O sistema PBL, problem-based learning, no ensino de medicina no Brasil : análise bibliográfica sobre a sua execução

Introdução: Entre as estratégias de ensino e aprendizagem utilizadas nas práticas pedagógicas, a Problem Based Learning (PBL) (Aprendizagem Baseada em Problemas) é utilizada desde 1960, em especial nos cursos de Medicina. Mesmo sendo uma estratégia valiosa, um dos seus obstáculos é a pouca prática dos alunos em atividades autodirigidas, pesquisa e construção coletiva do conhecimento. Objetivo: Rastrear elementos constitutivos da PBL através de dados colhidos em artigos pesquisados em sítios de divulgação científica; Avaliar, nos estudos selecionados, os aspectos positivos e negativos que estejam relacionados com a metodologia do Sistema PBL aplicada ao ensino médico no Brasil. Metodologia: Estudo bibliográfico de 13 textos utilizando um modelo de desconstrução, denominada Análise Textual Discursiva (ATD) que consiste em: transformação dos artigos em pedaços menores; análise textual; identificação de padrões convergentes e divergentes em relação a PBL; organização e síntese dos dados, culminando com a elaboração de estratégia adaptativa da PBL para o curso de Medicina. Resultados: Foram encontradas 116 citações que convergiam para referências positivos acerca da metodologia PBL e 40 citações que divergiam acerca dos pontos positivos. Os aspectos positivos como o desenvolvimento de atitudes e habilidades; desenvolvimento de competências anteriores ao curso; efeitos positivos depois de terminada a graduação, como autonomia de estudo e a articulação entre currículo e realidade profissional, representam pontos a serem reforçados na aula. Em contraponto, foi observado que dentre os negativos a não compreensão do papel do professor como tutor; necessidade de conteúdo formal tradicional pelos alunos e a expectativa que o professor retire as suas dúvidas são pontos a serem evitados. Conclusões: A metodologia PBL deverá servir como metodologia ativa para aproveitar ao máximo as habilidades que os alunos já apresentam, potencializando o aprendizado na educação médica em sala de aula. Palavras-Chave: PBL; curso de medicina; metodologia ativa; educação médica.

Complex Congenital Heart Disease: The Influence of Prenatal Diagnosis

INTRODUCTION: Complex congenital heart disease is a group of severe conditions. Prenatal diagnosis has implications on morbidity and mortality for most severe conditions. The purpose of this work was to evaluate the influence of prenatal diagnosis and distance of residence and birth place to a reference center, on immediate morbidity and early mortality of complex congenital heart disease. MATERIAL AND METHODS: Retrospective study of complex congenital heart disease patients of our Hospital, born between 2007 and 2012. RESULTS: There were 126 patients born with complex congenital heart disease. In 95%, pregnancy was followed since the first trimester, with prenatal diagnosis in 42%. There was a statistically significant relation between birth place and prenatal diagnosis. Transposition of great arteries was the most frequent complex congenital heart disease (45.2%), followed by pulmonary atresia with ventricular septal defect (17.5%) and hypoplastic left ventricle (9.5%). Eighty-two patients (65.1%) had prostaglandin infusion and 38 (30.2%)were ventilated before an intervention. Surgery took place in the neonatal period in 73%. Actuarial survival rate at 30 days, 12 and 24 months was 85%, 80% and 75%, respectively. There was no statistically significant relation between prenatal diagnosis and mortality. DISCUSSION: Most patients with complex congenital heart disease did not have prenatal diagnosis. All cases with prenatal diagnosis were born in a tertiary center. Prenatal diagnosis did not influence significantly neonatal mortality, as already described in other studies with heterogeneous complex heart disease. CONCLUSION: prenatal diagnosis of complex congenital heart disease allowed an adequate referral. Most patients with complex congenital heart disease were not diagnosed prenatally. This data should be considered when planning prenatal diagnosis of congenital heart disease.

Composition of Aleutian forearc sediments

The ultimate composition of any sandstone is affected by a host of primary and secondary factors, including the lithologies present in source terranes, climate, depositional environment and diagenesis. In the case of a subduction complex, however, unequivocal identification of detrital provenance may be impossible because of the cumulative effects of tectonic and sedimentary transport. Long-distance sedimentary transport (> 1000 km) is common within trenches, and abyssal-plain turbidites can be tectonically transported for long distances as the underlying oceanic basement drifts towards a subduction front. Post-accretionary displacement can occur as a consequence of strike-slip faulting, and the total distance of tectonic dislocation may reach several thousand kilometers. The present-day Aleutian forearc region (North Pacific Ocean) illustrates many of the "problems" which typify subduction zones. Several petrologic suites can be identified, and there are significant variations in detrital modes in both time and space. The Aleutian region serves as a sobering modern analog for accreted rock units such as the Franciscan Complex of California, where intercalations of discrete sandstone suites have been noted. In the absence of paleomagnetic control, interpretations of sediment provenance within ancient subduction complexes probably should be restricted to the generic level.

Chemical and isotope compositions of rocks from altered ocean crust at DSDP/ODP Sites 417/418

Large-scale compositional domains at DSDP/ODP drill sites 417A, 417D and 418A were analyzed for O, Sr and Nd isotope ratios, and REE, U, K, Rb and Sr abundances, to constrain the bulk chemical composition of the oceanic crust that is recycled at subduction zones. The combination of the three sites gives the composition of the upper oceanic crust in this region over a distance of about 8 km. The d18O(SMOW) and 87Sr/86Sr(meas) of compositional domains 10-100 m in size correlate well, with a range of 7.7-19.2 and 0.70364-0.70744, and mean of 9.96 and 0.70475, respectively. The Rb inventory of the upper crust increases by about an order of magnitude, while Sr contents remain constant. U abundances increase moderately under oxidizing alteration conditions and nearly triple in the commonly reducing alteration environments of the upper oceanic crust. REEs are influenced by alteration only to a small extent, and recycled oceanic crust is similar to MORB with respect to 143Nd/144Nd. Even though the average composition of the upper oceanic crust is well defined, the large scale composition varies widely. Highly altered compositional domains may not have a large impact on the average composition of the oceanic crust, but they may preferentially contribute to fluids or partial melts derived from the crust by prograde metamorphic reactions.

Sea-floor images from during POLARSTERN cruise ANT-XV/3 to the Weddell Sea, Antarctica

Transects of a Remotely Operated Vehicle (ROV) providing sea-bed videos and photographs were carried out during POLARSTERN expedition ANT-XV/3 focussing on the ecology of benthic assemblages on the Antarctic shelf in the South-Eastern Weddell Sea. The ROV-system sprint 103 was equiped with two video- and one still camera, lights, flash-lights, compass, and parallel lasers providing a scale in the images, a tether-management system (TMS), a winch, and the board units. All cameras used the same main lense and could be tilted. Videos were recorded in Betacam-format and (film-)slides were made by decision of the scientific pilot. The latter were mainly made under the aspect to improve the identification of organisms depicted in the videos because the still photographs have a much higher optical resolution than the videos. In the photographs species larger than 3 mm, in the videos larger than 1 cm are recognisable and countable. Under optimum conditions the transects were strait; the speed and direction of the ROV were determined by the drift of the ship in the coastal current, since both, the ship and the ROV were used as a drifting system; the option to operate the vehicle actively was only used to avoide obstacles and to reach at best a distance of only approximately 30 cm to the sea-floor. As a consequence the width of the photographs in the foreground is approximately 50 cm. Deviations from this strategy resulted mainly from difficult ice- and weather conditions but also from high current velocity and local up-welling close to the sea-bed. The sea-bed images provide insights into the general composition of key species, higher systematic groups and ecological guilds. Within interdisciplinary approaches distributions of assemblages can be attributed to environmental conditions such as bathymetry, sediment characteristics, water masses and current regimes. The images also contain valuable information on how benthic species are associated to each other. Along the transects, small- to intermediate-scaled disturbances, e.g. by grounding icebergs were analysed and further impact to the entire benthic system by local succession of recolonisation was studied. This information can be used for models predicting the impact of climate change to benthic life in the Southern Ocean. All these approaches contribute to a better understanding of the fiunctioning of the benthic system and related components of the entire Antarctic marine ecosystem. Despite their scientific value the imaging methods meet concerns about the protection of sensitive Antarctic benthic systems since they are non-invasive and they also provide valuable material for education and outreach purposes.

Analysis of coastal sediment transport processes from Wrightsville Beach to Fort Fisher, North Carolina /

A comprehensive engineering analysis of the coastal sediment transport processes along a 42-kilometer segment of the North Carolina shoreline from Wrightsville Beach to Fort Fisher is presented. Included in the analysis is an interpretation of the littoral processes, longshore transport, and the behavior and success of beach nourishment projects at Wrightsville Beach and Carolina Beach, North Carolina. The historical position of the MLW, MSL, and MHW contours, relative to a fixed base line, is plotted for the period between 1964 and 1975. An equivalent volumetric erosion or accretion between successive surveys is determined by multiplying the average excursion distance of the contours by a constant of proportionality. The plots of excursion distance versus time for the MLW, MSL, and MHW contours also show the time response of the beach fills. This response is described by a mathematical function. The alongshore components of wave-induced energy flux are also determined within the study area through wave refraction analysis. This information, together with the information on volumetric change, is used in a sediment budget analysis to determine the coefficient of alongshore sediment transport and the inlet trapping characteristics. (Author).

Postsecondary education and the new workforce /

"PLLI 96-8005"--P. [4] of cover.

Realizing the potential : improving postsecondary teaching, learning and assessment /

"Grant R117G10037"--T.p. verso.

Educational lessons from wartime training,

Mode of access: Internet.

Ultrasound Mapping of Nerve Stimulator Response during Sciatic Nerve Blockade and Relation to Postoperative Pain Scores

1.1 Background and Purpose: Ultrasound guided sciatic nerve blockade has rapid onset but at 24 hours pain is greater than nerve stimulator techniques. Injection of the nerve branches or trunk and sub-sheath blockade increase success and reduce onset times but risk injury. This study mapped needle coordinates for sciatic nerve blockade with nerve stimulation and its relation to postoperative pain scores. 1.2 Method: Angle and distance of the needle tip and infusion catheter from the popliteal sciatic nerve at which stimulated plantar flexion occurred were measured. Pain scores at postanesthesia unit discharge and 24 hours were recorded. 1.3 Results: 81% of opioid naïve patients reported immediate analgesia and 20.8% at 24 hours. In opioid tolerant patients 56.8% reported immediate analgesia and 9.1% at 24 hours. Plantar flexion was observed with the needle in the posterior medial quadrant near the sciatic nerve. Opioid tolerant patients reported adequate analgesia when the needle was located more medially and proximally to the sciatic nerve. 1.4 Conclusion: Stimulated plantar flexion is isolated to a narrow angular range in the posterior medial quadrant adjacent to the sciatic nerve. Opioid tolerant patients report adequate analgesia if the needle and catheter are more medial and proximal to the nerve surface.

Exploring the spatial variation of tides for seafloor mapping data corrections

Senior thesis written for Oceanography 445

The family costs of attending hospital outpatient appointments via videoconference and in person

We compared the costs incurred by families attending outpatient appointments at the Royal Children's Hospital (RCH) in Brisbane with those incurred by families who had a consultation via videoconference in their regional area. In each category 200 families were interviewed. The median time spent travelling for videoconferences was 30 min compared with 80 min for face-to-face appointments. Families interviewed in the outpatient department had travelled a median distance of 70 km, while those who had a videoconference at the local hospital had travelled only 20 km. It cost these families much more to attend an appointment at the RCH than to attend a videoconference. Ninety-six per cent of families (193) reported at least one of the following types of expense: 150 families had expenses related to parking (median A$10), 156 had fuel expenses (median A$10) and 122 reported costs related to meals purchased at the RCH (median A$10). Only 21 families who had their appointment via local videoconference reported any additional costs. Specialist appointments via videoconference were a more convenient and cheaper option for families living in regional areas of Queensland than the conventional method of attending outpatient appointments at the specialist hospital in Brisbane.

Layered silicate nanocomposites based on various high-functionality epoxy resins. Part II: The influence of an organoclay on the rheological behavior of epoxy prepolymers

The effect of an organically surface modified layered silicate on the viscosity of various epoxy resins of different structures and different functionalities was investigated. Steady and dynamic shear viscosities of the epoxy resins containing 0-10 wt% of the organoclay were determined using parallel plate rheology. Viscosity results were compared with those achieved through addition of a commonly used micron-sized CaCO3 filler. It was found that changes in viscosities due to the different fillers were of the same order, since the layered silicate was only dispersed on a micron-sized scale in the monomer (prior to reaction), as indicated by X-ray diffraction measurements. Flow activation energies at a low frequency were determined and did not show any significant changes due to the addition of organoclay or CaCO3. Comparison between dynamic and steady shear experiments showed good agreement for low layered silicate concentrations below 7.5 wt%, i.e. the Cox-Merz rule can be applied. Deviations from the Cox-Merz rule appeared at and above 10 wt%, although such deviations were only slightly above experimental error. Most resin organoclay blends were well predicted by the Power Law model, only concentrations of 10 wt% and above requiring the Herschel-Buckley (yield stress) model to achieve better fits. Wide-angle X-ray measurements have shown that the epoxy resin swells the layered silicate with an increase in the interlayer distance of approximately 15 Angstrom, and that the rheology behavior is due to the lateral, micron-size of these swollen tactoids.

[0 0 1] zone-axis bright-field diffraction contrast from coherent Ge(Si) islands on Si(0 0 1): Dedicated to Professor Fang-hua Li on the occasion of her 70th birthday

Coherent Ge(Si)/Si(001) quantum dot islands grown by solid source molecular beam epitaxy at a growth temperature of 700degreesC were investigated using transmission electron microscopy working at 300 kV. The [001] zone-axis bright-field diffraction contrast images of the islands show strong periodicity with the change of the TEM sample substrate thickness and the period is equal to the effective extinction distance of the transmitted beam. Simulated images based on finite element models of the displacement field and using multi-beam dynamical diffraction theory show a high degree of agreement. Studies for a range of electron energies show the power of the technique for investigating composition segregation in quantum dot islands. (C) 2003 Elsevier B.V. All rights reserved.

Two new blood flukes (Digenea: Sanguinicolidae) from epinephelinae (Perciformes: Serranidae) of the Pacific Ocean

Pearsonellum pygmaeus n. sp. is described from Cromileptes altivelis (Serranidae), the Barramundi Cod, from Heron Island (southern Great Barrier Reef) and Lizard Island (northern Great Bat-Her Reef). This new species differs from Pearsonellum eorventum (type and only species) in the combination of smaller overall body size, the relative distance of the brain from the anterior end, the relative lengths of both the oesophagus and the testis, the degree to which the testis extends outside the intercaecal field, the shape of the testis, the shape and size of the ovary and the extent to which the uterzus loops around the ovary. There are in addition, 20 base pair differences between the ITS2 rDNA sequence of P. pygmaeus n. sp. and that of P corventum. Three new host records for P. corventum are reported. Adelomyllos teenae n. g., n. sp. is described from Epinephelus coioides (Serranidae), the Estuary Cod, from Moreton Bay, southeast Queensland. The new genus differs from the 22 other sanguinicolid genera in the combined possession of two testes, a cirrus-sac, separate genital pores, a post-ovarian uterus and an H-shaped intestine. A. teenae n. sp. is the third sanguinicolid described from the Epinephelinae. Sanguinicolids have now been reported from 11 species of Serranidae. (C) 2004 Elsevier Ireland Ltd. All rights reserved.