O aprender e o orientar na atenção primária: relato de experiência de um semestre de atividades no PET-Saúde

O programa PET-Saúde atua promovendo a formação de grupos de aprendizagem tutorial em áreas estratégicas para o Sistema Único de Saúde. Este trabalho tem o objetivo de relatar a experimentação de um semestre de atividades vivenciadas por acadêmicos da UFPA que compõem uma equipe multiprofissional do PET-Saúde/Ananindeua. Este projeto está atuando como estimulador de diversas atividades que valorizam o aprendizado e a humanização. Dentre as atividades estimuladoras de aprendizado dos acadêmicos estão: palestras e formação complementar; discussão de artigos científicos; e acompanhamento de atividades na Unidade Básica de Saúde. A Atenção Primária representa interessante espaço de aprendizado para acadêmicos em saúde, e a inserção destes em seu âmbito representa grande ganho à comunidade, que passa a receber valiosas orientações em saúde.

Percepções de alunos de medicina sobre marketing médico

INTRODUÇÃO: Marketing médico é um assunto controverso, principalmente no que concerne a princípios éticos. Portanto, frente à competição acirrada de mercado, é necessário o preparo profissional. Conhecer a percepção dos alunos de Medicina pode auxiliar na estruturação de alternativas de capacitação. METODOLOGIA: Inicialmente, identificaram-se crenças sobre marketing médico através de grupo focal composto por 12 alunos. Com base nesses dados, dez afirmações para avaliar atitudes foram aplicadas aos alunos de uma Faculdade de Medicina pública brasileira. RESULTADOS: Observou-se falta de clareza sobre o conceito de marketing, preocupação com princípios éticos e necessidade de marketing no mercado competitivo. Na fase de aplicação, foram obtidas 280 respostas de diversos estágios do curso. Apenas 16,8% admitiram contato com o tema. Houve clareza sobre ética em relação ao paciente, influenciada positivamente pela progressão no curso, mas houve divergência na ética entre profissionais. CONCLUSÕES: Marketing médico é uma área pouco compreendida e relegada ao currículo oculto, sendo influenciada por transposições inadequadas de métodos didáticos destinados à comunicação profissional para a população leiga. Novos métodos de ensino, como a educação tutorial, podem ser uma alternativa para lidar com essas situações.

Aprendizagem Reflexiva: o Uso do Portfólio Coletivo

RESUMO Este artigo tem por objetivo refletir sobre o uso do portfólio coletivo como instrumento da aprendizagem reflexiva, com base na experiência de um grupo tutorial multidisciplinar no PET/Vigilância em Saúde do campus da Universidade Federal de Alagoas (Ufal), em Maceió. Optou-se por trabalhar com o portfólio coletivo como um dos instrumentos para acompanhamento e avaliação do processo de ensino-aprendizagem reflexivo dos estudantes, na intenção de contribuir para divulgar instrumentos que facilitem esse processo em grupos tutoriais. A organização e a apresentação do portfólio coletivo foram norteadas pelo Arco de Charles Maguerez numa perspectiva problematizadora, abrangendo cinco sessões: vivência no serviço, atividades de ensino, pesquisa, extensão e relatório. Graças a essa experiência, foi possível identificar que o portfólio tem sido um instrumento facilitador para a construção do aprendizado do estudante e do grupo, permitindo o registro crítico e reflexivo do caminho percorrido e da aprendizagem significativa, estimulando a comunicação, a integração e as relações estabelecidas no grupo, além das sensações e emoções do que foi vivenciado.

Exploring Adaptive Implementation of On-Chip Networks

As technology geometries have shrunk to the deep submicron regime, the communication delay and power consumption of global interconnections in high performance Multi- Processor Systems-on-Chip (MPSoCs) are becoming a major bottleneck. The Network-on- Chip (NoC) architecture paradigm, based on a modular packet-switched mechanism, can address many of the on-chip communication issues such as performance limitations of long interconnects and integration of large number of Processing Elements (PEs) on a chip. The choice of routing protocol and NoC structure can have a significant impact on performance and power consumption in on-chip networks. In addition, building a high performance, area and energy efficient on-chip network for multicore architectures requires a novel on-chip router allowing a larger network to be integrated on a single die with reduced power consumption. On top of that, network interfaces are employed to decouple computation resources from communication resources, to provide the synchronization between them, and to achieve backward compatibility with existing IP cores. Three adaptive routing algorithms are presented as a part of this thesis. The first presented routing protocol is a congestion-aware adaptive routing algorithm for 2D mesh NoCs which does not support multicast (one-to-many) traffic while the other two protocols are adaptive routing models supporting both unicast (one-to-one) and multicast traffic. A streamlined on-chip router architecture is also presented for avoiding congested areas in 2D mesh NoCs via employing efficient input and output selection. The output selection utilizes an adaptive routing algorithm based on the congestion condition of neighboring routers while the input selection allows packets to be serviced from each input port according to its congestion level. Moreover, in order to increase memory parallelism and bring compatibility with existing IP cores in network-based multiprocessor architectures, adaptive network interface architectures are presented to use multiple SDRAMs which can be accessed simultaneously. In addition, a smart memory controller is integrated in the adaptive network interface to improve the memory utilization and reduce both memory and network latencies. Three Dimensional Integrated Circuits (3D ICs) have been emerging as a viable candidate to achieve better performance and package density as compared to traditional 2D ICs. In addition, combining the benefits of 3D IC and NoC schemes provides a significant performance gain for 3D architectures. In recent years, inter-layer communication across multiple stacked layers (vertical channel) has attracted a lot of interest. In this thesis, a novel adaptive pipeline bus structure is proposed for inter-layer communication to improve the performance by reducing the delay and complexity of traditional bus arbitration. In addition, two mesh-based topologies for 3D architectures are also introduced to mitigate the inter-layer footprint and power dissipation on each layer with a small performance penalty.

Modelling of combustion and sorbent reactions in three-dimensional flow environment of a circulating fluidized bed furnace

This thesis presents a three-dimensional, semi-empirical, steady state model for simulating the combustion, gasification, and formation of emissions in circulating fluidized bed (CFB) processes. In a large-scale CFB furnace, the local feeding of fuel, air, and other input materials, as well as the limited mixing rate of different reactants produce inhomogeneous process conditions. To simulate the real conditions, the furnace should be modelled three-dimensionally or the three-dimensional effects should be taken into account. The only available methods for simulating the large CFB furnaces three-dimensionally are semi-empirical models, which apply a relatively coarse calculation mesh and a combination of fundamental conservation equations, theoretical models and empirical correlations. The number of such models is extremely small. The main objective of this work was to achieve a model which can be applied to calculating industrial scale CFB boilers and which can simulate all the essential sub-phenomena: fluid dynamics, reactions, the attrition of particles, and heat transfer. The core of the work was to develop the model frame and the required sub-models for determining the combustion and sorbent reactions. The objective was reached, and the developed model was successfully used for studying various industrial scale CFB boilers combusting different types of fuel. The model for sorbent reactions, which includes the main reactions for calcitic limestones, was applied for studying the new possible phenomena occurring in the oxygen-fired combustion. The presented combustion and sorbent models and principles can be utilized in other model approaches as well, including other empirical and semi-empirical model approaches, and CFD based simulations. The main achievement is the overall model frame which can be utilized for the further development and testing of new sub-models and theories, and for concentrating the knowledge gathered from the experimental work carried out at bench scale, pilot scale and industrial scale apparatus, and from the computational work performed by other modelling methods.

Coffee seedlings in different substrates and protected environments

The production of high-quality seedlings is a critical factor for successful implementation of a determined crop in the field. In order to evaluate the production of coffee seedlings, experiments were conducted with different substrates and in different protected environments. Treatments consisted of evaluation of the following substrates: 50% cattle manure + 50% commercial substrate, 50% cattle manure + 50% vermiculite, 50% commercial substrate + 50% vermiculite, 1/3 cattle manure + 1/3 commercial substrate + 1/3 vermiculite, 50% cattle manure + 50% sand, 1/3 sand + 1/3 cattle manure + 1/3 commercial substrate and 50% commercial substrate + 50% sand. These substrates were tested in different protected environments: agricultural greenhouse, mesh screen with 50% shading, aluminized screen with 50% shading, black screen with 30% shading, black screen with 70% shading, nursery with a buriti straw roof and full sunlight. In each environment, the experiments were conducted in a completely randomized design with five replicates of four plants each followed by joint analysis. The substrates containing 50% cattle manure associated with vermiculite or the commercial substrate may be indicated for production of coffee seedlings. Screened environments with 30, 50 and 70% shading resulted in the highest quality seedlings.

Effects of vinasse application under the physical attributes of soil covered with sugarcane straw

Areas under vinasse application have been associated to favorable physical conditions for root development, aeration, infiltration and water movement in soil profile. This study aimed to evaluate changes on physical attributes of soil under sugarcane straw after vinasse application in two sugarcane growing areas (Area 1 and Area 2) under mechanized management in the state of Paraíba, Brazil. In each area, the samples were collected in the 0-0.20, 0.20-0.40 and 0.40-0.60m layers of the soil, in 36 points, distributed in a 10×10m mesh, one day before and 40 days after vinasse application. The data were submitted to multivariate analysis with repeated measures and geostatistics. The vinasse application decreased soil density and increased total porosity in both Areas and increased organic matter in Area 2. In Area 1 occurred pure nugget effect for the fractions of sand, silt and clay, independent of soil layer. In Area 2, this effect was verified mostly at superficial layers, except for the fraction of clay that presented a moderate degree of spatial dependence.

Wet bulbs from the subsurface drip irrigation with water supply and treated sewage effluent

The use of treated sewage effluent (TSE) combined with the subsurface drip irrigation (SDI) method in agriculture can decrease the costs of agricultural production, in attempts to fertigate crops more efficiently. In this study it was compared the dimensions of the wet bulb formed by the application of TSE and municipal water supply (MWS) in an Oxisoil. We have evaluated the effect of water quality and discharge between drippers used in sugarcane crop. Three trenches were opened and 21 three-rod TDR probes were setup in a mesh and a dripper was buried at 0.30 m, for each constant discharge of 1.0 L h-1and 1.6 L h-1. Comparing results from different wetted soil profiles it was observed that the vertical and horizontal dimensions of the wet bulb are similar for both MWS and TSE, being peculiars according to the discharges used and volume applied. Regardless the water quality, an increase of 60% in discharge decreased the deepest infiltration.

Hérnia perineal após disjunçao da sínfise púbica: apresentação de caso e técnica para correção

Traunatic perineal hernia remains a rare clinical entity despite an overall increase in blunt trauma. Because of the incidence of other associated injuries, the mortality is high. Most of the perineal defects are repaired during the orthopaedics surgery to reconstitute the pelvis and few patients develop a true perineal hernia without pelvic instability. A 80-year-old woman was involved in a running over accident with disjunction of pubic symphysis, dislocation of sacrum-iliac junction and fracture of pubis and ischium. The patient was submitted to an orthopaedic surgery and latter development an perineal hernia through the genitalia. The diagnosis could be established with physical examination alone. Conventional radiology, computadorized tomography, and ultrasound should also be done to progran the surgery. The repair approach was performed using a marlex mesh, fixed in the pelvic bones, Cooper ligament, and the abdominal wall. The mesh was stood in a retro- peritoneal position, rebuilding the pelvic floor without reconstruction the pelvic bones. We conclude that this is an efficient approach to repair of traumatic postoperative perineal hernia, mainly in patients with high operative risk, when the osseous repair is not necessary.

Hérnia traumática da parede abdominal

A rare case of blunt traumatic abdominal hernia is presented in which jejunal loops herniated through the abdominal wall. The patient had a serious motor vehicle accident seven years ago, while wearing the seat belt. He developed a traumatic hernia in the anterior lateral abdominal wall, which was operated, and relapsed after some months. The patient was reoperated and we observed the unattachment of the anterior lateral abdominal musculature from the ilium crest. After the hernial sac treatment, the defect was solved with the use of a polypropylene mesh. The postoperative evolution was good and four months later there were no signs of recurrence. Traumatic abdominal hernia remains a rare clinical entity, despite the increase in blunt abdominal trauma. Traumatic abdominal wall hernia falls into two general categories: small lower quadrant abdominal defects, typically the result of blunt trauma with bicycle handlebars, and larger abdominal wall defects related to motor vehicle accidents. The diagnosis may be often established by the physical examination alone. Conventional radiology and computerized tomography usefulness have been proved. In the vast majority of cases, early repair is recommended. The appropriate treatment is the reduction of the herniated bowel into the abdomen, the debridment of nonviable tissues, and a primary tension free closure of the detect.

Revisão sistemática: uma revisão narrativa

OBJETIVO: realizar uma revisão narrativa sobre revisão sistemática. FONTE DOS DADOS: foi realizada busca no Cochrane Methodology Register, na Medline, na LILACS, no Google Scholar e na Cochrane Library, no período de 2000 a janeiro de 2007. Foram utilizados a busca manual das listas de referências e os contatos pessoais. SELEÇÃO DOS ESTUDOS: a estratégia de busca empregou, na Medline, as seguintes combinações dos termos MeSH: "Meta-Analysis" [Publication Type] AND "Evidence-Based Medicine"[MeSH] Limits: Publication Date from 2000 to 2007, Humans, Systematic Reviews. Na LILACS: (metanalise) or "metanalise" [Descritor de assunto] and [ medicina baseada em evidências] or "medicina baseada em evidências" [Descritor de assunto]. No Cochrane Methodology Register e no Google Scholar: "revisão sistemática e metanálise" e "medicina baseada em evidências". Após uma revisão independente por dois revisores, dez artigos que se referiam ao objetivo proposto foram selecionados. SÍNTESE DOS DADOS: os temas mencionados nos estudos foram agrupados em duas categorias: aqueles que se reportavam à história da revisão sistemática e aqueles que definiam Medicina Baseada em Evidência, revisão sistemática e metanálise. CONCLUSÃO: os autores concluem com a necessidade de mais discussões sobre revisão sistemática entre os cirurgiões.

Baço migratório em hérnia paraestomal

The authors report a case of a parastomal hernia that incarcerated a wandering spleen. We present a very rare case of an 85-year-old woman with a giant parastomal hernia. Computed tomography revealed a parastomal hernia with a wandering spleen inside. We introduce a different and simple alternative approach, with the smallest inconvenience as possible to solve the trouble. We carried out the treatment with a prosthetic repair closing the defect with ePTFE mesh, performed through a laparoscopic approach, intraperitoneal, like a tie and move the spleen back to its anatomical place. The result was excellent.

O uso da prótese na correção das hérnias da parede abdominal é um avanço, mas o seu uso indiscriminado, um abuso

The objective is to alert the surgeon about the indiscriminate use of synthetic prosthesis in the correction of inguinal and incisional hernias. The authors provide a brief history of surgery on hernias and a review of the literature, showing the importance of classifying inguinal hernias to fit the type of surgical correction with the defect found, abstaining from treating all hernias, with the same type of surgical procedure. In our opinion, small indirect inguinal hernias (type 1 and 2 of Gilbert) and hernias in women must not, in general, be treated with prostheses. The synthetic material should be reserved for direct and large indirect hernias. Even so, this attitude, besides determining a higher cost for the procedure, can lead to important complications such as infection, rejection, fistula formation, chronic pain, alterations in spermatogenesis and the possibility of carcinogenesis, according to more recent reports. The physiology and anatomy of the abdominal wall should be considered when dealing with incisional hernia corrections, where the surgeon can choose among many techniques to correct those defects, and in selected cases, utilize synthetic material. We conclude that although the use of biomaterials has constituted a great advance in surgery for abdominal wall hernia corrections because they decrease recurrences, and permit treatment of large abdominal hernias, the indiscriminate prosthesis usage is an abuse, and it can determine many serious complications, certainly avoidable with a well indicated non mesh technique .

Reparo intraperitoneal de defeitos da parede ventral do abdome com telas de poliéster com colágeno e polipropileno com ácido poliglicólico

OBJETIVO: Avaliar a incorporação de telas de poliéster revestido em uma de suas faces por colágeno (Parietex, Covidien) e polipropileno recoberto por ácido poliglicólico (Optilene Mesh Elastic e Safil, BBD Aesculap) no reparo de defeitos da parede ventral de coelhos avaliando a cicatrização no aspecto macroscópico, o depósito de colágeno e a imunomarcação tecidual pelos anticorpos MMP-1, MMP-8 e MMP-13. MÉTODOS: Utilizaram-se 16 coelhos, divididos em dois grupos de oito animais, avaliados após eutanásia após 30 e 60 dias de pós-operatório. Os animais foram submetidos à realização de dois defeitos simétricos na parede ventral do abdome, à direita e esquerda da linha alba, que compreendendo todos os folhetos musculares e o peritônio. O reparo dos defeitos foi realizado mediante implante intraperitoneal de dois modelos diferentes de telas. Utilizou-se a tela de poliéster revestido com camada protetora de colágeno (grupo controle) e a tela de polipropilene revestido com malha de ácido poliglicólico (manufaturacao própria, grupo de experimentacao). A avaliacao constou de aspectos clínicos, achados macroscópicos, análise dos colágenos tipos I/III e avaliação imunoistoquímica de metaloproteinases. RESULTADOS: Os resultados da avaliacao clínica e os parâmetros macroscópicos foram semelhantes entre os grupos. 50% dos animais do grupo Parietex tiveram ausência de aderencias intraperitoneais a no 30° dia de pós-operatrório. Em ambos os grupos observou-se reducao das aderências entre o 30° e o 60° dias de pós-operatório, contudo sem diferenca estatística. As aderências observadas foram classificadas principalmente de frouxas. Nao se observou a ocorrencia de complicacoes envolvendo vísceras intraabdominais. No Grupo Parietex houve a ocorrência de formacao de ulceracao da pele que recobria a tela em quatro animais, em comparacao com um no grupo de experimentacao. No Grupo Parietex foi observada uma insuficiencia de reparo após 60 dias. Quanto ao depósito do colágeno tipos I e III, nao houve diferenca significativa entre os grupos. Os resultados da imunoistoquímica referentes aos anticorpos MMP-1 e MMP-8 também não demonstraram diferença significativa entre as telas. CONCLUSÃO: As duas telas pesquisadas obtiveram resultados semelhantes tanto nos aspectos macro como nos microscópicos, podendo ser consideradas semelhantes quanto ao reparo de defeitos cirúrgicos da parede ventral do abdome em coelhos.

Hérnia intercostal transdiafragmática após fratura espontânea de costelas secundária à crise de tosse

One case of transdiafragmatic intercostal hernia after intense coughing fit followed by rib fractures in patient with history of pneumonia is presented. He had a severe coughing fit, developed a right toracoabdominal hematoma and then a tumor that was gradually enlarging. Image exams confirmed the diagnosis. Treatment consisted of surgical repair with the use of a polypropylene prosthetic mesh. It is a rare type of hernia. Only four cases were found in literature. The sooner the disease is diagnosed and treated the better the prognoses will be since it will prevent hernia from strangulation and incarceration.