Utilização de mapas conceituais como ferramenta de ensino para o desenvolvimento do raciocínio clínico no curso de medicina da Universidade Federal do Rio Grande do Norte

BACKGROUND: Among the wide range of skills displayed by a medical doctor is undoubtedly the need to use cohesive and well grounded clinical reasoning in order for medical care to be indeed effective. It is in this respect that conceptual maps emerge; these are a methodological innovation that allows a comprehensive, panoramic and associative outlook of theoretical content, making it more practical and applicable to the reality of clinical observation. Promoting learning, learning resources and a feedback system between professor and students, as well as assessing and monitoring the performance of students during their academic training, are the main features of this tool. OBJETIVE: Assess the use of conceptual maps as a teaching-learning tool in the training of undergraduate medical students at Universidade Federal do Rio Grande do Norte (UFRN). METHODOLOGY: Interventional, randomized, cross-sectional study conducted with students from the 3rd and 5th periods of the medical course at UFRN, during the second semester of 2014, totaling 86 participants, divided into two groups: GI (intervention – clinical case resolution with a conceptual map) and GII (control – clinical case resolution without a conceptual map) in each period. RESULTS: The use of conceptual maps to teach liver failure syndrome resulted in a statistically significant cognitive gain for G1 students from the 5th period (GI: 6.8±1.6 and 8.0±1.5, p = 0.024; GII: 7.2±2.1 and 8.0±1.7, p = 0.125, pre and post-intermediate means, respectively), a result not observed in the period 3rd (GI: 7.7±1.3 and 8.0±1.4, p = 0.501; GII: 6.7±1.8 and 7.8±1.8; p=0.068, pre and post-intermediate means, respectively). Students in the 3 rd period gave better responses to the first clinical case, with a larger number of suitable concepts and crosslinks, when they used conceptual maps (GI: 91.3±13.15 and GII: 64.84±22.84, p=0,002). Students in the 5th period exhibited better clinical reasoning and more complete responses using the tool (p=0,01). Most of the students were not aware of the tool (53.8% from the 3rd period and 65.3% from the 5th period). Among those who knew about conceptual maps, most (59.3%) had only used them during high school, 14.8% had never used them and only seven students (25.9%) used them during the medical course. Analysis of open responses, obtained in process assessment showed clear satisfaction and enthusiasm with learning about the new tool, and frequent suggestions to use it at other moments in the course. Assessment of learning profile, using the VARK questionnaire, showed that most students from both periods exhibited a multimodal style. CONCLUSION: Despite their scant knowledge regarding the tool, good acceptability and understanding was observed in the study participants. The conceptual maps allowed cognitive gains, better responses and clinical reasoning in teaching liver failure syndrome to 5th period students.

Iterative reconstruction as a novel method of radiation dose reduction at computed tomography in patients with Crohn's disease

Prior work of our research group, that quantified the alarming levels of radiation dose to patients with Crohn’s disease from medical imaging and the notable shift towards CT imaging making these patients an at risk group, provided context for this work. CT delivers some of the highest doses of ionising radiation in diagnostic radiology. Once a medical imaging examination is deemed justified, there is an onus on the imaging team to endeavour to produce diagnostic quality CT images at the lowest possible radiation dose to that patient. The fundamental limitation with conventional CT raw data reconstruction was the inherent coupling of administered radiation dose with observed image noise – the lower the radiation dose, the noisier the image. The renaissance, rediscovery and refinement of iterative reconstruction removes this limitation allowing either an improvement in image quality without increasing radiation dose or maintenance of image quality at a lower radiation dose compared with traditional image reconstruction. This thesis is fundamentally an exercise in optimisation in clinical CT practice with the objectives of assessment of iterative reconstruction as a method for improvement of image quality in CT, exploration of the associated potential for radiation dose reduction, and development of a new split dose CT protocol with the aim of achieving and validating diagnostic quality submillisiever t CT imaging in patients with Crohn’s disease. In this study, we investigated the interplay of user-selected parameters on radiation dose and image quality in phantoms and cadavers, comparing traditional filtered back projection (FBP) with iterative reconstruction algorithms. This resulted in the development of an optimised, refined and appropriate split dose protocol for CT of the abdomen and pelvis in clinical patients with Crohn’s disease allowing contemporaneous acquisition of both modified and conventional dose CT studies. This novel algorithm was then applied to 50 patients with a suspected acute complication of known Crohn’s disease and the raw data reconstructed with FBP, adaptive statistical iterative reconstruction (ASiR) and model based iterative reconstruction (MBIR). Conventional dose CT images with FBP reconstruction were used as the reference standard with which the modified dose CT images were compared in terms of radiation dose, diagnostic findings and image quality indices. As there are multiple possible user-selected strengths of ASiR available, these were compared in terms of image quality to determine the optimal strength for this modified dose CT protocol. Modified dose CT images with MBIR were also compared with contemporaneous abdominal radiograph, where performed, in terms of diagnostic yield and radiation dose. Finally, attenuation measurements in organs, tissues, etc. with each reconstruction algorithm were compared to assess for preservation of tissue characterisation capabilities. In the phantom and cadaveric models, both forms of iterative reconstruction examined (ASiR and MBIR) were superior to FBP across a wide variety of imaging protocols, with MBIR superior to ASiR in all areas other than reconstruction speed. We established that ASiR appears to work to a target percentage noise reduction whilst MBIR works to a target residual level of absolute noise in the image. Modified dose CT images reconstructed with both ASiR and MBIR were non-inferior to conventional dose CT with FBP in terms of diagnostic findings, despite reduced subjective and objective indices of image quality. Mean dose reductions of 72.9-73.5% were achieved with the modified dose protocol with a mean effective dose of 1.26mSv. MBIR was again demonstrated superior to ASiR in terms of image quality. The overall optimal ASiR strength for the modified dose protocol used in this work is ASiR 80%, as this provides the most favourable balance of peak subjective image quality indices with less objective image noise than the corresponding conventional dose CT images reconstructed with FBP. Despite guidelines to the contrary, abdominal radiographs are still often used in the initial imaging of patients with a suspected complication of Crohn’s disease. We confirmed the superiority of modified dose CT with MBIR over abdominal radiographs at comparable doses in detection of Crohn’s disease and non-Crohn’s disease related findings. Finally, we demonstrated (in phantoms, cadavers and in vivo) that attenuation values do not change significantly across reconstruction algorithms meaning preserved tissue characterisation capabilities with iterative reconstruction. Both adaptive statistical and model based iterative reconstruction algorithms represent feasible methods of facilitating acquisition diagnostic quality CT images of the abdomen and pelvis in patients with Crohn’s disease at markedly reduced radiation doses. Our modified dose CT protocol allows dose savings of up to 73.5% compared with conventional dose CT, meaning submillisievert imaging is possible in many of these patients.

ThreeDimensional Epigraphic Recording at Stobi (Former Yugoslav Republic of Macedonia): Creating a Virtual Lapidarium

There is an increased need for 3D recording of archaeological sites and digital preservation of their artifacts. Digital photogrammetry with prosumer DSLR cameras is a suitable tool for recording epigraphy in particular, as it allows for the recording of inscribed surfaces with very high accuracy, often better than 2 mm and with only a short time spent in the field. When photogrammetry is fused with other computational photography techniques like panoramic tours and Reflectance Transformation Imaging, a workflow exists to rival traditional LiDAR­based methods. The difficulty however, arises in the presentation of 3D data. It requires an enormous amount of storage and end­user sophistication. The proposed solution is to use game­engine technology and high definition virtual tours to provide not only scholars, but also the general public with an uncomplicated interface to interact with the detailed 3D epigraphic data. The site of Stobi, located near Gradsko, in the Former Yugoslav Republic of Macedonia (FYROM) was used as a case study to demonstrate the effectiveness of RTI, photogrammetry and virtual tour imaging working in combination. A selection of nine sets of inscriptions from the archaeological site were chosen to demonstrate the range of application for the techniques. The chosen marble, sandstone and breccia inscriptions are representative of the varying levels of deterioration and degradation of the epigraphy at Stobi, in which both their rates of decay and resulting legibility is varied. This selection includes those which are treated and untreated stones as well as those in situ and those in storage. The selection consists of both Latin and Greek inscriptions with content ranging from temple dedication inscriptions to statue dedications. This combination of 3D modeling techniques presents a cost and time efficient solution to both increase the legibility of severely damaged stones and to digitally preserve the current state of the inscriptions.

Before the “Comics:” On the Seriality of Graphic Narratives during the Nineteenth Century

While the connection between seriality and comics in the twentieth century has frequently been a subject of study, far less attention has been paid to the role of serialisation in the previous century, when the language of comics gradually developed in the illustrated and satirical press. This article discusses a heterogeneous group of graphic narratives published in various European countries between the 1830s and the 1880s, before a new generation of comic magazines influenced by American newspaper strips transformed this emerging field into the autonomous medium of comics. Serial works flourished during this period and included diverse modes, such as series of “graphic novels,” the use of recurring characters, the serialisation of picture stories in humour periodicals, and the use of graphic narratives as a regular feature in the illustrated news magazines. By providing a panoramic survey of various types of serial texts, the article suggests that the hybrid nature of these graphic narratives and the publishing strategies applied to them can be better understood if considered in relation to the larger context of nineteenth-century print culture, rather than in comparison with the future of the medium.

Calcaneus-navicular coalition associated to flatfoot in a child. A case report

Tarsal coalition (a congenital fibrous, cartilaginous or bony connection between two bones) often leads to a flatfoot deformity in children. Usually it presents with recurrent ankle sprains or insidious onset of a painful rigid flatfoot and movement limitation of midtarsal and subtalar joints. Clinical diagnosis is confirmed by X-rays, computed axial tomography and nuclear magnetic resonance. The anteater nose sign is caused by a tubular elongation of the anterior process of the calcaneus that approaches or overlaps the tarsal scaphoid (navicular) and resembles the nose of an anteater on a lateral foot or ankle radiograph. The treatment of this union is primarily symptomatic but if the pain persists must be surgical .

Paire stéréoscopique Panomorphe pour la reconstruction 3D d’objets d’intérêt dans une scène

Il existe désormais une grande variété de lentilles panoramiques disponibles sur le marché dont certaines présentant des caractéristiques étonnantes. Faisant partie de cette dernière catégorie, les lentilles Panomorphes sont des lentilles panoramiques anamorphiques dont le profil de distorsion est fortement non-uniforme, ce qui cause la présence de zones de grandissement augmenté dans le champ de vue. Dans un contexte de robotique mobile, ces particularités peuvent être exploitées dans des systèmes stéréoscopiques pour la reconstruction 3D d’objets d’intérêt qui permettent à la fois une bonne connaissance de l’environnement, mais également l’accès à des détails plus fins en raison des zones de grandissement augmenté. Cependant, à cause de leur complexité, ces lentilles sont difficiles à calibrer et, à notre connaissance, aucune étude n’a réellement été menée à ce propos. L’objectif principal de cette thèse est la conception, l’élaboration et l’évaluation des performances de systèmes stéréoscopiques Panomorphes. Le calibrage a été effectué à l’aide d’une technique établie utilisant des cibles planes et d’une boîte à outils de calibrage dont l’usage est répandu. De plus, des techniques mathématiques nouvelles visant à rétablir la symétrie de révolution dans l’image (cercle) et à uniformiser la longueur focale (cercle uniforme) ont été développées pour voir s’il était possible d’ainsi faciliter le calibrage. Dans un premier temps, le champ de vue a été divisé en zones à l’intérieur desquelles la longueur focale instantanée varie peu et le calibrage a été effectué pour chacune d’entre elles. Puis, le calibrage général des systèmes a aussi été réalisé pour tout le champ de vue simultanément. Les résultats ont montré que la technique de calibrage par zone ne produit pas de gain significatif quant à la qualité des reconstructions 3D d’objet d’intérêt par rapport au calibrage général. Cependant, l’étude de cette nouvelle approche a permis de réaliser une évaluation des performances des systèmes stéréoscopiques Panomorphes sur tout le champ de vue et de montrer qu’il est possible d’effectuer des reconstructions 3D de qualité dans toutes les zones. De plus, la technique mathématique du cercle a produit des résultats de reconstructions 3D en général équivalents à l’utilisation des coordonnées originales. Puisqu’il existe des outils de calibrage qui, contrairement à celui utilisé dans ce travail, ne disposent que d’un seul degré de liberté sur la longueur focale, cette technique pourrait rendre possible le calibrage de lentilles Panomorphes à l’aide de ceux-ci. Finalement, certaines conclusions ont pu être dégagées quant aux facteurs déterminants influençant la qualité de la reconstruction 3D à l’aide de systèmes stéréoscopiques Panomorphes et aux caractéristiques à privilégier dans le choix des lentilles. La difficulté à calibrer les optiques Panomorphes en laboratoire a mené à l’élaboration d’une technique de calibrage virtuel utilisant un logiciel de conception optique et une boîte à outils de calibrage. Cette approche a permis d’effectuer des simulations en lien avec l’impact des conditions d’opération sur les paramètres de calibrage et avec l’effet des conditions de calibrage sur la qualité de la reconstruction. Des expérimentations de ce type sont pratiquement impossibles à réaliser en laboratoire mais représentent un intérêt certain pour les utilisateurs. Le calibrage virtuel d’une lentille traditionnelle a aussi montré que l’erreur de reprojection moyenne, couramment utilisée comme façon d’évaluer la qualité d’un calibrage, n’est pas nécessairement un indicateur fiable de la qualité de la reconstruction 3D. Il est alors nécessaire de disposer de données supplémentaires pour juger adéquatement de la qualité d’un calibrage.

Improving the Accuracy of 3-D Reconstruction in Robotic Vision Applications

Thesis (Ph.D.)--University of Washington, 2016-08

Aspiração de corpo estranho na criança: um perigo escondido

Introdução: A aspiração de corpo estranho (ACE) é uma emergência pediátrica e uma causa importante de morte acidental na criança. A maioria dos casos ocorre com objetos orgânicos e inorgânicos de pequenas dimensões, sobretudo em idade pré-escolar. A ACE cursa com amplo espectro de manifestações e o seu diagnóstico representa muitas vezes um desafio. Caso clínico: Descrevemos o caso clínico de uma criança de dois anos que recorreu ao Serviço de Urgência por tosse, disfonia e disfagia. Ao exame objetivo apresentava acessos de tosse estridulosa, tiragem supra-esternal ligeira e auscultação pulmonar com sibilos inspiratórios/expiratórios e roncos dispersos bilateralmente. A telerradiografia do tórax evidenciava um reforço hilar bilateral, mais notável à direita. A avaliação por Otorrinolaringologia, incluindo a nasolaringofibroscopia, não de- mostrou alterações. A broncoscopia revelou a presença de corpo estranho vegetal condicionando obstrução superior a 50% do lúmen do brônquio principal direito. Conclusão: Pretendemos com este caso salientar a necessidade de manter alto índice de suspeição perante a possibilidade de ACE, pois o atraso no seu reconhecimento condiciona o seu tratamento e o eventual aparecimento de sequelas irreversíveis.

Caso imagiológico

Introdução: A tosse constitui um dos principais motivos de consulta médica e, apesar de na maioria dos casos ser de etiologia vírica ou alérgica, por vezes surgem diagnósticos inesperados. Caso Clínico: Criança do sexo feminino, 19 meses, sem antecedentes relevantes. Recorreu ao Serviço de Urgência por tosse produtiva há 3 semanas e rinorreia serosa, sem febre. Noção materna de dificuldade respiratória e recusa alimentar parcial. À admissão, polipneica, com tiragem subcostal e gemido expiratório. Auscultatoriamente, murmúrio vesicular globalmente diminuído, tempo expiratório aumentado e sibilos dispersos. Analiticamente sem alterações. A radiografia torácica evidenciou volumosa imagem quística no hemitórax direito. A TC to- rácica documentou estômago intratorácico. Foi submetida a laparoscopia que constatou hérnia do hiato paraesofágica. Após Fundoplicatura de Nissen ficou assintomática. Discussão: A hérnia do hiato é rara em idade Pediátrica, tendo sido um achado inesperado no caso clínico descrito. Consideramos assim que, apesar da sua raridade, as anomalias anatómicas devem ser consideradas no diagnóstico diferencial da tosse persistente.

Acute Psychosis as Major Clinical Presentation of Legionnaires’ Disease

We report a case of a 61-year-old woman who presented with acute psychosis as a major manifestation of Legionnaires’ disease in the absence of other neuropsychiatric symptoms. Clinical history revealed dry cough and nausea. Observation showed fever and auscultation crackles in the lower lobe of the right lung. Laboratory testing demonstrated elevated C-reactive protein and lung chest radiograph showed patchy peribronchial and right lower lobe consolidation. Soon after admission, she started producing purulent sputum. Epidemiological data suggested Legionella pneumophila as possible cause of the clinical picture that was confirmed by urinary antigen detection and polymerase chain reaction of the sputum. She was treated with levofloxacin 750 mg/day for 10 days with complete remission of pulmonary and psychiatric symptoms. She has not had further psychotic symptoms.

Optical Wireless Communication for Mobile Platforms

The past few decades have witnessed the widespread adaptation of wireless devices such as cellular phones and Wifi-connected laptops, and demand for wireless communication is expected to continue to increase. Though radio frequency (RF) communication has traditionally dominated in this application space, recent decades have seen an increasing interest in the use of optical wireless (OW) communication to supplement RF communications. In contrast to RF communication technology, OW systems offer the use of largely unregulated electromagnetic spectrum and large bandwidths for communication. They also offer the potential to be highly secure against jamming and eavesdropping. Interest in OW has become especially keen in light of the maturation of light-emitting diode (LED) technology. This maturation, and the consequent emerging ubiquity of LED technology in lighting systems, has motivated the exploration of LEDs for wireless communication purposes in a wide variety of applications. Recent interest in this field has largely focused on the potential for indoor local area networks (LANs) to be realized with increasingly common LED-based lighting systems. We envision the use of LED-based OW to serve as a supplement to RF technology in communication between mobile platforms, which may include automobiles, robots, or unmanned aerial vehicles (UAVs). OW technology may be especially useful in what are known as RF-denied environments, in which RF communication may be prohibited or undesirable. The use of OW in these settings presents major challenges. In contrast to many RF systems, OWsystems that operate at ranges beyond a few meters typically require relatively precise alignment. For example, some laser-based optical wireless communication systems require alignment precision to within small fractions of a degree. This level of alignment precision can be difficult to maintain between mobile platforms. Additionally, the use of OW systems in outdoor settings presents the challenge of interference from ambient light, which can be much brighter than any LED transmitter. This thesis addresses these challenges to the use of LED-based communication between mobile platforms. We propose and analyze a dual-link LED-based system that uses one link with a wide transmission beam and relaxed alignment constraints to support a more narrow, precisely aligned, higher-data-rate link. The use of an optical link with relaxed alignment constraints to support the alignment of a more precisely aligned link motivates our exploration of a panoramic imaging receiver for estimating the range and bearing of neighboring nodes. The precision of such a system is analyzed and an experimental system is realized. Finally, we present an experimental prototype of a self-aligning LED-based link.

Contributos para uma leitura do cartaz na obra gráfica de João Machado

Dissertação de Mestrado para obtenção do Grau de Mestre em Design de Comunicação, apresentada na Faculdade de Arquitectura da Universidade Técnica.

Notas sobre la lengua guaymí en Costa Rica

Como aproximación panorámica al estudio actual del guaymí, una de las lenguas de la familia chibcha, es un análisis introductorio de los rasgos gramaticales y tipológicos generales de esa lengua. Previa información de índole antropológica e histórico-cultural, se exponen en forma analítica aspectos sintácticos, sobre la frase verbal, el morfema de negación, el de reflexivización, los sujetos dativos, los objetos directos. Señala algunas tareas pendientes, que suponen un estudio más pormenorizado y extendido.Providing a panoramic view of the present studies of the Guaymí language, one of the Chibchan languages, this is an introductory analysis of the general grammatical and typological features of that language. First, information is given on anthropological, historical and cultural aspects. Then syntactic features are described for the verb phrase, the morpheme for negation, reflexive forms, dative subjects and direct objects. Mention is made of pending tasks requiring a broader and more detailed study.

From the Humpata Plateau to Namibe Desert, SW Angola

After the Congress, a six-day field trip, will be held through three southwestern provinces of Angola (Huíla, Namibe and Cunene), every day starting and ending in the city of Lubango, for overnight stay in Lubango, with the purpose to observe some of the main sites of geological interest in this zone of Angola. The itinerary of this field trip presents the geologic history of Southwestern Angola and its evolution in the scope of the Congo Craton, through a trip that begins in the first excursion days by the oldest geologic formations and phenomena until the recent geologic formations and phenomena on the last excursion days. On the first and second excursion days, September 5th and September 6th, the field trip will go along the Kunene Anorthosite Complex of Angola (KAC), to observe some petrographic features of the KAC that are important to understand the emplacement of this huge igneous massif of the early Kibarean age. These days of the field trip allow the observation of Earthen Construction, because this region of Cunene is privileged to appreciate a kind of Eco-construction, made of raw earth and in wattle and daub, built with ancient techniques, which constitute a real GeoHeritage. On September 7th, in the morning, the destination will be Tundavala, to visit Tundavala Gap, a huge escarpment of more than 1,000 m high cutted in Neo-Archean and Paleo-Proterozoic igneous rocks, the Ruins of Tundavala (quartzite blocks with sedimentary structures) and Tundavala Waterfalls on a quartzitic scarp. After lunch, the field trip continues towards Humpata plateau to observe the panoramic view over Lubango city from the Statue of Cristo Rei, then the outcrops of dolomitic limestones with stromatolites and dolerites and finally the Leba passage, a huge escarpment and one of the most spectacular parts of the Serra da Chela, traversed by a mountain road built in the early 70s of the last century, that can be observed from the belvedere of the Serra da Chela. On September 8th, the destination is the carbonatite complexes of Tchivira and Bonga, belonging to the Mesozoic alkaline massifs of ultrabasic rocks, a rift valley system that occurs during the Early Cretaceous. In this forth excursion day, due to the huge dimensions of these two carbonatite structures it will be visited, only, the Complex of Bonga, namely the outcrops of the northern part of the structure and secondary deposits on the boundary on the southern part of the of the Complex. The last two excursion days, September 9th and September 10th, are to observe the Cretaceous Basin of Namibe. On September 9th, the northern part of Namibe Basin will be visited to observe the volcanic basic rocks of Namibe as well as the interesting paleontological site of Bentiaba. On September 10th, the destination is the southern and more recent part of Namibe Basin, where on the Namib Desert, the exotic plant Welwitschia mirabilis can be observed, as well as Arco, an oasis in the desert. This last excursion day, ends up at the dunes of Tombwa near the mouth of Curoca river and the beautiful bay of Tombwa, where can be observed heavy minerals in their beach sands.