Issues in assessing students in the clinical workforce : an exploratory study

The Monash Mini Case Record (MCR), based on Norcinis mini CEX, is an observed interaction between a student and a real patient in an authentic clinical setting. The assessor rates the students competence in history taking or physical examination and clinical reasoning on eight point scales. Professional / ethical behaviour within the encounter is evaluated on a four point scale. The assessor also grades the complexity of the case as low, medium or high. On completion of the student patient interaction, or her performance, and the assessor provides verbal and written feedback. Students complete both formative and summative MCRs across the academic year.

Health care use during 20 years following bariatric surgery

Context Bariatric surgery results in sustained weight loss; reduced incidence of diabetes, cardiovascular events, and cancer; and improved survival. The long-term effect on health care use is unknown.

Objective To assess health care use over 20 years by obese patients treated conventionally or with bariatric surgery.

Design, Setting, and Participants The Swedish Obese Subjects study is an ongoing, prospective, nonrandomized, controlled intervention study conducted in the Swedish health care system that included 2010 adults who underwent bariatric surgery and 2037 contemporaneously matched controls recruited between 1987 and 2001. Inclusion criteria were age 37 years to 60 years and body mass index of 34 or higher in men and 38 or higher in women. Exclusion criteria were identical in both groups.

Interventions Of the surgery patients, 13% underwent gastric bypass, 19% gastric banding, and 68% vertical-banded gastroplasty. Controls received conventional obesity treatment.

Main Outcome Measures Annual hospital days (follow-up years 1 to 20; data capture 1987-2009; median follow-up 15 years) and nonprimary care outpatient visits (years 2-20; data capture 2001-2009; median follow-up 9 years) were retrieved from the National Patient Register, and drug costs from the Prescribed Drug Register (years 7-20; data capture 2005-2011; median follow-up 6 years). Registry linkage was complete for more than 99% of patients (4044 of 4047). Mean differences were adjusted for baseline age, sex, smoking, diabetes status, body mass index, inclusion period, and (for the inpatient care analysis) hospital days the year before the index date.

Results In the 20 years following their bariatric procedure, surgery patients used a total of 54 mean cumulative hospital days compared with 40 used by those in the control group (adjusted difference, 15; 95% CI, 2-27; P = .03). During the years 2 through 6, surgery patients had an accumulated annual mean of 1.7 hospital days vs 1.2 days among control patients (adjusted difference, 0.5; 95% CI, 0.2 to 0.7; P < .001). From year 7 to 20, both groups had a mean annual 1.8 hospital days (adjusted difference, 0.0; 95% CI, −0.3 to 0.3; P = .95). Surgery patients had a mean annual 1.3 nonprimary care outpatient visits during the years 2 through 6 vs 1.1 among the controls (adjusted difference, 0.3; 95% CI, 0.1 to 0.4; P = .003), but from year 7, the 2 groups did not differ (1.8 vs 1.9 mean annual visits; adjusted difference, −0.2; 95% CI, −0.4 to 0.1; P = .12). From year 7 to 20, the surgery group incurred a mean annual drug cost of US $930; the control patients, $1123 (adjusted difference, −$228; 95% CI, −$335 to −$121; P < .001).

Conclusions Compared with controls, surgically treated patients used more inpatient and nonprimary outpatient care during the first 6-year period after undergoing bariatric surgery but not thereafter. Drug costs from years 7 through 20 were lower for surgery patients than for control patients.

Quantifying the positive effects of sponsor level, length, prominence and relatedness on recall and residual recall rates over time

This study is the first multi-year examination of the relative influence of the four main variables said to influence sponsorship recall. Sponsor recall data were collected from season ticket holders (STHs) of 10 professional sports teams, over periods ranging from 3 to 5 years per team. Across those teams and over that time, 309 sponsor–team relationships were examined, and sponsor recall data from over 117,000 individual STHs were collected. Sponsorship length and level were shown to have the strongest impact on recall, followed by relatedness and prominence. These variables affected both the recall of current sponsors and the decay rates of residual recall following the end of a sponsorship. The average rates of sponsor recall growth and decline have been derived from these data, giving managers a tool by which to benchmark sport sponsorship recall performance.

Designing and implementing a kindergarten-based, family-involved intervention to prevent obesity in early childhood: the ToyBox-study

The development of the ToyBox-intervention was based on the outcomes of the preliminary phase of the ToyBox-study, aiming to identify young children's key behaviours and their determinants related to early childhood obesity. The ToyBox-intervention is a multi-component, kindergarten-based, family-involved intervention with a cluster-randomized design, focusing on the promotion of water consumption, healthy snacking, physical activity and the reduction/ breaking up of sedentary time in preschool children and their families. The intervention was implemented during the academic year 2012–2013 in six European countries: Belgium, Bulgaria, Germany, Greece, Poland and Spain. Standardized protocols, methods, tools and material were used in all countries for the implementation of the intervention, as well as for the process, impact, outcome evaluation and the assessment of its cost-effectiveness. A total sample of 7,056 preschool children and their parents/caregivers, stratified by socioeconomic level, provided data during baseline measurements and participated in the intervention. The results of the ToyBox-study are expected to provide a better insight on behaviours associated with early childhood obesity and their determinants and identify effective strategies for its prevention. The aim of the current paper is to describe the design of the ToyBox-intervention and present the characteristics of the study sample as assessed at baseline, prior to the implementation of the intervention.

Transitions in reflective practice: exploring student development and preferred methods of engagement

Aim: Health-care professional students are required to demonstrate their reflective practice skills during their degree training programme. Online and digital technologies are increasingly being used to support this skill development. Our study aimed to explore whether different technology-based methods supported student growth and skill development in reflective practice at separate developmental time points (novice and competent). Methods: Third- (n = 23) and fourth-year undergraduate dietetic students (n = 22) from a single university were cross-sectionally surveyed via an online anonymous questionnaire at the end of the academic year. The mixed methods survey of 37 questions investigated the student experience of different reflective practice activities, their effect on a student's ability to self-reflect and whether using them aided a student's perceived transition towards becoming a competent dietitian. The data analysis included brief thematic enquiry, descriptive and independent t-test statistical examination. Results: Differences emerged in the way students engaged in reflection over time. Fourth-year students preferred to use more independent methods such as e-journaling (fourth- vs third-year students, P = 0.003) and engaged in reflection for reasons outside assessment (fourth- vs third-years, P = 0.027). Fourth-year students also identified fewer negative barriers to participating in reflection and reported being comfortable engaging in reflective practice. Conclusions: Overall, offering students a range of ways to engage in reflective practice over time supported their understanding and increased confidence in their reflective practice skills, thus potentially enabling a smoother transition into their profession where reflective practice is an essential and autonomous skill. © 2014 Dietitians Association of Australia.

The National Perinatal Depression Initiative: An evaluation of access to general practitioners, psychologists and psychiatrists through the Medicare Benefits Schedule

OBJECTIVE: To evaluate the impact of the National Perinatal Depression Initiative on access to Medicare services for women at risk of perinatal mental illness. METHOD: Retrospective cohort study using difference-in-difference analytical methods to quantify the impact of the National Perinatal Depression Initiative policies on Medicare Benefits Schedule mental health usage by Australian women giving birth between 2006 and 2010. A random sample of women of reproductive age enrolled in Medicare who had not given birth where used as controls. The main outcome measures were the proportions of women giving birth each month who accessed a Medicare Benefits Schedule mental health items during the perinatal period (pregnancy through to the end of the first postnatal year) before and after the introduction of the National Perinatal Depression Initiative. RESULTS: The proportion of women giving birth who accessed at least one mental health item during the perinatal period increased from 88 to 141 per 1000 between 2007 and 2010. The difference-in-difference analysis showed that while there was an overall increase in Medicare Benefits Schedule mental health item access as a result of the National Perinatal Depression Initiative, this did not reach statistical significance. However, the National Perinatal Depression Initiative was found to significantly increase access in subpopulations of women, particularly those aged under 25 and over 34 years living in major cities. CONCLUSION: In the 2 years following its introduction, the National Perinatal Depression Initiative was found to have increased access to Medicare funded mental health services in particular groups of women. However, an overall increase across all groups did not reach statistical significance. Further studies are needed to assess the impact of the National Perinatal Depression Initiative on women during childbearing years, including access to tertiary care, the cost-effectiveness of the initiative, and mental health outcomes. It is recommended that new mental health policy initiatives incorporate a planned strategic approach to evaluation, which includes sufficient follow-up to assess the impact of public health strategies.

The relationship between school violence and student proficiency

School violence has recently become a central concern among teachers, students, students' parents and policymakers. Violence can induce behaviors on educational agents that go against the goals of improving the quality of education and increasing school attendance. In fact, there is evidence that school environmental characteristics and student performance and behavior at school are related. Although school violence may have a direct impact on students’ performance, such impact has not yet been quantified. In this paper, we investigate this issue using Brazilian data and show that, on average, students who attended more violent schools had worse proficiency on a centralized test carried out by the Brazilian Ministry of Education, even when we controlled for school, class, teachers and student characteristics. We also show that school violence affects more the students from the bottom of the proficiency distribution. Furthermore, we find out that besides the direct effect on student proficiency, it seems that school violence has an indirect effect on it operating through teacher turnover. Indeed, we show that the occurrence of violent episodes in a school decreases the probability of a class in that school having only one teacher during the academic year, and increases the probability of that class having more than one teacher (teacher turnover).

Acesso e permanência na universidade federal do rio grande do Norte sob o ponto de vista do docente e do estudante com deficiência Natal-RN

Inclusion of students with disabilities is a recent case that has been discussed in school contexts, but the current policy of inclusion for access and retention of students in higher education is still a problem face there is much to do, therefore, are incipient studies in which this student body is involved. Accordingly, what is happening is that the most studies deal with on these students and little is said about them. For inclusive education thus the institution should prepare to receive students, having as one of its premises their point of views about what actually experience aiming at promoting education for all. Therefore, this study deals with the process of inclusion of students with disabilities regularly enrolled in undergraduate courses at the Universidade Federal do Rio Grande do Norte - UFRN.They were used the assumptions of qualitative research enabled by the case study method and semi-structured interviews. It has been analyzed by guiding actions and teaching practices, under the views of disabled students and teachers, the conditions of access and permanence offered by UFRN. Twelve students with physical, visual, hearing disabilities participated and five teachers from the acedemic centers that in academic year 2008 taught to these students. For data analysis it was used the technique of content analysis. It was extracted two themes: access and retention of students with disabilities in UFRN, in which emerged the categories described and analyzed in the course of this work. The results show the difficulties of access and retention of students with disabilities within the UFRN, such as attitudinal, pedagogical and architectural barriers. However, as it has also turned out, initial advances in the quest for achieving more effective actions to guarantee access and permanence of these students in UFRN. It has concluded that the scope for the exercise of citizenship in the pupils with disabilities who need this Higher Education Institution has an inclusive education Project, wide and consolidated, for the actions undertaken by the Ministry of Education - MEC, by itself, are not guaranteed to all students due to mobility, autonomy and security. It has hoped this work will bring benefits for new studies to develop features that were located, but were not our focus, because then the UFRN may advance the inclusive process of disabled students

Educação inclusiva: práticas de professores frente à deficiência intelectual

The present work is a survey of pedagogical practices of teachers who experience the daily school with students with Intellectual Disability (ID) in their classrooms, considered inclusive. The study was conducted in academic year 2010 in a municipal school in Natal-RN, aimed at investigating the pedagogical practices developed by the participating teachers as well as its view of the front of Intellectual Disabilities students who are inserted in the initial years of Elementary School. In methodological choice, considering the nature of the phenomenon, we chose the qualitative approach and the case study method. The observation and semi-structured interview were used as procedures, which contributed to a significant collection of data in an attempt to answer the objectives. The study subjects were selected by convenience and were formed into two teachers from Elementary School I, linked to the public educational system, which volunteered to collaborate in this research. The analysis of the observations and of the speeches made possible build pedagogical considerations on the action with students with Intellectual Disabilities in a regular school. The results point to a practice covered with a traditional pedagogy, with a few adjustments, although there is an initial process of change, what we observe in the classroom and captured in the words, because, at various times, we saw an interest in developing a pedagogy of Freire. One aspect that caught our attention refers to the formative action at school for these teachers. We found its incipiency, because this does not happen in a systematic way at school. Throughout the years investigated, the teachers had no access to any form of training neither to any form of specialized monitoring. We realize that there is still a concept of Intellectual Disability that makes difficult to "see" this student as a human being having learning opportunities. The aspects that interfere in the formation hinder the development of a pedagogical practice that meets the uniqueness of its customers and promotes a truly effective school inclusion, consistent with social rights proclaimed in this century. We believe in the irreversibility of the inclusive process initiated a few decades ago and that obstacles to the practice of teaching students with ID are visible and possible to overcome if they are turned into challenges for all those who compose the school, the municipal education system and those who build public policies for inclusive education

Custo de produção de amora-preta em região tropical

O cultivo da amora-preta é recente no Brasil. A espécie apresenta elevada adaptabilidade, baixa exigência em frio, facilidade de manejo, rusticidade e pouca utilização de defensivos agrícolas. É uma fruta que vem despertando elevada atenção dos consumidores devido à presença de compostos fenólicos com propriedades antioxidantes. Com este trabalho, objetivou-se analisar o custo de produção do cultivo da amora-preta, em primeiro ano de produção. Para estimar a matriz de coeficientes técnicos e os custos de produção, em 2007, os preços de venda foram levantados junto a um produtor, e o restante das informações foi obtido de um experimento. de acordo com os dados e os cálculos de custos, a primeira produção da cultura foi de 3.000 kg.ha-1, com custo de implantação e condução, no primeiro ano, de R$ 8.710,63, e no segundo ano, apresentou custo de R$ 6.467,50. o custo de produção foi relativamente baixo comparado com outras frutíferas perenes cultivadas na região, evidenciando que esta atividade pode ser mais uma alternativa de renda para agricultura familiar.

Concepções sobre Assimilação Solidária num curso universitário

O presente artigo é parte de uma tese de doutorado (Silva, 1997). A pesquisa foca as possibilidades, conseqüências e reflexões epistemológicas da implantação de uma proposta pedagógica alternativa ao ensino tradicional vigente (ETV) na disciplina Cálculo I, do Curso de Licenciatura em Matemática, Unesp, Câmpus de Bauru, durante o ano de 1995. Partindo do Contrato de Trabalho, segundo a Assimilação Solidária (cf. Baldino, 1995a), tematiza a articulação do funcionamento das regras do Contrato com a avaliação e o trabalho em grupo. Ao lado do prêmio ao saber, é considerado o justo prêmio ao trabalho coletivo produzido em sala de aula. A investigação, de ordem qualitativa, localiza-se na vertente Pesquisa-Ação (cf. Thiollent, 1992), na qual o professor-pesquisador tematiza sua própria sala de aula, além de contextualizar os sujeitos no seu meio sócio-histórico-político-cultural.

Dinâmica de populações e fitossociologia de plantas daninhas no cultivo do feijão-caupi e mandioca no sistema corte e queima com o uso de arado

Este estudo investigou a composição florística das plantas daninhas em área queimada durante três anos agrícolas. A pesquisa foi conduzida no município de Zé Doca, Maranhão. O preparo da área no primeiro ano agrícola (2006/2007) foi realizado com corte e queima da vegetação para o cultivo de milho seguido do feijão-caupi. No segundo e no terceiro ano agrícola, o preparo da área consistiu de aração para o cultivo do milho seguido de mandioca (2007/2008) e depois para o feijão-caupi em sucessão à cultura de mandioca (2008/2009). A coleta das plantas daninhas ocorreu nas culturas de feijão-caupi e mandioca aos 30 e 60 dias após a semeadura (DAS), no primeiro e no segundo ano agrícola, respectivamente, e no feijão-caupi aos 30 DAS do terceiro ano agrícola, com retângulo (0,5 x 0,3 m) lançado 10 vezes ao acaso na área cultivada. A cada lançamento, as plantas daninhas foram colhidas, para contagem, identificação, secagem e, assim, obter os índices fitossociológicos. O fogo reduziu a diversidade e o número das plantas daninhas. As espécies com maior valor de IVI foram Imperata brasiliensis, Sida glomerata e Corchorus argutus, após o fogo na cultura do feijãocaupi; e Juncus sp., Spermacoce verticillata, Aeschynomene americana e Cyperus sp., após preparo da área com aração nas culturas de mandioca e feijão-caupi. As plantas de capoeira ocorreram depois da queima, porém sua importância foi reduzida com o passar do tempo.

The success rate of immediate implant placement of mandibular molars: A clinical and radiographic retrospective evaluation between 2 and 8 years

Background: Dental implants, indicated for re-establishing both mastigatory and aesthetic functions, can be placed in the sockets immediately after tooth extraction. Most studies investigate the anterior and upper regions of the dental arch, whereas few examine longitudinal appraisal of immediate implant installation in the mandibular molar region. Objective: The aim of this retrospective study was to evaluate the success rate of immediate dental implants placement in mandibular molars within a follow-up period as long as 8 years. Materials and methods: Seventy-four mandibular molar implants after non-traumatic tooth extraction between 2002 and 2008 were examined in the study. All implants were evaluated radiographically immediately after prosthesis placement, 1 year after implantation, and by the end of the experimental period, in 2010. Clinical evaluation was done according to [Albrektsson et al. (1986) The International Journal of Oral & Maxillofacial Implants, 1, 11-25] success criteria for marginal bone loss. The mean bone losses, calculated as the difference between the final evaluation measures and those taken by the end of the first year of implant, were compared using Kruskal-Wallis test with a significance level of 5%. Results: All implants presented clinical and radiographic stable conditions, that is, 100% success rate. Significant bone loss was not found between final evaluation and that of the first functional year (P > 0.05). Conclusion: Immediate implant placement of mandibular molars proved to be a viable surgical treatment given the high success rate up to 8 years after implantation. © 2012 John Wiley & Sons A/S.

Efeito de resíduos vegetais de milheto (Pennisetum americanum) e da calagem em algumas propriedades físicas de um nitossolo vermelho em sistema de semeadura direta

Pós-graduação em Agronomia (Agricultura) - FCA

Atributos químicos do solo, densidade de raiz e produtividade da cana-de-açúcar em função da aplicação de gesso agrícola

Pós-graduação em Agronomia (Ciência do Solo) - FCAV