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.

Some comments on the numerical simulation of self-synchronization of four non-ideal exciters

In this paper, self-synchronization of four non-ideal exciters is examined via numerical simulation. The mathematical model consists of four unbalanced direct Current motors with limited power supply mounted on a flexible Structural frame support. (c) 2004 Elsevier B.V. All rights reserved.

Short comments on self-synchronization of two non-ideal sources supported by a flexible portal frame structure

A practical problem of synchronization of a non-ideal (i.e. when the excitation is influenced by the response of the system) and non-linear vibrating system was posed and investigated by means of numerical simulations. Two rotating unbalanced motors compose the mathematical model considered here with limited power supply mounted on the horizontal beam of a simple portal frame. As a starting point, the problem is reduced to a four-degrees-of-freedom model and its equations of motion, derived elsewhere via a Lagrangian approach, are presented. The numerical results show the expected phenomena associated with the passage through resonance with limited power. Further, for a two-to-one relationship between the frequencies associated with the first symmetric mode and the sway mode, by using the variation of torque constants, the control of the self-synchronization and synchronization (in the system) are observed at certain levels of excitations.

On an Optimal Linear Control Applied to a Non-Ideal Load Transportation System, Modeled with Periodic Coefficients

In this paper, a load transportation system in platforms or suspended by cables is considered. It is a monorail device and is modelled as an inverted pendulum built on a car driven by a DC motor. The governing equations of motion were derived via Lagrange's equations. In the mathematical model we consider the interaction between the DC motor and the dynamical system, that is, we have a so-called non-ideal periodic problem. The problem is analysed and we also developed an optimal linear control design to stabilize the problem.

Control and chaos for vibro-impact and non-ideal oscillators

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

On an Non-Ideal Global and Local Energy Transfer, Using an Electro-Magneto and Magneto-Rheological Dampers

In this paper, we investigated the nonlinear vibrations of a Non-ideal (NIS) electromechanical absorber (NEVA), taking into account a modified mathematical model of (MR) Damper. We observed the presence of the Sornmerfeld effect (it is the steady state frequencies of the DC motor, which it will usually increasing as more power (Voltage) is given to it, in a step-by-step fashion. When a resonance condition it is reached, the better part of this energy it is consumed to generate large amplitude vibrations of the foundation, without sensible change of the motor frequency). The obtained results, by using numerical and analytical simulations, were discussed, in details.

On a nonlinear and chaotic non-ideal vibrating system with shape memory alloy (SMA)

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Nonlinear Dynamics and Control of an Ideal/Nonideal Load Transportation System With Periodic Coefficients

In this paper, a loads transportation system in platforms or suspended by cables is considered. It is a monorail device and is modeled as an inverted pendulum built on a car driven by a dc motor the governing equations of motion were derived via Lagrange's equations. In the mathematical model we consider the interaction between the dc motor and the dynamical system, that is, we have a so called nonideal periodic problem. The problem is analyzed, qualitatively, through the comparison of the stability diagrams, numerically obtained, for several motor torque constants. Furthermore, we also analyze the problem quantitatively using the Floquet multipliers technique. Finally, we devise a control for the studied nonideal problem. The method that was used for analysis and control of this nonideal periodic system is based on the Chebyshev polynomial exponsion, the Picard iterative method, and the Lyapunov-Floquet transformation (L-F transformation). We call it Sinha's theory.

On a control of a non-ideal mono-rail system with periodics coefficients

In this work, the problem in the loads transport (in platforms or suspended by cables) it is considered. The system in subject is composed for mono-rail system and was modeled through the system: inverted pendulum, car and motor and the movement equations were obtained through the Lagrange equations. In the model, was considered the interaction among of the motor and system dynamics for several potencies motor, that is, the case studied is denominated a non-ideal periodic problem. The non-ideal periodic problem dynamics was analyzed, qualitatively, through the comparison of the stability diagrams, numerically obtained, for several motor torque constants. Furthermore, one was made it analyzes quantitative of the problem through the analysis of the Floquet multipliers. Finally, the non-ideal problem was controlled. The method that was used for analysis and control of non-ideal periodic systems is based on the Chebyshev polynomial expansion, in the Picard iterative method and in the Lyapunov-Floquet transformation (L-F trans formation). This method was presented recently in [3-9].

On non-ideal and non-linear portal frame dynamics analysis using Bogoliubov averaging method

We apply the Bogoliubov Averaging Method to the study of the vibrations of an elastic foundation, forced by a Non-ideal energy source. The considered model consists of a portal plane frame with quadratic nonlinearities, with internal resonance 1:2, supporting a direct current motor with limited power. The non-ideal excitation is in primary resonance in the order of one-half with the second mode frequency. The results of the averaging method, plotted in time evolution curve and phase diagrams are compared to those obtained by numerically integrating of the original differential equations. The presence of the saturation phenomenon is verified by analytical procedures.

A Short Note on a Nonlinear System vibrations under Two Non-Ideal Excitations

This paper describes a nonlinear phenomenon in the dynamical behavior of a nonlinear system under two non-ideal excitations: the self-synchronization of unbalanced direct current motors. The considered model is taken as a Duffing system that is excited by two unbalanced direct current motors with limited power supplies. The results obtained by using numerical simulations are discussed in details.

Fluorescence spectroscopy for tongue carcinoma detection: Study in an animal model

Fluorescence diagnosis of malignant lesions has been showed as an attractive optical technique due especially to its real-time response and a more objective and quantitative evaluation. Even though the oral cavity allows a direct examination many lesions are diagnosed when it is already in advanced stage, compromising the patient prognosis. In this study, the fluorescence spectroscopy was used to the detection of chemically induced carcinoma at the lateral border of the tongue in a hamster model. Two excitations wavelengths in visible region were applied: 442 and 532 nm. All the spectra results were analyzed comparing with the histopathological diagnosis. The better results were achieved with the 442 nm laser excitation. The spectra from carcinoma showed new emission bands and these were used to determined different ratios for a quantitative analysis. Using the 625-645 nm fluorescence range under 442 nm excitation (A3 coefficient) the percentage of false negative was of 9.1%, however the false positive percentage was of 18.5%. The 532 nm excitation provided a better normal tissue detection compared to 442 nm excitation. The ideal clinical condition is probably the use of multiple wavelengths excitation for a broader tissue fluorescence investigation.

On numerical simulations of a nonlinear self-excited system with two non-ideal sources

In this work, the dynamic behavior of self-synchronization and synchronization through mechanical interactions between the nonlinear self-excited oscillating system and two non-ideal sources are examined by numerical simulations. The physical model of the system vibrating consists of a non-linear spring of Duffing type and a nonlinear damping described by Rayleigh's term. This system is additional forced by two unbalanced identical direct current motors with limited power (non-ideal excitations). The present work mathematically implements the parametric excitation described by two periodically changing stiffness of Mathieu type that are switched on/off. Copyright © 2005 by ASME.

A nonlinear and non-ideal wind generator supporting structure

We present a simple mathematical model of a wind turbine supporting tower. Here, the wind excitation is considered to be a non-ideal power source. In such a consideration, there is interaction between the energy supply and the motion of the supporting structure. If power is not enough, the rotation of the generator may get stuck at a resonance frequency of the structure. This is a manifestation of the so-called Sommerfeld Effect. In this model, at first, only two degrees of freedom are considered, the horizontal motion of the upper tip of the tower, in the transverse direction to the wind, and the generator rotation. Next, we add another degree of freedom, the motion of a free rolling mass inside a chamber. Its impact with the walls of the chamber provides control of both the amplitude of the tower vibration and the width of the band of frequencies in which the Sommerfeld effect occur. Some numerical simulations are performed using the equations of motion of the models obtained via a Lagrangian approach.

Experimental model of pulmonary carcinogenesis in Wistar rats

Purpose: To elaborate an experimental model of pulmonary carcinogenesis in Wistar rats. Methods: Male Rattus norvegicus albinus, Wistar lineage was carried through an intra-pulmonary instillation of the Benzo[a]pyrene (B[a]P) dilution in alcohol 70%, a polycyclic aromatic hydrocarbon widely known by its power of tumoral induction. Three experimental groups had been formed with 08 animals each: Control Group (Alcohol 70%); B[a]P Group 10 mg/kg; e B[a]P Group 20mg/ kg, submitted to euthanasia 08, 10, 12 and 14 weeks after the experimental procedure. The pulmonary sections had been colored by hematoxilin-eosin (HE) and submitted to the morphometrical analysis to describe the tissue alterations. Results: The presence of diffuse inflammatory alterations was observed in all groups, however, at the analysis of the pulmonary tissue of the experimental groups, it had been observed hyperplasic alterations (BALT hyperplasia), and in one of the animals of the experimental group 20mg/kg (12 weeks), it was noticed the presence of cellular epithelial tracheal pleomorphism, suggesting the adenocarcinoma formation in situ. Conclusion: The main secondary alterations to the intra-pulmonary instillation of B[a]P in Wistar rats were: cellular proliferation, inflammatory alterations of several degrees and nodular lymphoid hyperplasias. The association of an activator agent of the pulmonary metabolic reply is necessary to establish the ideal reply-dose to the development of the lung cancer.