Los pacientes del hospital como recurso pedagógico irremplazable: "Todos los pacientes son neurológicos"

Con el advenimiento de la nueva tecnología es necesario prevenir una eventual distorsión en el proceso de enseñanza-aprendizaje en medicina, especialmente por erróneas suposiciones de carencia de pacientes para la realización de actividades prácticas. Situación que también ha sido detectada desde la actividad docente en nuestra Cátedra

Parto vaginal posterior a cesárea como factor asociado a Apgar bajo al nacer

Objetivo: Evaluar si el parto vaginal posterior a cesárea es un factor asociado a Apgar bajo al nacer. Material y métodos: Cohortes retrospectiva en base a registros de gestantes con cesárea previa, que ingresaron al Hospital Belén de Trujillo en el periodo Enero 2010 a Diciembre 2015. Usando la prueba Chi cuadrado (x2) y la medida de asociación Riesgo Relativo (RR), se analizó las variables parto vaginal posterior a cesárea y cesárea repetida con la presencia de Apgar bajo al nacer (puntaje < 7 a los 5 minutos), con un IC del 95%. Además, se estableció el grado de significancia para la presencia de Apgar bajo al nacer, de las variables: parto vaginal previo, edad materna, sexo del RN, edad gestacional, peso al nacer y grado de control prenatal. Resultados: El grupo parto vaginal constituyó el 14.6% y el grupo cesárea repetida, el 85.4%. Se encontró 2 RN del grupo de parto vaginal posterior a cesárea con puntaje de Apgar bajo al nacer (incidencia: 0.75%) y 12 RN (incidencia: 0.77%) en el grupo de cesárea repetida (RR 1.03, x2 = 0.001, p> 0.05, IC 95 %: 0.217 – 4.372). El sexo del RN fue la única variable complementaria relacionada con la presencia de Apgar bajo al nacer (RR = 7, IC 95%: 1.559-31.301, p = 0.003). Conclusión: No existencia diferencia significativa en la presencia de Apgar bajo al nacer entre parto vaginal posterior a cesárea y cesárea repetida.Purpose: To assess whether vaginal delivery after cesarean is an associated factor with low Apgar at birth. Material and methods: Retrospective cohort based on records of pregnant women with a previous cesarean section who entered the Belén Hospital in Trujillo from January 2010 to December 2015. With the help of the Chi square test (x2) and the measure of association Relative Risk (RR), analyzed the variables vaginal delivery after cesarean section and repeated cesarean section with the presence of low Apgar at birth (score <7 at 5 minutes), with a CI of 95%. Likewise, the degree of significance was established for the presence of Apgar at birth, of the variables: previous vaginal delivery, maternal age, sex of the RN, gestational age, birth weight and degree of prenatal control. Results: The vaginal delivery group constituted 14.6% and the repeated cesarean group, 85.4%. We found 2 neonates from the vaginal delivery group after cesarean section with low Apgar score at birth (incidence: 0.75%) and 12 neonates (incidence: 0.77%) in the repeat cesarean group (RR 1.03, x2 = 0.001, p> 0.05, IC 95 %: 0.217 – 4.372).The sex of the RN was the only complementary variable related to the presence of Apgar low at birth (RR = 7, IC 95%: 1.559-31.301, p = 0.003). Conclusion: There is not significant difference in the presence of low Apgar at birth between vaginal delivery after cesarean section and repeated cesarean section.Tesi

CHANGES IN PRECIPITATION EXTREMES IN BRAZIL (PARAN&#193; RIVER BASIN)

Made available in DSpace on 2018-12-11T17:00:33Z (GMT). No. of bitstreams: 0 Previous issue date: 2016-02-01This research was aimed at addressing aspects related to variation in the amount of precipitation during the period from 1986 to 2011 in the Paraná River Hydrographical Basin, Brazil, for 32 meteorological stations using 11 climate indices created by the ETCCDI (Expert Team, ET, on Climate Change Detection and Indices, ETCCDI). The daily rainfall data were organized in spreadsheets, which were subjected to an intense quality control and an accurate historical research. For each pluviometric index, we have estimated the trends and the statistical significant of the slopes have been calculated. The results confirm that an increase in total precipitation in almost all analyzed stations was registered, and the extreme precipitations were the main contributors to such additions. In fact, the significant increase in total annual rainfall in north-central sector of the basin are related to higher rates of heavy rain, mainly above 95th percentile, as well as to the highest event of rainfall above 10 mm. Instead the northern part of the region, showed declining trends of extreme rainfall, caused mainly by the reduction in the rainfall occurrences over 95th percentile. In order to evaluate the impact that the increasing extreme rainfall may cause in large urban centers, we have investigated the data of two municipalities (Curitiba, PR and Goiânia, GO-Brazil), where the positive trend can cause inconvenience to the population (floods and inundations) suggesting, at least, the need of implementation of more effective urban planning for the future.Programa de Pós-Graduação em Geografia Universidade Estadual Paulista - UNESP Instituto de Geociências e Ciências Exatas, Avenida 24 A, número 1515Dipartimento di Scienze della Terra Università di Torino, Via Valperga Caluso 35Centro di Ricerca sui Rischi Naturali in Ambiente Montano e Collinare (NatRisk), via Leonardo da Vinci 4Programa de Pós-Graduação em Geografia Universidade Estadual Paulista - UNESP Instituto de Geociências e Ciências Exatas, Avenida 24 A, número 151

Polarizations and differential calculus in affine spaces

Within the framework of mappings between affine spaces, the notion of $n$-th polarization of a function will lead to an intrinsic characterization of polynomial functions. We prove that the characteristic features of derivations, such as linearity, iterability, Leibniz and chain rules, are shared -- at the finite level -- by the polarization operators. We give these results by means of explicit general formulae, which are valid at any order $n$, and are based on combinatorial identities. The infinitesimal limits of the $n$-th polarizations of a function will yield its $n$-th derivatives (without resorting to the usual recursive definition), and the above mentioned properties will be recovered directly in the limit. Polynomial functions will allow us to produce a coordinate free version of Taylor's formula

Text Versus Verbal Real-time Feedback During Simulation-based Training Of Higher-order Cognitive Skills

A crucial component of instructional design for simulation-based training systems involves optimizing the presentation of complex material in order to maximize knowledge acquisition and application. One approach toward facilitating the learning of this complex information is to instantiate instructional strategies within the training systems themselves. However, there are few established guidelines in place which are meant specifically for real-time guidance strategies within simulation-based environments. Consequently, this study aims to apply findings from the literature on instructional information presentation to drive decisions for how to most effectively provide real-time feedback during training of simulated decision-making tasks. Research has shown that presenting text information in an auditory mode during direct instruction of operational tasks enhances learning and reduces the probability of learners experiencing cognitive overload. Similar effects have been found regarding the presentation modality of feedback during operational tasks. In the current study, this principle was extended by comparing text versus verbal real-time feedback presentation during learning of higher-level cognitive skills in a virtual environment. Participants were instructed on how to perform a simulated decisionmaking task, while receiving text, verbal or no instructional feedback in real-time, based on their performance. Participants then completed an assessment scenario in which no feedback was provided to any group. It was hypothesized that a linear relationship would exist across each of the three conditions, with the verbal group making the best decisions, followed by the text group, and then by the control group. Additionally, reduced cognitive load was expected throughout the instructional process for those receiving verbal feedback prompts compared to those receiving text prompts and the control. Analyses revealed several significant linear trends across iv conditions regarding measures of knowledge acquisition and application. The results provide support for the hypothesis that verbal real-time feedback is more effective than text during training of primarily visual tasks for the acquisition of higher-order cognitive skills such as decision making. There were no significant linear trends regarding the amount of cognitive load subjectively reported during training and assessment. The results of this study indicate that instructional systems intended to train primarily visual tasks should present real-time feedback in verbal rather than text form

New laboratory predictive tools in deep neck space infections

Introduction. Deep neck space infections (DNSIs) are a group of infective suppurative dis-eases involving deep neck spaces and cervical fascia. Necrotising and septic evolutions are rare, but severe complications can dramatically affect the prognosis and should be promptly managed. Clinical examination often has low sensitivity, although instrumental diagnosis may delay te treatment. We investigated two laboratory tools, LRINEC (Laboratory Risk Indicator for the Necrotizing fasciitis) and NLR (neutrophil to lymphocyte ratio), in the expectation to find a rapidly available predictive indicator that may help in distinguishing necrotising complications and/or systemic septic involvement. Methods. A retrospective observational cohort study was performed on 118 patients who had underwent surgical treatment for DNSIs at our Surgical Unit. LRINEC, NLR and the product LRINEC x NLR were calculated. Results. Statistical analysis showed that these scores may have utility in rapidly predicting the risk of necrotising fasciitis and systemic involvement at an early diagnostic stage. Conclusions. Further studies with a larger cohort may be necessary in order to increase the sensitivity and specificity

Helicopter Parenting and Young Adults’ Well-Being : A Comparison between United States and Finland

Helicopter parenting, defined as a form of overinvolved parenting of young adult children, is shown to be associated with young adult children’s well-being. Furthermore, the phenomenon of helicopter parenting is increasingly evident across various cultures. In this study, the association between helicopter parenting and young adult children’s well-being problems was examined, and the associations were compared between samples of American and Finnish young adults. With a sample of 441 American and 306 Finnish university students, results from path models suggested that maternal and paternal helicopter parenting was associated with university students’ symptoms of anxiety and depression, life dissatisfaction, and emotional dysregulation. Furthermore, even though the mean levels of helicopter parenting were lower among Finnish parents as compared with American parents, the associations between helicopter parenting and young adults’ well-being problems were, in general, equally significant. The implications for university students, parents of students, educators, and university administrators from different cultural backgrounds were also discussed.Peer reviewe