Uso da Simulação no Treino de Internos em Técnicas de Pediatria – Técnica da Punção Lombar

Introdução: A punção lombar (PL) é a técnica invasiva mais frequente em Pediatria. O treino é habitualmente realizado sob supervisão, directamente no paciente. O uso de simuladores, possibilita aquisição de capacidades num ambiente seguro, minimizando custos e riscos para o doente. Objectivos: Avaliar a capacidade dos internos de pediatria (IP) na realização da PL e o uso de simulação aplicada à educação médica como ferramenta de melhoria na aquisição de competências. Material e Métodos: Foi elaborado e apresentado a todos os IP, um protocolo e checklist da PL. Realizaram-se 2 sessões clínicas, usando simuladores de PL, a primeira uma semana depois da apresentação do protocolo e a segunda, dois meses depois. Foi avaliado em cada sessão, o cumprimento do protocolo e performance na execução da técnica, mediante a aplicação da checklist. No final de cada sessão foi aplicado um questionário (escala 0-10) sobre experiência, grau de confiança prévio, alterações notadas e reprodutividade da técnica no simulador. Resultados: Participaram em cada sessão, 13 IP Oito haviam realizado menos de 10 PL durante a sua prática clínica, sendo que nenhum tinha realizado, PL em simuladores. Na 1ª sessão, as principais falhas foram a ausência de esclarecimentos sobre a técnica (n=7), cuidados pós PL (n=6) e complicações (n=5); a não aplicação de anestésico local (n=3); ausência de monitorização (n=5) e falhas na assepsia A maioria (n=8) desconhecia, ainda, o sistema de medição da pressão intracraniana (PIC). Na 2ª sessão, verificou-se melhoria em todos os itens avaliados, persistindo, ainda, falhas na monitorização (n=2), informação cuidados pós PL (n=2) e complicações (n=2). Em todos os casos a medição da PIC foi correcta. O score médio do conhecimento e grau de confiança na execução da técnica prévia à 1ª sessão foi 5, constatando-se uma clara melhoria após as 2 sessões (score médio 9). Todos consideraram que os simuladores contribuíram para o aperfeiçoamento da técnica e que os mesmos reproduziam com fiabilidade a prática real (score médio 8). Conclusões: O uso de simuladores no treino da PL melhora a competência dos internos na sua realização, permitindo aquisição de experiência e confiança sem riscos para doente. A introdução destes simuladores no ensino médico pós-graduado deve ser considerado

Silvopastoral systems established with Pinus radiate D. Don and Betula pubescens Ehrh.: Tree growth, understorey biomass and vascular plant biodiversity

In the European Union, the majority of afforestation is carried out on former agricultural land. This afforestation causes fundamental changes in ecosystem structure and functioning, with the trees intercepting light and precipitation, producing litterfall and competing for soil nutrients. All of these effects could potentially have a negative impact on understorey biomass and vascular plant biodiversity in a relatively short time span. This study aims to evaluate the effects of afforestation with Pinus radiata D. Don (Monterey pine: pine) and Betula pubescens Ehrh. (Downy birch: birch), established at two different densities (2500 and 833 trees ha21) and sown with two different pasture mixtures (Dactylis glomerata L. + Trifolium repens L. + Trifolium pratense L. and Lolium perenne L. + T. repens L. + T. pratense L.), on understorey biomass, alpha plant biodiversity, life cycle type (annuals vs. perennials) and beta biodiversity over a period of 11 years. Pine showed better development than birch throughout the study, although both species were very sensitive to tree density. While increasing density increased pine height and decreased pine diameter, both aspects of birch development were reduced by higher tree densities. Aboveground biomass increased throughout the study. Alpha plant biodiversity was drastically reduced under pine established at high density, 11 years after afforestation. However, the similarities in species richness, species composition and the low beta growth rates found under pine at low density, and birch at both high and low density suggest that, in these cases, the choice of canopy tree has little consequence for understorey biodiversity at this stage of system development.info:eu-repo/semantics/publishedVersio

Two-bands superconductivity with intra- and interband pairing for synthetic superlattices

We consider a model for superconductivity in a two-band superconductor, having an anisotropic electronic structure made of two partially overlapping bands with a first hole-like and a second electron-like fermi surface. In this pairing scenario, driven by the interplay between interband $V_{i,j}$ and intraband $V_{i,i}$ pairing terms, we have solved the two gap equations at the critical temperature $T = T_c$ and calculate $T_c$ and the chemical potential $\mu$ as a function of the number of carriers $n$ for various values of pairing interactions, $V_{1,1}$, $V_{2,2}$, and $V_{1,2}$. The results show the complexity of the physics of condensates with multiple order parameters with the chemical potential near band edges.Comment: 6 pages, 2 figure

Effect of Tree Species and Density on Pasture Production in Galicia, Spain

Galicia produces 50% of the forest products of Spain. Livestock production earns 62% of the income of the agrarian sector in Galicia. Afforestation has been very important in the last decade to such an extent that the area of forest and woodlands now covers 62% of Galicia. It is necessary to increase the rate of return on investments in planted forests in order to avoid rural depopulation through improvement of rural development and welfare. This paper reports on the effect of combining pastures with trees

Seasonal Variation of Crude Protein Content of Different Herbaceous, Shrub and Tree Species

Silvopastoralism is a sustainable way of land management that reduces fire risk due to the reduction of fuel under trees when plants are used as animal food. This is particularly important in areas like Galicia that have 16% of the fired area of Europe. Silvopastoral systems can contribute to environment conservation and provide feed for autochthonous breeds more adapted to mountain conditions, enhancing biodiversity conservation. In formation on seasonal changes in crude protein content of spontaneous species will indicate better management of pasture resources in mountain areas

Metal-Insulator Transition in the Two-Dimensional Hubbard Model at Half-Filling with Lifetime Effects within the Moment Approach

We explore the effect of the imaginary part of the self-energy, $Im\Sigma(\vec{k},\omega)$, having a single pole, $\Omega(\vec{k},\omega)$, with spectral weight, $\alpha(\vec{k})$, and quasi-particle lifetime, $\Gamma(\vec{k})$, on the density of states. We solve the set of parameters, $\Omega(\vec{k},\omega$), $\alpha(\vec{k})$, and $\Gamma(\vec{k})$ by means of the moment approach (exact sum rules) of Nolting. Our choice for $\Sigma(k,\omega)$, satisfies the Kramers - Kronig relationship automatically. Due to our choice of the self - energy, the system is not a Fermi liquid for any value of the interaction, a result which is also true in the moment approach of Nolting without lifetime effects. By increasing the value of the local interaction, $U/W$, at half-filling ($\rho = 1/2$), we go from a paramagnetic metal to a paramagnetic insulator, (Mott metal - insulator transition ($MMIT$)) for values of $U/W$ of the order of $U/W \geq 1$ ($W$ is the band width) which is in agreement with numerical results for finite lattices and for infinity dimensions ($D = \infty$). These results settle down the main weakness of the spherical approximation of Nolting: a finite gap for any finite value of the interaction, i.e., an insulator for any finite value of $U/W$. Lifetime effects are absolutely indispensable. Our scheme works better than the one of improving the narrowing band factor, $B(\vec{k})$, beyond the spherical approximation of Nolting.Comment: 5 pages and 5 ps figures (included

Uncertainty propagation using the full second-order approach for probabilistic fatigue crack growth life

Uncertainty propagation of fatigue crack growth life commonly aims to provide the probability distribution of the lifespan needed for probabilistic damage tolerance analysis and for structural integrity assessment. This paper presents a novel methodology for efficiently estimating the parameters of the probability distribution of fatigue lifespan considering the Pearson distribution family. First, the full second-order approach for expected value and variance prediction of probabilistic fatigue crack growth life is extended to predict higher order statistical moments of the underlying distribution. That is, the expected value (first raw moment) and the variance (second central moment) equations are complemented with the probabilistic formulations for the skewness and for the kurtosis (third and fourth central standardized moments, respectively). Then, from these moments, the Pearson distribution type is automatically determined. Finally, the parameters of the particular Pearson distribution type are estimated making the statistical moments of the constructed lifespan distribution match the first four prescribed moments predicted by the probabilistic equations. The validity of the proposed method is verified by a numerical example regarding the fatigue crack growth in a railway axle under random bending loading. It is proven that the probability density function of the lifespan is properly derived by the methodology, without knowing or assuming the output probability distribution beforehand. The methodology presented enables an efficient and an accurate quantification of the lifespan uncertainties via its probabilistic distribution. This probabilistic description of fatigue crack growth life can be subsequently used in reliability studies or in damage tolerance assessment

Moment Approach for the 2D Attractive Hubbard Model

We constructed the one-particle spectral functions (diagonal and off-diagonal) which reproduce BCS for weak coupling and which take into account the effect of correlations on superconductivity in the attractive Hubbard model. The diagonal spectral function is composed of three peaks and the off-diagonal one is composed of two peaks. This ansatz satisfies the sum rules for the first six moments. Our solutions are valid for intermediate coupling, i.e., for $U/t \approx -4.0$. Our set of analytical equations for the unknown variables is self-consistent and has been solved numerically in lowest order of the order parameter. As a result, we obtain that the presence of the third band, or {\it upper Hubbard band}, strongly renormalizes the two lower bands, making that the energy gap be ${\bf k}$-dependent while the order parameter is pure s-wave. This shows that the order parameter and the gap are two different quantities.Comment: 8 pages, 3 figures (2 ps files for Fig. 2) To appear in Physica

Estrategia didáctica para el aprendizaje de la antropología forense en Latinoamérica

A didactic strategy based on the case method for learning forensic anthropology is presented. Case designed and implemented with 33 students enrolled in the Diploma in Forensic Sciences and Criminalistics, José Antonio Páez University-Venezuela. Five groups were formed to which the case was handed over, with three questions: Who is the victim? What happened? And how did it happen? After a debate of ideas and decision making, the conclusions were presented by group, then a consensus was generated to summarize and support the answers. It is concluded that the method used fostered meaningful and collaborative learning to establish the identity of the victim.Se presenta una estrategia didáctica basada en el método de casos para el aprendizaje de la antropología forense. Caso diseñado e implementado con 33 estudiantes inscritos en el Diplomado en Ciencias Forenses y Criminalística, de la Universidad José Antonio Páez-Venezuela. Se conformaron cinco grupos a los cuales se les entregó el caso, con tres interrogantes ¿Quién es la víctima?, ¿Qué ocurrió? y ¿Cómo ocurrió? Tras un debate de ideas y toma de decisiones, se presentaron las conclusiones por grupo, seguidamente se generó un consenso para resumir y sustentar las respuestas. Se concluye que el método utilizado fomentó el aprendizaje significativo y colaborativo para establecer la identidad de la víctima