Ambiente Virtual de Avaliação de Competências no Manejo do Diabetes Mellitus

RESUMO O diabetes mellitus apresenta inúmeras lacunas na efetividade do seu tratamento, e a avaliação em serviço necessita ser contínua, sistemática e com dimensão orientadora de seus elementos intrínsecos: processo formativo e avaliação de competências profissional. Objetivo Apresentar o desenho didático de construção de ferramenta de avaliação de competências que o médico possui sobre o manejo do diabetes mellitus, com base em sua fisiopatologia. Métodos Estruturada como uma pesquisa participativa, o Ambiente Virtual de Avaliação de Competências, por meio de casos clínicos virtuais simulados, propõe um desenho aberto que vai sendo construído, avaliado, corrigido e melhorado durante sua execução. Resultados Com Tecnologias de Informação e Comunicação (TIC), o instrumento foi desenvolvido no âmbito de uma pesquisa de mestrado vinculada à Telessaúde da Faculdade de Medicina da Universidade Federal de Goiás. Validado o instrumento, viabilizou-se sua utilização por discentes e profissionais. Considerações As ações interativas propostas pelo ambiente virtual possibilitarão avaliar conhecimentos e identificar padrões que poderão melhorar conteúdos para manejo do DM. Propõe-se sua utilização na rede básica de saúde para confirmar sua validação, a fim de alcançar seus objetivos.

THE LOGICAL SYSTEM OF FREGE'S GRUNDGESTZE: A RATIONAL RECONSTRUCTION

This paper aims at clarifying the nature of Frege's system of logic, as presented in the first volume of the Grundgesetze . We undertake a rational reconstruction of this system, by distinguishing its propositional and predicate fragments. This allows us to emphasise the differences and similarities between this system and a modern system of classical second-order logic.

Avaliação do treinamento de operadores de harvester com uso de simulador de realidade virtual

Este trabalho teve por objetivo avaliar os potenciais ganhos de operadores de harvester no treinamento com uso de simuladores de realidade virtual. Foram coletados dados durante o treinamento de 39 operadores, avaliando-se os seus desempenhos nas variáveis: tempo de execução no corte da árvore, direção de queda, altura de corte, eficiência no processamento, eficiência no empilhamento e produtividade. Os resultados permitiram a conclusão de que o simulador de realidade virtual é uma ferramenta viável do ponto de vista técnico e essencial no apoio ao treinamento de operadores de máquinas florestais, possibilitando a obtenção de elevados ganhos de qualidade e produtividade. O melhor desempenho dos operadores ocorreu com a variável produtividade, cujo ganho médio foi de 41,3% em relação ao início do treinamento, seguido pelo tempo de execução, com 38,8%; e pela direção de queda, com ganho médio de 36,1%.

DENDROCLIMATOLOGICAL RECONSTRUCTION OF SPRING-SUMMER PRECIPITATION FOR FAZENDA RIO GRANDE, PR, WITH SAMPLES OF Araucaria angustifolia (Bertol.) Kuntze

ABSTRACT Samples of Araucaria angustifolia were collected at Fazenda Rio Grande, Paraná, Brazil (25°39'S 49 18'O) in January 2011. The 32 samples from 8 trees were subjected to treatments following dendrochronological techniques. The cores were measured and dated using optical and computational methodology, and then standardized to obtain a growth-ring time series, which considers the 1907-2009 time range and represents Fazenda Rio Grande. Tree-ring indices were analyzed and correlated to temperature and precipitation averages from the 1961-2009 range. This procedure aimed to study and understand the influence of the local climate on the plant growth and if this influence can be quantified. A. angustifolia trees produce visible annual growth rings, and their earlywood and latewood are clearly defined. The present study shows that A. angustifolia is sensitive to climate variables (e.g., low temperatures in wintertime tend to stop the growth rate). The correlation between tree rings and monthly precipitation series showed a common trend, making it possible to estimate the seasonal rainfall behavior for the entire 1907-2009 range.

Virtual Battlespace 2 Panssarikoulun opetuksessa : tapaustutkimus sotilaspedagogiikan näkökulmasta

Tutkielmani tavoitteena oli tutkia tapauksena Bohemia Interactive Simulationsin valmistaman Virtual Battlespace 2 (VBS2) -tietokonepelisimulaattorin käyttöönottoa Panssariprikaatin Panssarikoulun varusmieskoulutuksessa. Tutkimuskysymysten avulla oli tarkoituksena selvittää, mitkä tekijät ja tapahtumat vaikuttivat siihen, että VBS2 otettiin käyttöön, minkälaisin perustein koulutus suunniteltiin ja järjestelmän käyttö varusmieskoulutuksessa käynnistettiin. Lisäksi ajatuksena oli aineiston mahdollistamissa puitteissa tutkia VBS2:n käytöstä tähän mennessä kertyneitä kokemuksia kouluttajien näkökulmasta, tavoitteena tuottaa myös perustietoa tulevaisuuden VBS2-koulutuksen suunnittelua ja toteuttamista varten. Tutkimusmenetelmänä oli tapaustutkimus, jonka aineisto kerättiin toteuttamalla teemahaastatteluita. Tutkimusta varten haastateltiin kahta VBS2-järjestelmää ensimmäisenä varusmieskoulutuksessa käyttänyttä kouluttajaa. Haastatteluaineisto käsiteltiin aineistolähtöisen sisällönanalyysin menetelmin. Tuloksia tarkasteltiin sotilaspedagogiikan näkökulmasta ja suhteessa oppimisympäristöjen sekä oppimisprosessin suunnittelun teorioihin. Tutkielma rakentuu johdannosta, menetelmäluvusta, yhdistetystä teoria- ja tulosluvusta sekä johtopäätös- ja pohdintaluvusta. Tutkimuksen tuloksina ilmeni, että Virtual Battlespace 2:n käyttöönotto Panssarikoulussa oli aktiivisten ja innovatiivisten henkilöiden aikaansaannosta, jossa spontaanin, ennakkoluulottoman ja opetuksen laadun kehittämiseen tähtäävän kokeilun myötä otettiin käyttöön uudenlainen koulutusväline. Samalla saatiin aikaan myönteisiä oppimistuloksia ja kiinnostavia muutoksia yhden joukkoyksikön koulutuskulttuuriin ja totunnaisiin koulutuksen käytäntöihin. VBS2:n käyttöön liittyviä keskeisiä teemoja ovat oppimisprosessin kokonaisvaltainen hallinta, eli VBS2-koulutuksen huolellinen suunnittelu ja integrointi osaksi muuta koulutusta, koulutustapahtumien valmistelujen ja kouluttajien ammattitaidon merkitys, koulutustapahtumien johtamisen paikoin muusta sotilaskoulutuksesta poikkeavat käytännöt sekä VBS2:n aikaansaaman oppimisen ymmärtäminen. Kouluttajien kokemusten perusteella VBS2 on avoin oppimisympäristö, joka ei korvaa mitään olemassa olevista koulutusmuodoista, mutta täydentää niitä tehokkaasti tarjoten uudenlaisia ulottuvuuksia sotilaskoulutukseen. Sen avulla voidaan tehokkaasti kehittää erityisesti sotilaan henkistä ja sosiaalista toimintakykyä sekä siirtää koulutuksen painopistettä soveltaviin maastoharjoituksiin. Tutkielma avaa näkökulmia VBS2:n ja muiden virtuaalisten oppimisympäristöjen pedagogiselle pohtimiselle ja tuleville aiheeseen syventyville tutkimuksille. Lisäksi se herättää keskustelua varusmieskoulutuksemme parhaista käytänteistä ja kehitystrendeistä.

Realidade virtual e robótica em cirurgia: aonde chegamos e para onde vamos?

Minimally Invasive Surgery, Telesurgery, Robotics and Virtual Reality represent the technological frontiers that have revolutionized operating practices nowadays. These new technologies aim at improving the quality of assistance offered to patients; thus, they demand from the medical staff more effective measures as far as scientific research, training and expenditure of time and financial resources are concerned. In the past, surgeons have led several medical revolutions, such as the use of antiseptic surgical methods by Semelweiss, the use of anesthesia by Warren, antibiotic therapy, the transplants and the onset of the minimally invasive surgery by Mouret and Perissat. The objective of this article is to present the outreach of this new technology which comprises minimal access, computing, robotics and teletransmission. We have concluded that the new technologies developed in the medical field in the last decades, will offer new options and challenges for the treatment of the surgical patient, leading the scientific knowledge to a new era, the one of the virtual environment.

Vulvar reconstruction should be performed using gluteal-fold perforator flap because of less morbidities and complications

The autors present a case of bilateral vulvar defects after abrasion of malignant skin neoplasm, reconstructed with a gluteal-fold perforator flap, resulting in a successful outcome.

Splenic vein graft for the reconstruction of the mesenteric-portal trunk after gastroduodenopancreatectomy

Resection of the confluence of the superior mesenteric and portal veins has been performed most frequently in the treatment of adenocarcinoma of the pancreas, in view of the reported positive results, but it can also be used in cases of benign pancreatic neolpasias when they are strongly adhered to the mesenteric-portal trunk. Nevertheless, there is no study on the best type of venous grafts for reconstruction of the mesenteric-portal trunk when required. The choice of graft depends on the preference of the surgeon or the institution. This technical note critically discusses the use of the splenic vein as an option for mesenteric-portal trunk reconstruction after gastroduodenopancreatectomy.

Ureteral reconstruction with abdominal wall muscle flap: experimental study in rabbits

The authors detail the experimental development of a technique for the reconstruction of the ureter using a tubular shape, muscle flap of the abdominal wall. the preliminary results indicate the feasibility of this surgical technique.

Use of the amniotic membrane to cover the peritoneal cavity in the reconstruction of the abdominal wall with polypropylene mesh in rats

OBJECTIVE: to evaluate the efficacy of the amniotic membrane used with polypropylene mesh against the formation of adhesions and its influence on healing. METHODS: twenty five female Wistar rats were anesthetized for creating a parietal defect in the anterior abdominal wall. Its correction was made with polypropylene mesh alone and associated with amniotic membrane. In the control group (n=11), the screen was inserted alone. In group A (n=7) we interposed the amniotic membrane between the screen and the abdominal wall. In group B, the amniotic membrane was placed on the mesh, covering it. After seven days, the animals were euthanized for macroscopic and microscopic evaluation of healing. RESULTS: adhesions were observed in all animals except one in the control group. Severe inflammation was observed in all animals in groups A and B and in three of the control group, with significant difference between them (A and B with p=0.01). Pronounced angiogenic activity was noted in one animal in the control group, six in group A and four in group B, with a significant difference between the control group and group A (p=0.002) and group B (p=0.05). The scar collagen was predominantly mature, except in five animals of the control group, with significant difference between the control group and group A (p=0.05) and group B (p=0.05). CONCLUSION: The amniotic membrane did not alter the formation of adhesions in the first postoperative week. There were also pronounced inflammation, high angiogenic activity and predominance of mature collagen fibers, regardless of the anatomical plane that it was inserted in.

Plastic surgery in chest wall reconstruction: relevant aspects - case series

Objective: to discuss the participation of Plastic Surgery in the reconstruction of the chest wall, highlighting relevant aspects of interdisciplinaryness. Methods: we analyzed charts from 20 patients who underwent extensive resection of the thoracic integument, between 2000 and 2014, recording the indication of resection, the extent and depth of the raw areas, types of reconstructions performed and complications. Results: among the 20 patients, averaging 55 years old, five were males and 15 females. They resections were: one squamous cell carcinoma, two basal cell carcinomas, five chondrosarcomas and 12 breast tumors. The extent of the bloody areas ranged from 4x9 cm to 25x40 cm. In 12 patients the resection included the muscular plane. In the remaining eight, the tumor removal achieved a total wall thickness. For reconstruction we used: one muscular flap associated with skin grafting, nine flaps and ten regional fasciocutaneous flaps. Two patients undergoing reconstruction with fasciocutaneous flaps had partially suffering of the flap, solved with employment of a myocutaneous flap. The other patients displayed no complications with the techniques used, requiring only one surgery. Conclusion: the proper assessment of local tissues and flaps available for reconstruction, in addition to the successful integration of Plastic Surgery with the specialties involved in the treatment, enable extensive resections of the chest wall and reconstructions that provide patient recovery.

Value co-creation through virtual community participation

Consumers create a great deal of content in the Internet. As they do not get a monetary compensation for doing so, it seems apparent that other types of reward are derived from giving up one's time and other resources. The purpose of this study is to describe value creation and user participation in a virtual community. It can be broken down into three research questions. 1. What is the value creation logic of a virtual community? 2. What value is perceived by virtual community users? 3. What is the association between value perceived by virtual community users and their participation in a community? The study employs the discussion on value co-creation as well as perspectives on the notion of value for consumers to create a theoretical framework for value creation. To understand value creation in the context of virtual communities and to create a theoretical framework for user participation, existing literature and research on virtual communities is discussed. The empirical part of the study employs quantitative methodology to analyze data collected by sending a survey questionnaire to the users of a Finnish wellbeing-based virtual community. The results indicate that virtual community users perceive self-development, enjoyment, reputation-building and community commitment value when using the service and that value perceptions are associated with community participation. Moreover, it was found that different types of value are associated with different forms of participation. Based on the findings, it is suggested that the four types of value make up a considerable share of value for virtual community users. Moreover, as the results indicate that different value types are associated with different forms of participation, it suggested that virtual community organizers consider what forms of participation they want to promote and design their virtual communities to support creation of the different types of value accordingly.

A new climatic periodisation of the Gold and Guinea Coasts in West Africa, 1750-1798 : a reconstruction of the climate during the slave trade era, including an analysis of the climatically facilitated Trans-Atlantic slave trade

Avsikten med studien är att producera den första rekonstruktionen av det västafrikanska klimatet mellan 1750 och 1798. Kunskapen om det västafrikanska klimatet före 1800-talet är till dags dato bristfällig, vilket gör det svårare att förstå framtida klimatvariationer. Det är bristen på instrumentell meteorologisk data (temperatur, regnmängd, och lufttryck), vilket i princip bara täcker det senaste århundradet, som är orsaken till att tidigare klimat är bristfälligt kartlagda. Klimatet och miljön är även sådana att proxydata från ’naturens arkiv’ (såsom t.ex. trädringar) har begränsad användning. Således är historiska dokument, främst från gästande kulturer/nationer/intressenter, innehållande deskriptiv information om vädret och klimatet, klimatforskarens viktigaste källa. Genom att använda tidigare, för det här syftet, oanvända källor påvisade den här undersökningen att klimatet i västra Afrika och Guldkusten (Ghana) har ändrats sedan 1700-talet. Monsunregnen var svagare och kortvarigare, speciellt den sekundära regnperioden under hösten var betydligt svagare än idag. Det förekom kraftiga årliga variationer i monsunregnen, men sett ur längre tidsperspektiv utmärktes torrare och blötare perioder. Studien kunde också visa en viss korrelation mellan det globala väderfenomenet El Niño och regnperiodens intensitet längs med kusten. Flera torrperioder sammanföll med tidigare registrerade El Niño sekvenser. Speciellt slutet av 1760-talet påverkades kraftigt av El Niño och även det globala klimatet verkar ha genomgått graftiga förändringar just dessa år. På basis av den nya klimatrekonstruktionen genomfördes också en jämförelse av klimatets inverkan på den transatlantiska slavhandeln från 1750 till 1798, en fråga som historikerna gjort anspelningar på i över 30 år. Utförseln av slavar från västra Afrika var som kraftigast under 1700-talets andra hälft. Analysen visade att slavhandeln delvis tilltog i samband med klimatanomalierna.