve the question (John Stuart Mill) asserted that it is a kind of knowledge that uses the abstract (direct deductive) method but also that it is an exception because for all other phenomena in the field of moral science the correct method is the inverse deductive or historical method. On the other side, functionalist explanations that are condemned by the scientific precepts of economics are present in the science since its beginning with Adam Smith. Economics went ahead without worriment about these methodological issues but this indefiniteness has never gone off stage. Since the start of XXI century new facts are emerging. Developments in Psychology are giving a new breath to Friedman's point of view and seem to fortify the mainstream (Rogebert e Nordberg, 2005), whereas unfolding in complexity science promises to throw it down and put in its place another kind of explanation borrowed from Biology (Beinhocker, 2006). All this stimulates to retake the question. We do this here, under a critical vision, taking the taxonomy of scientific explanations framed by modern positivism.

Incerteza e não ergodicidade: crítica aos neoclássicos

The starting point of this essay is to show that, in our view, the problem of the traditional economics is not in the deductive method nor the mathematical methods used, but to attribute to economic agents "power" on the future and prescribe the existence of ergodic stochastic processes in their economic analyzes. Thus, building a theory on the ground whose bases are not able to sustain a proper understanding of the world, mainstream economics has difficulties in using the modeling for establishing deductions and conclusions that help understanding the system. Thus, the logical-mathematical rigor in economic models and deduction can be used with appropriate axioms, which is not the case of mainstream economics. Our hypothesis is that the inability of the mainstream in predicting economic crisis is due to the non-recognition of some principles that best describe the dynamics of financialized contemporary capitalism, as the principles of non-ergodicity and Keynesian uncertainty.

Multiple centroid method to evaluate the adaptability of alfalfa genotypes

This study aimed to evaluate the efficiency of multiple centroids to study the adaptability of alfalfa genotypes (Medicago sativa L.). In this method, the genotypes are compared with ideotypes defined by the bissegmented regression model, according to the researcher's interest. Thus, genotype classification is carried out as determined by the objective of the researcher and the proposed recommendation strategy. Despite the great potential of the method, it needs to be evaluated under the biological context (with real data). In this context, we used data on the evaluation of dry matter production of 92 alfalfa cultivars, with 20 cuttings, from an experiment in randomized blocks with two repetitions carried out from November 2004 to June 2006. The multiple centroid method proved efficient for classifying alfalfa genotypes. Moreover, it showed no unambiguous indications and provided that ideotypes were defined according to the researcher's interest, facilitating data interpretation.

An appraisal of the health planning method proposed by the Pan-American Health Organization for Latin America

A brief description of the main features of the health planning technique developed by the "Centro de Estudios del Desarrollo" (CENDES) in Venezuela, and proposed by the Pan-American Health Organization for use in Latin America, is presented. This presentation is followed by an appraisal of the planning method which includes comments both upon its positive aspects and upon its negative points. Comments are also made referring to other recent publications of the WHO/PAHO on health planning. In conclusion, the CENDES technique is considered a health planning method of great potential for use especially in underdeveloped areas, the success of its application depending upon the hability of the health planners to introduce the necessary modifications to adapt to the local circunstamces.

The use of wide-mesh gauze impregnated with lambda-cyhalothrin covering wall openings in huts as a vector control method in Suriname

An alternative vector control method, using lambda-cyhalothrin impregnated wide-mesh gauze covering openings in the walls of the houses was developed in an area in the Eastern part of the interior of Suriname. Experimental hut observations showed that Anopheles darlingi greatly reduced their biting activity (99-100%) during the first 5 months after impregnation. A model assay showed high mortality both of mosquitoes repelled by the gauze as well as of those that succeeded in getting through it. A field application test in 270 huts showed good acceptance by the population and good durability of the applied gauze. After introducing the method in the entire working area, replacing DDT residual housespraying, the malaria prevalence, of 25-37% before application dropped and stabilized at between 5 and 10% within one year. The operational costs were less than those of the previously used DDT housespraying program, due to a 50% reduction in the cost of materials used. The method using widemesh gauze impregnated with lambdacyhalothrin strongly affects the behavior of An. darlingi. It is important to examine the effect of the method on malaria transmission further, since data indirectly obtained suggest substantial positive results.

Ill-defined causes of death in Brazil: a redistribution method based on the investigation of such causes

OBJECTIVE To propose a method of redistributing ill-defined causes of death (IDCD) based on the investigation of such causes.METHODS In 2010, an evaluation of the results of investigating the causes of death classified as IDCD in accordance with chapter 18 of the International Classification of Diseases (ICD-10) by the Mortality Information System was performed. The redistribution coefficients were calculated according to the proportional distribution of ill-defined causes reclassified after investigation in any chapter of the ICD-10, except for chapter 18, and used to redistribute the ill-defined causes not investigated and remaining by sex and age. The IDCD redistribution coefficient was compared with two usual methods of redistribution: a) Total redistribution coefficient, based on the proportional distribution of all the defined causes originally notified and b) Non-external redistribution coefficient, similar to the previous, but excluding external causes.RESULTS Of the 97,314 deaths by ill-defined causes reported in 2010, 30.3% were investigated, and 65.5% of those were reclassified as defined causes after the investigation. Endocrine diseases, mental disorders, and maternal causes had a higher representation among the reclassified ill-defined causes, contrary to infectious diseases, neoplasms, and genitourinary diseases, with higher proportions among the defined causes reported. External causes represented 9.3% of the ill-defined causes reclassified. The correction of mortality rates by the total redistribution coefficient and non-external redistribution coefficient increased the magnitude of the rates by a relatively similar factor for most causes, contrary to the IDCD redistribution coefficient that corrected the different causes of death with differentiated weights.CONCLUSIONS The proportional distribution of causes among the ill-defined causes reclassified after investigation was not similar to the original distribution of defined causes. Therefore, the redistribution of the remaining ill-defined causes based on the investigation allows for more appropriate estimates of the mortality risk due to specific causes.

An ELISA method using serum derived HDAg for the sorological detection of HDV antigens and antibodies

One of the main difficulties related to the detection of the Hepatitis Delta Virus (HDV) antigen and antibody has been the source of the needed HD antigen since HDV containing human and animal livers are very difficult to obtain and since yield is low. This fact prompted us to try to use the serum of patients in the acute phase of HDV infection as a source of HDAg and turn to enzyme immunoassays (EIA) instead of RIA for the sake of easiness and economy in the amount of HDAg needed. The antigen for EIA was obtained from patients during the acute phase of HDV infection and the antibody from patients who have been carriers for many years. For the detection of the antigen, a sandwich type method was employed, whereas for the antibody a competition assay was developed. In order to assess the relative specificity and sensibility of the test, the antibody assay was compared to a commercial RIA (C. RIA, Abbott) and to a non-commercial RIA (NC RIA). Forty-two sera were tested by the two methods and only in two cases discrepant results were obtained. Its is concluded that: 1) sera from patients in the acute and chronic phases of HDV infection can be used as source of both antigen and antibody, for immunoassays; 2) EIA and RIA have comparable relative specificity and sensibility and 3) EIA is easier to perform, cheaper, non-hazardous, has a longer shelf-life and saves scarce HDAg.

A low cost method to produce a gaseous environment for the isolation of Helicobacter pylori

A low cost method (LCM) to produce a gaseous environment for the isolation of Helicobacter pylori, was compared with the standard Gas Park system. The LCM uses a carbonated antacid tablet, a plastic bag with tap water, a candle, and a wide-mouthed glass jar provided with a tight-fitting metalic screw cap and a rubber gasket. Antral gastric biopsies from 153 cases were incubated by duplicate on blood agar plates and treated with the two methods. In 95 cases the agent was isolated from both, and only from the standard method in 10 cases; the opposite condition was found in five cases, and 43 were negative. That difference is not significant (Pearson's X²= 93.25 p > 0,05)

Enzyme linked immunosorbent assay for rubella antibodies: a simple method of antigen production. A preliminary report

A simple method of rubella antigen production by treatment with sodium desoxycholate for use in enzyme immunoassay (IMT-ELISA) is presented. When this assay was compared with a commercial test (Enzygnost-Rubella, Behring), in the study of 108 sera and 118 filter paper blood samples, 96.9% (219/226) overall agreement and correlation coefficient of 0.90 between absorbances were observed. Seven samples showed discordant results, negative by the commercial kit and positive by our test. Four of those 7 samples were available, being 3 positive by HI.