Projeto Jovem Doutor: o aprendizado prático de estudantes de medicina por meio de atividade socioeducativa

This article presents the learning potentiation of medical students (undergraduates) through participation in socio-educational activity (Young Doctor Project-Health in Schools -YDP), using interactive educational resources, videos, 3D computer graphics and by 3D printer produced structures (Virtual Man). The YDP used hybrid education, bringing together educational platform, social media tools, web conferencing and educational learning objects with dynamic presence in the system structuring that provided flexible learning and in service, gathering experience and complementary expertise to the participants. Based on content that followed the priorities of the Ministry of Health of Brazil, the graduate students were able to learn aspects of primary care, develop various attitudes and acquire knowledge not covered by conventional medical curriculum. By being assigned to specific responsibilities, students developed active approach to learning the subjects in context (subjects research, discussion with teachers and professional experts). At the end of the project, 81.9% (8 of 11) of the YDP academics said that they had a critical training, reflective and greater communication skills. All (100%), considered to have expanded the ability to work in teams and knowledge in new technologies. The interaction of the undergraduate with teachers from cities where the YDP were implemented led them to become “symbols” for middle school, promoted the perception of future doctors about their role in the social context of health and stimulated the formation of social bond with middle school. Learning in service, through a socio-educational action, under the guidance of teachers and professional experts is a good way to encourage the learning of medical students and complies with the guidelines of 2014 CNE / MEC for undergraduates in medicine.O trabalho mostra a potencialização no aprendizado de estudantes de medicina (graduandos) através de participação em atividade sócio-educacional (Projeto Jovem Doutor-Saúde nas Escolas - PJD) usando recursos de educação interativa, vídeos, computação gráfica 3D e estruturas produzidas por impressora 3D (Homem Virtual). O PJD usou educação híbrida, reunindo plataforma educacional, ferramentas de mídias sociais, webconferências e objetos educacionais de aprendizagem com dinâmicas presenciais na estruturação de sistemática que proporcionou aprendizado flexível e em serviço, agregando experiências e conhecimentos complementares aos graduandos participantes do projeto. Baseado em conteúdos que seguiam as prioridades do Ministério da Saúde do Brasil, os graduandos puderam conhecer aspectos da Atenção Primária, desenvolver várias atitudes e aprender conhecimentos não previstos na grade curricular médica normal. Por meio de responsabilidades atribuídas a cada um, os graduandos desenvolveram postura ativa para aprender os assuntos de forma contextualizada (pesquisa de temas, debate com professores e profissionais especialistas). Ao final do projeto, 81,9% (8 de 11) graduandos do PJD responderam que tiveram uma formação crítica, reflexiva e maior habilidade em comunicação. Todos (100%), consideraram ter ampliado a capacidade de trabalho em equipe e conhecimentos em novas tecnologias. A interação dos graduandos com professores das escolas onde foram implantados o PJD levou-os a se tornarem “símbolos” para alunos do ensino fundamental II, promoveu a percepção dos futuros médicos sobre o seu papel no contexto social da saúde e estimulou a formação de vínculo social com alunos do ensino fundamental II. O aprendizado em serviço, através de uma ação sócio-educacional, sob orientação de professores e profissionais especialistas, é uma boa forma de estimular o aprendizado dos alunos de medicina e está em conformidade com as diretrizes de 2014 do CNE/MEC para graduação em Medicina

Automated Internet-based pain coping skills training to manage osteoarthritis pain: a randomized controlled trial

Osteoarthritis (OA) places a significant burden on worldwide public health because of the large and growing number of people affected by OA and its associated pain and disability. Pain coping skills training (PCST) is an evidence-based intervention targeting OA pain and disability. To reduce barriers that currently limit access to PCST, we developed an 8-week, automated, Internet-based PCST program called PainCOACH and evaluated its potential efficacy and acceptability in a small-scale, 2-arm randomized controlled feasibility trial. Participants were 113 men and women with clinically confirmed hip or knee OA and associated pain. They were randomized to a group completing PainCOACH or an assessment-only control group. Osteoarthritis pain, pain-related interference with functioning, pain-related anxiety, self-efficacy for pain management, and positive and negative affect were measured before intervention, midway through the intervention, and after intervention. Findings indicated high acceptability and adherence: 91% of participants randomized to complete PainCOACH finished all 8 modules over 8 to 10 weeks. Linear mixed models showed that, after treatment, women who received the PainCOACH intervention reported significantly lower pain than that in women in the control group (Cohen d = 0.33). Intervention effects could not be tested in men because of their low pain and small sample size. Additionally, both men and women demonstrated increases in self-efficacy from baseline to after intervention compared with the control group (d = 0.43). Smaller effects were observed for pain-related anxiety (d = 0.20), pain-related interference with functioning (d = 0.13), negative affect (d = 0.10), and positive affect (d = 0.24). Findings underscore the value of continuing to develop an automated Internet-based approach to disseminate this empirically supported intervention

The Long-Baseline Neutrino Experiment: Exploring Fundamental Symmetries of the Universe

The preponderance of matter over antimatter in the early Universe, the dynamics of the supernova bursts that produced the heavy elements necessary for life and whether protons eventually decay --- these mysteries at the forefront of particle physics and astrophysics are key to understanding the early evolution of our Universe, its current state and its eventual fate. The Long-Baseline Neutrino Experiment (LBNE) represents an extensively developed plan for a world-class experiment dedicated to addressing these questions. LBNE is conceived around three central components: (1) a new, high-intensity neutrino source generated from a megawatt-class proton accelerator at Fermi National Accelerator Laboratory, (2) a near neutrino detector just downstream of the source, and (3) a massive liquid argon time-projection chamber deployed as a far detector deep underground at the Sanford Underground Research Facility. This facility, located at the site of the former Homestake Mine in Lead, South Dakota, is approximately 1,300 km from the neutrino source at Fermilab -- a distance (baseline) that delivers optimal sensitivity to neutrino charge-parity symmetry violation and mass ordering effects. This ambitious yet cost-effective design incorporates scalability and flexibility and can accommodate a variety of upgrades and contributions. With its exceptional combination of experimental configuration, technical capabilities, and potential for transformative discoveries, LBNE promises to be a vital facility for the field of particle physics worldwide, providing physicists from around the globe with opportunities to collaborate in a twenty to thirty year program of exciting science. In this document we provide a comprehensive overview of LBNE's scientific objectives, its place in the landscape of neutrino physics worldwide, the technologies it will incorporate and the capabilities it will possess.Comment: Major update of previous version. This is the reference document for LBNE science program and current status. Chapters 1, 3, and 9 provide a comprehensive overview of LBNE's scientific objectives, its place in the landscape of neutrino physics worldwide, the technologies it will incorporate and the capabilities it will possess. 288 pages, 116 figure

Acidic Digestion in a Teleost: Postprandial and Circadian Pattern of Gastric pH, Pepsin Activity, and Pepsinogen and Proton Pump mRNAs Expression

Two different modes for regulation of stomach acid secretion have been described in vertebrates. Some species exhibit a continuous acid secretion maintaining a low gastric pH during fasting. Others, as some teleosts, maintain a neutral gastric pH during fasting while the hydrochloric acid is released only after the ingestion of a meal. Those different patterns seem to be closely related to specific feeding habits. However, our recent observations suggest that this acidification pattern could be modified by changes in daily feeding frequency and time schedule. The aim of this study was to advance in understanding the regulation mechanisms of stomach digestion and pattern of acid secretion in teleost fish. We have examined the postprandial pattern of gastric pH, pepsin activity, and mRNA expression for pepsinogen and proton pump in white seabream juveniles maintained under a light/dark 12/12 hours cycle and receiving only one morning meal. The pepsin activity was analyzed according to the standard protocol buffering at pH 2 and using the actual pH measured in the stomach. The results show how the enzyme precursor is permanently available while the hydrochloric acid, which activates the zymogen fraction, is secreted just after the ingestion of food. Results also reveal that analytical protocol at pH 2 notably overestimates true pepsin activity in fish stomach. The expression of the mRNA encoding pepsinogen and proton pump exhibited almost parallel patterns, with notable increases during the darkness period and sharp decreases just before the morning meal. These results indicate that white seabream uses the resting hours for recovering the mRNA stock that will be quickly used during the feeding process. Our data clearly shows that both daily illumination pattern and feeding time are involved at different level in the regulation of the secretion of digestive juices

Genome-Wide Analyses of Nkx2-1 Binding to Transcriptional Target Genes Uncover Novel Regulatory Patterns Conserved in Lung Development and Tumors

The homeodomain transcription factor Nkx2-1 is essential for normal lung development and homeostasis. In lung tumors, it is considered a lineage survival oncogene and prognostic factor depending on its expression levels. The target genes directly bound by Nkx2-1, that could be the primary effectors of its functions in the different cellular contexts where it is expressed, are mostly unknown. In embryonic day 11.5 (E11.5) mouse lung, epithelial cells expressing Nkx2-1 are predominantly expanding, and in E19.5 prenatal lungs, Nkx2-1-expressing cells are predominantly differentiating in preparation for birth. To evaluate Nkx2-1 regulated networks in these two cell contexts, we analyzed genome-wide binding of Nkx2-1 to DNA regulatory regions by chromatin immunoprecipitation followed by tiling array analysis, and intersected these data to expression data sets. We further determined expression patterns of Nkx2-1 developmental target genes in human lung tumors and correlated their expression levels to that of endogenous NKX2-1. In these studies we uncovered differential Nkx2-1 regulated networks in early and late lung development, and a direct function of Nkx2-1 in regulation of the cell cycle by controlling the expression of proliferation-related genes. New targets, validated in Nkx2-1 shRNA transduced cell lines, include E2f3, Cyclin B1, Cyclin B2, and c-Met. Expression levels of Nkx2-1 direct target genes identified in mouse development significantly correlate or anti-correlate to the levels of endogenous NKX2-1 in a dosage-dependent manner in multiple human lung tumor expression data sets, supporting alternative roles for Nkx2-1 as a transcriptional activator or repressor, and direct regulator of cell cycle progression in development and tumors

Resolution of inflammation: a new therapeutic frontier

Dysregulated inflammation is a central pathological process in diverse disease states. Traditionally, therapeutic approaches have sought to modulate the pro- or anti-inflammatory limbs of inflammation, with mixed success. However, insight into the pathways by which inflammation is resolved has highlighted novel opportunities to pharmacologically manipulate these processes — a strategy that might represent a complementary (and perhaps even superior) therapeutic approach. This Review discusses the state of the art in the biology of resolution of inflammation, highlighting the opportunities and challenges for translational research in this field

Automated Internet-based pain coping skills training to manage osteoarthritis pain

Osteoarthritis (OA) is a leading cause of disability in the United States and globally, [14; 39] and the burdens it causes are expected to increase as the world’s population ages [14; 23]. Non-pharmacological treatments are a recommended component of current guidelines for treating OA pain [53]. Although evidence is mixed that people benefit from non-pharmacological treatments such self-management interventions and patient education [e.g., 17; 25; 38; 45], one non-pharmacological therapy—pain coping skills training (PCST)—has demonstrated more consistently positive outcomes [38]. PCST focuses specifically on educating people about cognitive and behavioral pain coping skills and helping them master those skills so they can become more actively involved in managing their pain--the most common and debilitating OA symptom [33]. It includes two main components: 1) a rationale linking pain to patterns of cognitive, emotional, and behavioral pain responses, and 2) training in skills such as attention diversion (e.g., relaxation), cognitive restructuring (to address catastrophizing and other maladaptive cognitive patterns), and activity patterns (e.g., activity-rest cycling). It has traditionally been delivered in-person by a trained therapist over 10-12 weeks. Randomized controlled trials demonstrate that PCST significantly improves pain and other outcomes [e.g., 24; 29; 30; 31; 63]. Moreover, interventions such as PCST have fewer adverse effects than pharmacological pain treatments and are well-received by patients. Thus, research supports the efficacy of in-person PCST. However, access to this intervention is limited by barriers such as lack of trained therapists, the substantial resources needed to deliver it, and the need for people to travel to in-person training held at scheduled times [22; 59] There is a clear need for an approach that makes PCST more accessible. The Internet—a proven method for delivering behavioral interventions—provides an avenue for meeting this need [15; 42; 58; 65], especially given older adults’ increasing use of the Internet [69]. The present pilot study was a two-arm randomized controlled trial conducted to evaluate the potential efficacy and acceptability of an eight-week, automated, Internet-based version of PCST called PainCOACH. This program was designed to retain key therapeutic features of the in-person PCST protocol, simulating in-person PCST while presenting training in an easy-to-use format with guided instruction, individualized feedback, interactive exercises, and animated demonstrations [57]. We hypothesized that: (1) PainCOACH would reduce pain (primary outcome) and improve pain-related interference with functioning, pain-related anxiety, self-efficacy for pain management, and positive and negative affect; and (2) acceptability would be high. Our overarching goal was to use findings from this early-stage research to refine the program and study protocol in preparation for a larger-scale trial. Additionally, we explored sex differences in responses to PainCOACH, based on evidence in our own lab and others showing significant sex differences in pain, pain responses, pain behavior, and pain coping in people with OA [e.g., 1; 19; 27; 32; see 54; 62; 67]. The potential for men and women to respond differently to pain interventions is important but rarely evaluated in research