Professional values at the beginning of medical school: a quasi-experimental study.

BACKGROUND: Teaching professionalism in medical schools is central to medical education and society. We evaluated how medical students view the values of the medical profession on their first day of medical school and the influence of a conference about the competences of this profession on these students' levels of reflection. METHODS: We studied two groups of medical students who wrote narratives about the values of the medical profession and the influence of the COVID-19 pandemic on these values. The first group wrote the narratives after a conference about the competences of the medical profession (intervention group), and the second group wrote the same narratives after a biochemistry conference (control group). We also compared the levels of reflection of these two groups of students. RESULTS: Among the 175 medical students entering in the 2022 academic year, 159 agreed to participate in the study (response rate = 90.8%). There were more references to positive than negative models of doctor‒patient relationships experienced by the students (58.5% and 41.5% of responses, respectively). The intervention group referred to a more significant number of values than the control group did. The most cited values were empathy, humility, and ethics; the main competences were technical competence, communication/active listening, and resilience. The students' perspectives of the values of their future profession were strongly and positively influenced by the pandemic experience. The students realized the need for constant updating, basing medical practice on scientific evidence, and employing skills/attitudes such as resilience, flexibility, and collaboration for teamwork. Analysis of the levels of reflection in the narratives showed a predominance of reflections with a higher level in the intervention group and of those with a lower level in the control group. CONCLUSIONS: Our study showed that medical students, upon entering medical school, already have a view of medical professionalism, although they still need to present a deeper level of self-reflection. A single, planned intervention in medical professionalism can promote self-reflection. The vision of medical professional identity was strongly influenced by the COVID-19 pandemic, positively impacting the formation of a professional identity among the students who decided to enter medical school.

Comparison of the SMLM technique and the MSSR algorithm in confocal microscopy for super-resolved imaging of cellulose fibres.

Nowadays, the use of super-resolution microscopy (SRM) is increasing globally due to its potential application in several fields of life sciences. However, a detailed and comprehensive guide is necessary for understanding a single-frame image's resolution limit. This study was performed to provide information about the structural organisation of isolated cellulose fibres from garlic and agave wastes through fluorophore-based techniques and image analysis algorithms. Confocal microscopy provided overall information on the cellulose fibres' microstructure, while techniques such as total internal reflection fluorescence microscopy facilitated the study of the plant fibres' surface structures at a sub-micrometric scale. Furthermore, SIM and single-molecule localisation microscopy (SMLM) using the PALM reconstruction wizard can resolve the network of cellulose fibres at the nanometric level. In contrast, the mean shift super-resolution (MSSR) algorithm successfully determined nanometric structures from confocal microscopy images. Atomic force microscopy was used as a microscopy technique for measuring the size of the fibres. Similar fibre sizes to those evaluated with SIM and SMLM were found using the MSSR algorithm and AFM. However, the MSSR algorithm must be cautiously applied because the selection of thresholding parameters still depends on human visual perception. Therefore, this contribution provides a comparative study of SRM techniques and MSSR algorithm using cellulose fibres as reference material to evaluate the performance of a mathematical algorithm for image processing of bioimages at a nanometric scale. In addition, this work could act as a simple guide for improving the lateral resolution of single-frame fluorescence bioimages when SRM facilities are unavailable.

Plant Foliar Geometry as a Biomimetic Template for Antenna Design.

Plant diversity includes over 300,000 species, and leaf structure is one of the main targets of selection, being highly variable in shape and size. On the other hand, the optimization of antenna design has no unique solution to satisfy the current range of applications. We analyzed the foliar geometries of 100 plant species and applied them as a biomimetic design template for microstrip patch antenna systems. From this set, a subset of seven species were further analyzed, including species from tropical and temperate forests across the phylogeny of the Angiosperms. Foliar geometry per species was processed by image processing analyses, and the resultant geometries were used in simulations of the reflection coefficients and the radiation patterns via finite differences methods. A value below -10 dB is set for the reflection coefficient to determine the operation frequencies of all antenna elements. All species showed between 3 and 15 operational frequencies, and four species had operational frequencies that included the 2.4 and 5 GHz bands. The reflection coefficients and the radiation patterns in most of the designs were equal or superior to those of conventional antennas, with several species showing multiband effects and omnidirectional radiation. We demonstrate that plant structures can be used as a biomimetic tool in designing microstrip antenna for a wide range of applications.

Saber pedagógico e investigación narrativa

La formación docente, la investigación educativa, las relaciones pedagógicas y el saber articulan una compleja discusión que, en particular, pueden estar mediada por la "narrativa pedagógica"; es decir, un método que nos ayuda en la indagación por la acción docente y la experiencia "pedagógica", como crisis que se abre, profundiza, pero no se resuelve". Esto con el fin de descubrir interrogantes que nos conduzca a potenciales producciones "colaborativa[s] de saber pedagógico, la reconstrucción de la memoria pedagógica de la escuela y la transformación de las prácticas educativas" (Suárez, 2011, p. 17). Este dispositivo de transformación centra su atención en los relatos de experiencia docente que pregunta, relacionan, participan, focalizan y construyen estrategias para la indagación y reflexión a través de las narrativas.

Teacher training, educational research, pedagogical relations, and knowledge articulate a complex discussion that, in particular, can be mediated by the "pedagogical narrative;" that is to say, a method that helps us in the inquiry into the teaching action and the pedagogical experience. This in order to discover questions that lead us to potential "collaborative" productions of pedagogical knowledge, the reconstruction of the pedagogical memory of the school, and the transformation of educational practices (Suárez, 2011, p. 17). This transformation device focuses its attention on the accounts of teaching experience that question, relate, participate, focus, and build strategies for inquiry and reflection through narratives.

Nutrition Effects of a Family-Centered Health Promotion Program for Mexican-Heritage Children in the Lower Rio Grande Valley of Texas.

Systemic and social factors, like poverty and food insecurity, negatively influence fruit and vegetable (FV) intake and body mass index (BMI) among Latino/a children. Behavioral programs are needed to support children's nutrition. This study examined program effects on FV intake and BMI outcomes for Mexican-heritage children (9-11 years). The program used a modified stepped-wedge design in the Lower Rio Grande Valley of Texas (2019 and 2020). Promotoras led experiential nutrition education sessions and collected height, weight, and instant skin carotenoid scores (biomarker for FV intake) at pre-test (baseline), post-test (6 weeks), and maintenance (3-4 months after post-test). Mean changes and group differences in skin carotenoid scores, BMI z-scores and percentiles were obtained from analyses of variance. Linear mixed-effects models were used to determine overall program effects. Mexican-heritage children were enrolled (n = 57 and 52.6% female). An overall decrease in skin carotenoid scores was observed at post-test (-15.1; 95% CI: -24.95, -5.33). While scores varied widely (range: 17-498), an increase of 14.8 ± 23.8 points occurred in one intervention group. Compared to the control period, greater reductions in BMI outcomes occurred during the program. These findings provide evidence for the use of strengths-based approaches in behavioral nutrition programs.

Synthesis of Blue Gahnite (ZnAl2O4:Co, Nd): A Cost-Effective Method for Producing Solar-Reflective Pigments for Cool Coatings.

Developing strategies for the green synthesis of novel materials, such as pigments for protection from solar radiation, is a fundamental research subject in material science to mitigate the heat island effect. Within this perspective, the current study reports on the synthesis of blue pigments of ZnAl2O4:M (M = Co2+ and Co2+/Nd3+) using recycled metallic aluminum (discarded can seal) with reflective properties of Near-infrared radiation. The pigments were characterized by XRD, SEM, XPS, UV-Vis, NIR diffuse reflectance spectroscopy, and CIE-1976 L*a*b* color measurements. The wettability of the coatings containing the synthesized pigments was also evaluated. The structural characterization showed that the pigments present the Gahnite crystalline phase. Colorimetric measurements obtained by the CIEL*a*b* method show values correlated to blue pigments attributed to Co2+ ions in tetrahedral sites. The pigments exhibit high near-infrared solar reflectance (with R% ≥ 60%), with an enhancement of nearly 20% for the pigment-containing neodymium when applied in white paint, indicating that the prepared compounds have the potential to be energy-saving color pigments for coatings.

Potential Role of Fourier Transform Infrared Spectroscopy as a Screening Approach for Breast Cancer.

Breast cancer is a heterogeneous disease, and its spread involves a succession of clinical and pathological stages. Screening is predominantly based on mammography, which has critical limitations related to the effectiveness and production of false-positive or false-negative results, generating discomfort and low adherence. In this context, infrared with attenuated total reflection Fourier transform infrared (ATR FT-IR) spectroscopy emerges as a non-destructive sample tool, which is non-invasive, label-free, has a low operating-cost, and requires only a small amount of sample, including liquid plasma samples. We sought to evaluate the clinical applicability of ATR FT-IR in breast cancer screening. ATR FT-IR spectroscopy through its highest potential spectral biomarker could distinguish, by liquid plasma biopsy, breast cancer patients and healthy controls, obtaining a sensitivity of 97%, specificity of 93%, a receiver operating characteristic ROC curve of 97%, and a prediction accuracy of 94%. The main variance between the groups was mainly in the band 1511 cm-1 of the control group, 1502 and 1515 cm-1 of the cancer group, which are the peaks of the bands referring to proteins and amide II. ATR FT-IR spectroscopy has demonstrated to be a promising tool for breast cancer screening, given its time efficiency, cost of approach, and its high ability to distinguish between the liquid plasma samples of breast cancer patients and healthy controls.

Challenge and barriers: teacher reflection on teaching physical education and sports during Covid-19 pandemic / Desafios e barreiras: reflexões docentes sobre o ensino da educação física e esportes durante a pandemia de Covid-19

ABSTRACT The covid-19 pandemic in some countries has been declared over. Learning activities began to be transferred face-to-face as before. However, online learning that lasted for almost 2 years certainly left unforgettable memories. During the pandemic, physical education (PE) teachers have become one of those who feel the heavy impact of teaching online. The objective of this study is to explore the online teaching experience of PE teachers. The variable on this research is the difficulties perceived by PE teachers while delivering lesson during pandemic. This research is qualitative research that uses a narrative analysis design. A total of 8 PE teachers from junior and senior high school is being involved in the study. We delivered semi-structured interviews to explore the experiences of teachers during online teaching in the pandemic era. The experience contained in this article is related to problems that are commonly encountered by teachers in Indonesia when implementing online learning. It is argued that most problem are coming from student's side. However, they admitted that teacher also set drawbacks on online learning through limitations on computing skill, poor learning design, and low adaptation on migrating the course from offline to online. This research has the potential to help identify crucial strategies for utilizing ICT and digital technologies in blended teaching settings.

RESUMO A pandemia de covid-19 em alguns países foi declarada encerrada. As atividades de aprendizagem começaram a ser transferidas presencialmente, como antes. Porém, o aprendizado online que durou quase 2 anos certamente deixou lembranças inesquecíveis. Durante a pandemia, os professores de educação física (EF) tornaram-se um dos que mais sentiram o forte impacto do ensino online. O objetivo deste estudo é explorar a experiência de ensino online de professores de EF. A variável desta pesquisa são as dificuldades percebidas pelos professores de EF ao ministrarem das aulas durante a pandemia. Esta pesquisa é uma pesquisa qualitativa que utiliza um desenho de análise narrativa. Um total de 8 professores de educação física do ensino fundamental e médio estão envolvidos no estudo. Realizamos entrevistas semiestruturadas para explorar as experiências dos professores durante o ensino online na era da pandemia. A experiência contida neste artigo está relacionada com problemas que são comumente encontrados pelos professores na Indonésia ao implementarem a aprendizagem online. Argumenta-se que a maioria dos problemas origina-se do lado do aluno. No entanto, os professores também admitiram que criaram desvantagens na aprendizagem on-line através de limitações nas competências informáticas, no design de aprendizagem e limitada adaptação na migração do curso de off-line para on-line. Esta investigação pode então ser utilizada por professores e partes interessadas para maximizar a aprendizagem em antecipação à possível pandemia que se aproxima.

Attenuated total reflection FTIR dataset for identification of type 2 diabetes using saliva.

Diabetes is one of the top 5 non-communicable diseases that occur worldwide according to the World Health Organization. Despite not being a fatal disease, a late diagnosis as well as poor control can cause a fatal outcome, because of that, several studies have been carried out with the aim of proposing additional techniques to the gold standard to assist in the diagnosis and control of this disease in a non-invasive way. Considering the above, and in order to provide a solid starting point for future researches, we share a primary research dataset with 1040 saliva samples obtained by Fourier Transform Infrared Spectroscopy considering the Attenuated Total Reflectance method. Database include: gender, age, individuals (patients) with/without diabetes, the glucose value, and the result to the A1C test for the diabetic population. We believe that sharing dataset as is could increase experimentation, research, and analysis of spectra through different strategies broaden its range of applicability by chemists, doctors, physicists, computer scientists, among others, to identify the effects that the virus causes in the body and to propose possible clinical treatments as well as to develop devices that allow us to assist in the characterization of possible carriers.

Is there a precise correlation between the lengths of the peritoneal reflection and the middle rectal valve?

Introduction: Pelvic anatomy remains a challenge, and thorough knowledge of its intricate landmarks has major clinical and surgical implications in several medical specialties. The peritoneal reflection is an important landmark in intraluminal surgery, rectal trauma, impalement, and rectal adenocarcinoma. Objectives: To investigate the correlation between the lengths of the middle rectal valve and of the peritoneal reflection determined with rigid sigmoidoscopy and to determine whether there are any differences in the location of the peritoneal reflection between the genders and in relation to body mass index (BMI) and parity. Design: We prospectively investigated the location of the middle rectal valve and of the peritoneal reflection via intraoperative rigid sigmoidoscopy in colorectal cancer patients undergoing elective colorectal surgery. Results: We evaluated 38 patients with a mean age of 55.5 years old (57.5% males) who underwent colorectal surgery at the coloproctology service of the Hospital Santa Marcelina, São Paulo, state of São Paulo, Brazil. There was substantial agreement between the lengths of the middle rectal valve and of the peritoneal reflection (Kappa = 0.66). In addition, the peritoneal reflection was significantly lower in overweight patients (p = 0.013 for women and p < 0.005 for men) and in women with > 2 vaginal deliveries (p = 0.009), but there was no significant difference in the length of the peritoneal reflection between genders (p = 0.32). Conclusion: There was substantial agreement between the lengths of the peritoneal reflection and of the middle rectal valve, and the peritoneal reflection was significantly lower in overweight patients and in women with more than two vaginal deliveries. (AU)

Mixed pollination system and floral signals of Paepalanthus (Eriocaulaceae): insects and geitonogamy ensure high reproductive success.

BACKGROUND AND AIMS: Eriocaulaceae exhibit a great variety of floral traits associated with insect (e.g. nectariferous structures) and wind pollination (unisexual flowers, exposed sexual organs and small pollen grains), as well as the 'selfing syndrome' (small flowers, short distance between stigma and anthers, and temporal overlap of male and female phases). Paepalanthus bifidus, P. subtilis and P. tortilis are related species that differ in form, size and colour of floral structures. We aimed to investigate the pollination and reproductive biology of these three species. METHODS: We analysed the floral biology, floral visitors, pollinator behaviour, and the contribution of insects, wind and spontaneous geitonogamy to fruit set. We also evaluated the floral colour and scent of the species. Colour reflectance of capitula of each species was measured and plotted in models of insect vision. Floral scent samples were extracted and the compounds were compared to vegetative scent samples. KEY RESULTS: In all species, the staminate and pistillate flowers are arranged in alternating cycles with a temporal overlap between these phases. Ants were the most frequent floral visitors and were effective pollinators in P. bifidus and P. tortilis, while flies were occasional pollinators in P. tortilis. Floral visitors were not observed in P. subtilis. In all species, fruits were produced by spontaneous geitonogamy, with no evidence of wind pollination. According to the models of insect vision, the colours of the capitula of P. bifidus and P. subtilis are the most inconspicuous for ants and flies. We found no difference between the emission of volatiles of inflorescences and vegetative structures. CONCLUSIONS: This study suggests that ant pollination might be more widespread in Eriocaulaceae than currently assumed. Furthermore, for small monocarpic plants, mixed mating strategies are most favourable, by ensuring reproduction either by outcrossing when pollinators are abundant or by spontaneous geitonogamy when pollinations are scarce/absent.

Aprimoramento em grupoterapia: adaptação ao contexto on-line / Group therapy improvement: adaptation to the online context / Formación profesional en terapia de grupo: adaptación al contexto online

Este é um Relato de Experiência de Aprimoramento em Coordenação e Manejo de Grupos. A experiência ocorreu durante a pandemia da COVID-19, sendo assim, desafios e adaptações estiveram presentes na vida cotidiana e acadêmica. A adaptação do aprimoramento para a modalidade on-line e em contexto pandêmico, provocou questionamentos a respeito do êxito da tarefa. O emprego dos dispositivos on-line para o aprimoramento de grupoterapeutas é um campo relativamente novo, justificando a relevância deste trabalho. Foi utilizado Diário de Campo para a coleta de dados e optou-se pelo referencial teórico de Pichon-Rivière, e outros autores da Psicanálise das Configurações Vinculares que discutem a questão da virtualidade na atualidade. Entendemos que a adaptação ao modelo on-line possibilitou a continuidade das atividades grupais programadas e a existência de um espaço de formação, troca e suporte entre pares. O Grupo Psicanalítico de Reflexão foi fundamental neste contexto, favoreceu a aprendizagem e o desenvolvimento de competências, oportunizou a construção e fortalecimento de vínculos, estimulou a postura crítica e criativa diante dos desafios, limites e potencialidades da adaptação ao modelo on-line, além de acolher as experiências decorrentes dos aprimoramentos do estado de pandemia.

This is an Experience Report on the Improvement Group Coordination and Management. The Experience occurred during the COVID-19 pandemic; therefore, challenges and adaptations were present in daily and academic life. Questions about the success of the task were raised after the adaptation of the Group Therapy to the modality due to the pandemic context. The usage of online devices to enhance group therapists is a relatively new field, justifying the relevance of this work. Field Diary was used for data collection. We opted for the theoretical framework of Pichon-Rivière, and the Psychoanalysis of Binding Configurations' authors, who discuss the issue of virtuality today. We understand that the adaptation to the online model enabled the continuity of scheduled group activities and the existence of training spaces, exchanges, and support peers. The Psychoanalytic Reflection Group was fundamental in this context, it favored learning and the development of skills. It provided the opportunity to build, strengthen bonds, and encourage critical and creative stances in the face of the challenges, limits, and potentials of adapting to the online model; and welcomed the experiences of improvements resulting from the pandemic state.

Este es un informe de Experiencia de Formación Profesional en la Coordinación y Gestión de Grupos. En el año de esta experiencia ocurrió la pandemia del COVID-19, desafíos y adaptaciones se hicieron presentes en la vida cotidiana y académica. La adaptación de la formación a la modalidad en línea y el contexto de pandemia, planteó interrogantes sobre el éxito de la tarea. El uso de dispositivos en línea para la formación de terapeutas grupales es un campo relativamente nuevo, que justifica la relevancia de este trabajo. Se utilizó Diario de Campo para recoger datos. Optamos por el marco teórico de Pichon-Rivière y autores del Psicoanálisis de las Configuraciones Vinculantes que discuten el tema de la virtualidad en la actualidad. Entendemos que la adaptación al modelo en línea permitió la continuidad de las actividades grupales programadas y la existencia de un espacio de formación, intercambio y apoyo entre pares. El Grupo de Reflexión Psicoanalítica fue fundamental en este contexto, favoreció el aprendizaje y el desarrollo de habilidades, brindó la oportunidad de construir y fortalecer lazos, estimuló una actitud crítica y creativa frente a los desafíos, límites y potencialidades de la adaptación al modelo en línea y acogió las experiencias de la formación derivadas del estado de pandemia.

Belas artes para estudantes de medicina: motivando debates transformadores / Fine arts for medical students: driving transformative debates

Introdução: Debater artes durante a graduação pode ser uma forma criativa de desenvolver novas percepções e perspectivas para estudantes de medicina. Promover atividades que visem criar momentos envolvendo temáticas humanísticas, simultaneamente ao conhecimento técnico médico, como artes e atividades físicas em um ambiente lúdico, continua sendo um desafio. Nesse contexto, foi criado um Programa Extracurricular de Aperfeiçoamento Global de Estudantes de Medicina (GIPMS) da Universidade de Fortaleza, que incluiu encontros envolvendo diversos estímulos artísticos. Objetivo: O objetivo deste trabalho é avaliar se o contato com a arte durante a graduação no contexto do GIPMS pode gerar percepções, sentimentos e reflexões para proporcionar importantes debates. Métodos: Foi realizado um estudo qualitativo prospectivo com um total de 42 sessões de grupo focal, que foram gravadas e transcritas na íntegra. Cada grupo foi conduzido por 2 mentores, e todos os 6 grupos focais utilizaram questionários qualitativos padronizados nas sessões, que foram realizadas a cada 45 dias. Foi realizada uma análise temática das transcrições, confirmada com o software QSR NVIVO (versão 11). Resultados: Um total de 40 alunos (15 homens e 25 mulheres) participaram deste estudo de um ano. As categorias encontradas foram: Os estímulos artísticos foram capazes de fazer os participantes pensarem (124 citações), sentirem (78, 65 sobre sentimentos positivos e 13 sobre sentimentos negativos) e lembrarem (41). Destacaram-se: a influência da carga horária de estudos no tempo dedicado às artes e às reflexões (61); relação entre arte e vida e produtividade acadêmica (75); mudanças de atitudes proporcionadas pelos estímulos artísticos propostos (38 citações). Conclusões: O programa foi capaz de gerar, de forma inovadora, novas percepções de sentimentos, sensações e reflexões, bem como evocar memórias que proporcionaram debates importantes, que, segundo os próprios alunos, serviram de inspiração para mudar perspectivas e atitudes e proporcionou benefícios subjetivos na vida acadêmica. [au]

Introduction: Debating arts during graduation can be a creative way to develop new perceptions and perspectives for medical students. To promote activities that aim to create moments involving humanistic themes, simultaneously to technical medical knowledge, such as arts and physical activities in a playful setting, remains a challenge. A extracurricular Global Improvement Programme of Medical Students (GIPMS) of the University of Fortaleza was created on this context, and included meetings involving various artistic stimuli. Purpose: The objective of this paper is to evaluate if the contact with art during graduation in the context of GIPMS can generate perceptions, feelings and reflections to provide important debates. Methods: A prospective qualitative study was conducted including a total of 42 focal group sessions, which were recorded and fully transcribed. Each group was conducted by 2 mentors, and all 6 focal groups used standardized qualitative questionnaires each session, which were performed every 45 days. A thematic analysis of the transcripts was performed, confirmed with the QSR NVIVO software (version 11). Results: A total of 40 students (15 men and 25 women) participated in this one-year study. The categories found were: Artistic stimuli were able to make participants think (124 quotes), feel (78, 65 about positive feelings and 13 about negative ones) and remember (41). The following stood out: the influence of the time load of studies in the time dedicated to the arts and the reflections. (61); relationship between the arts and life and academic productivity (75); changes in attitudes provided by the proposed artistic stimuli (38 citations). Conclusions: The program was able to generate, in an innovative way, new perceptions of feelings, sensations and reflections, as well as to evoke memories that provided important debates, which, according to the students themselves, served as inspiration to change perspectives and attitudes and provided subjective benefits in academic life. [au]

The use of deliberate reflection to reduce confirmation bias among orthopedic surgery residents / O uso da reflexão deliberada para reduzir o viés de confirmação em residentes de ortopedia

Introduction: cognitive biases might affect decision-making processes such as clinical reasoning and confirmation bias is among the most important ones. The use of strategies that stimulate deliberate reflection during the diagnostic process seems to reduce availability bias, but its effect in reducing confirmation bias needs to be evaluated. Aims: to examine whether deliberate reflection reduces confirmation bias and increases the diagnostic accuracy of orthopedic residents solving written clinical cases. Methods: experimental study comparing the diagnostic accuracy of orthopedic residents in the resolution of eight written clinical cases containing a referral diagnosis. Half of the written cases had a wrong referral diagnosis. One group of residents used deliberate reflection (RG), which stimulates comparison and contrast of clinical hypotheses in a systematic manner, and a control group (CG), was asked to provide differential diagnoses with no further instruction. The study included 55 third-year orthopedic residents, 27 allocated to the RG and 28 to the CG. Results: residents on the RG had higher diagnostic scores than the CG for clinical cases with a correct referral diagnosis (62.0±20.1 vs. 49.1±21.0 respectively; p = 0.021). For clinical cases with incorrect referral diagnosis, diagnostic accuracy was similar between residents on the RG and those on the CG (39.8±24.3 vs. 44.6±26.7 respectively; p = 0.662). We observed an overall confirmation bias in 26.3% of initial diagnoses (non-analytic phase) and 19.5% of final diagnoses (analytic phase) when solving clinical cases with incorrect referral diagnosis. Residents from RG showed a reduction in confirmation of incorrect referral diagnosis when comparing the initial diagnosis given in the non-analytic phase with the one provided as the final diagnosis (25.9±17.7 vs. 17.6±18.1, respectively; Cohen d: 0.46; p = 0.003). In the CG, the reduction in the confirmation of incorrect diagnosis was not statistically significant. Conclusions:confirmation bias was present when residents solved written clinical cases with incorrect referral diagnoses, and deliberate reflection reduced such bias. Despite the reduction in confirmation bias, diagnostic accuracy of residents from the RG was similar to those from the CG when solving the set of clinical cases with a wrong referral diagnosis.

Introdução: os vieses cognitivos podem afetar tanto os processos de tomada de decisão como o raciocínio clínico e o viés de confirmação está entre os mais importantes. O uso de estratégias que estimulem a reflexão deliberada durante o processo diagnóstico parece reduzir o viés de disponibilidade, mas seu efeito na redução do viés de confirmação precisa ser avaliado. Objetivos: examinar se a reflexão deliberada reduz o viés de confirmação e aumenta a acurácia do diagnóstico de residentes de ortopedia ao resolverem casos clínicos escritos. Métodos: estudo experimental comparando a acurácia diagnóstica de residentes de ortopedia na resolução de oito casos clínicos escritos contendo um diagnóstico de encaminhamento. Metade dos casos escritos tinha um diagnóstico de encaminhamento errado. Um grupo de residentes utilizou a reflexão deliberada (GR), que estimula a comparação e o contraste de hipóteses clínicas de maneira sistemática, e um grupo controle (GC) foi solicitado a fornecer diagnósticos diferenciais sem maiores instruções. O estudo incluiu 55 residentes de ortopedia do terceiro ano, 27 alocados no GR e 28 no GC. Resultados: residentes no GR tiveram escores diagnósticos mais altos do que o GC para casos clínicos com um diagnóstico de encaminhamento correto (62,0±20,1 vs. 49,1±21,0 respectivamente; p = 0,021). Para os casos clínicos com diagnóstico de encaminhamento incorreto, a acurácia diagnóstica foi semelhante entre os residentes do GR e os do GC (39,8±24,3 vs. 44,6±26,7 respectivamente; p = 0,662). Observamos viés geral de confirmação em 26,3% dos diagnósticos iniciais (fase não analítica) e 19,5% dos diagnósticos finais (fase analítica) na resolução de casos clínicos com diagnóstico de encaminhamento incorreto. Os residentes do GR mostraram uma redução na confirmação do diagnóstico de encaminhamento incorreto ao comparar o diagnóstico inicial dado na fase não analítica com aquele fornecido como diagnóstico final (25,9±17,7 vs. 17,6±18,1, respectivamente; Cohen d: 0,46; p = 0,003). No GC, a redução na confirmação do diagnóstico incorreto não foi estatisticamente significativa. Conclusões: o viés de confirmação esteve presente quando os residentes resolveram casos clínicos escritos com diagnósticos de encaminhamento incorretos e a reflexão deliberada reduziu esse viés. Apesar da redução do viés de confirmação, a acurácia diagnóstica dos residentes do GR foi semelhante à do GC na solução do conjunto de casos clínicos com diagnóstico de encaminhamento incorreto.

Evaluation of Lake Sediment Thickness from Water-Borne Electrical Resistivity Tomography Data.

Lakes are integrators of past climate and ecological change. This information is stored in the sediment record at the lake bottom, and to make it available for paleoclimate research, potential target sites with undisturbed and continuous sediment sequences need to be identified. Different geophysical methods are suitable to identify, explore, and characterize sediment layers prior to sediment core recovery. Due to the high resolution, reflection seismic methods have become standard for this purpose. However, seismic measurements cannot always provide a comprehensive image of lake-bottom sediments, e.g., due to lacking seismic contrasts between geological units or high attenuation of seismic waves. Here, we developed and tested a complementary method based on water-borne electrical-resistivity tomography (ERT) measurements. Our setup consisted of 13 floating electrodes (at 5 m spacing) used to collect ERT data with a dipole-dipole configuration. We used a 1D inversion to adjust a layered-earth model, which facilitates the implementation of constraints on water depth, water resistivity, and sediment resistivity as a priori information. The first two parameters were readily obtained from the echo-sounder and conductivity-probe measurements. The resistivity of sediment samples can also be determined in the laboratory. We applied this approach to process ERT data collected on a lake in southern Mexico. The direct comparison of ERT data with reflection seismic data collected with a sub-bottom profiler (SBP) showed that we can significantly improve the sediment-thickness estimates compared to unconstrained 2D inversions. Down to water depths of 20 m, our sediment thickness estimates were close to the sediment thickness derived from collocated SBP seismograms. Our approach represents an implementation of ERT measurements on lakes and complements the standard lake-bottom exploration by reflection seismic methods.

Fecal calprotectin as a predictor of COVID-19 severity

Coronavirus disease 2019 (COVID-19) is highly transmittable through contact with respiratory droplets. The virus is also shed in fecal matter. Some patients may present with effects in more than one system; however, there are no defined biomarkers that can accurately predict the course or progression of the disease. The present study aimed to estimate the severity of the disease, to correlate the severity of the disease with biochemical predictors, to identify valuable biomarkers indicative of gastrointestinal disease, and to determine the cutoff values. A cross-sectional study was conducted on COVID-19 patients admitted to the Kafrelsheikh University Hospital (isolation unit) between July 10, 2020, and October 30, 2020. The diagnosis of COVID- 19 was confirmed via reverse transcription-polymerase chain reaction (RT-PCR), which was employed for the detection of the viral RNA. We conclude that lymphopenia, elevated C-reactive protein (CRP) level, and liver enzymes were among the most important laboratory findings in COVID-19 patients. Statistically significant differences in platelet count, neutrophil count, D-dimer level, and fecal calprotectin levels were observed among patients presenting with chest symptoms only and patients with both chest and gastrointestinal symptoms (p=0.004;<0.001; 0.010; 0.003; and<0.001, respectively). C-reactive protein, D-dimer, and fecal calprotectin levels positively correlated with disease severity. The cutoff value for fecal calprotectin that can predict gastrointestinal involvement in COVID-19 was 165.0, with a sensitivity of 88.1% and a specificity of 76.5%. (AU)

Por um refinamento dos saberes disponíveis: Dimensões para a articulação das Filosofias de Treinadores / For a refinement of available knowledge: Dimensions for an articulation of Coaching Philosophies / Para un refinamiento de los saberes disponibles: Dimensiones para la articulación de las Filosofías de Entrenadores

Em certa medida, está suficientemente claro na literatura que a articulação das filosofias de treinadores é uma tarefa a priori, que antecede e sustenta a prática. Da mesma forma, também está posto que articular filosofias claras e definitivas seria um elemento imprescindível na prática de treinadores. Neste texto, a partir de um outro olhar do termo experiência, mais precisamente a partir do filósofo e pedagogo espanhol Jorge Larrosa, pretende-se não apenas questionar os dois pressupostos como ultrapassá-los de alguma forma, apresentando sete dimensões práticas: abertura, coerência, incompletude, paixão, pluralidade, realismo, subjetividade, a partir das quais se podem articular as filosofias de treinadores, por um outro olhar da experiência. Dessa forma, talvez seja possível tornar o processo de articulação de filosofias não apenas mais palpável, como também mais humano (AU).

To some extent, it is clear enough in the literature that the articulation of Coaching Philosophies is an a priori task, which precedes and sustains practice. Likewise, it is also clear that articulating clear and definitive philosophies would be an essential element in coaches' practice. In this text, from another perspective of the term experience, more precisely from the Spanish philosopher and pedagogue Jorge Larrosa, it is intended not only to question the two assumptions but to overcome them in some way, presenting seven practical dimensions - openness, coherence, incompleteness, passion, plurality, realism, subjectivity: from which Coaching Philosophies can be articulated, from another perspective of experience. In this way, it may be possible to make the process of articulating philosophies not only more palpable, but also more human (AU)

Hasta cierto punto, está bastante claro en la literatura que la articulación de las filosofías de los entrenadores es una tarea a priori, que precede y sostiene la práctica. Asimismo, también está claro que articular filosofías claras y definitivas sería un elemento esencial en la práctica de los entrenadores. En este texto, desde otra perspectiva del término experiencia, más precisamente del filósofo y pedagogo español Jorge Larrosa, se pretende no solo cuestionar los dos supuestos sino superarlos de alguna manera, presentando siete dimensiones prácticas: apertura, coherencia, incompletitud, pasión, pluralidad, realismo, subjetividad, desde donde se pueden articular las filosofías de los entrenadores, desde otra perspectiva de la experiencia. De esta forma, puede ser posible hacer que el proceso de articulación de filosofías no solo sea más palpable, sino también más humano (AU).

Uma formação pedagógico-reflexiva em psicologia: análise de diários de aprendizagem / A pedagogical-reflexive experience at a Psychology course: analysis of learning logs / Una formación pedagógica-reflexiva en Psicología: análisis de diarios de aprendizaje

O presente artigo buscou, através da análise de diários de aprendizagem, discutir a respeito das possibilidades que uma formação universitária em psicologia que seja acolhedora e promotora de reflexões pode ter na formação de estudantes de psicologia. Foram analisados treze diários redigidos por estudantes do sexto semestre de um curso de graduação em Psicologia matriculados em uma disciplina relacionada à Abordagem Centrada na Pessoa de um Centro Universitário do Centro-Oeste brasileiro. Os diários foram escritos tendo como base a concepção de Versão de Sentido, com uma escrita livre após as aulas. Foi utilizada a Análise Temática e, a partir dela emergiram seis temas que demonstraram a importância da construção de um espaço acadêmico dialógico que promova as condições facilitadoras para o desenvolvimento pessoal e profissional.

The present article aimed, through the analysis of learning diaries, to discuss about the possibilities that a psychology university degree which promotes reflection and shelters students' thoughts and emotions can have in the training of psychology students. Were analyzed thirteen learning logs written by students of the sixth semester of an undergraduate degree course in Psychology enrolled in a discipline related to the Person Centered Approach.The logs were written based on the Sense's Version, after each class, with indication of free writing. Thematic Analysis was used, and from it six themes emerged that demonstrated the importance of building an academic context that promotes the facilitating conditions for personal and professional development.

El presente artículo buscó, a través del análisis de diarios de aprendizaje, discutir acerca de las posibilidades que una formación universitaria en psicología que sea acogedora y promotora de reflexiones puede tener en la formación de estudiantes de psicología. Se analizaron trece diarios redactados por estudiantes del sexto semestre de un curso de graduación en Psicología matriculados en una disciplina relacionada al Enfoque Centrado en la Persona. Los diarios fueron escritos teniendo como base la concepción de Versión de Sentido, con una escritura libre después de las clases. Se utilizó el Análisis Temático y, a partir de ella surgieron seis temas que demostraron la importancia de la construcción de un espacio académico dialógico que promueve las condiciones facilitadoras para el desarrollo personal y profesional.

Asociación entre gastritis biliar y gastritis por Helicobacter pylori en pacientes con reflujo duodenogástrico en el Hospital Central Militar / Association between biliary gastritis and gastritis by Helicobacter pylori in patients with duodenogastric reflection in the Military Central Hospital

Resumen Introducción: Esta investigación está orientada a conocer si existe una asociación (directa o indirecta) entre el reflujo duodenogástrico y las gastritis crónicas por Helicobacter pylori. Material y Metodo: Se recolectaron los datos de pacientes a quienes se les realizó panendoscopía diagnóstica en el departamento de endoscopia del Hospital Central Militar desde marzo del 2018 a febrero del 2019, por medio de una entrevista clínica y una hoja de recolección de datos. Resultados: Del grupo evaluado con reflujo duodenogástrico, el 44.1% (202 casos) presentaron gastritis química por reporte histopatológico. En el grupo de pacientes con reflujo duodenogástrico y gastritis química o biliar (n=202), el 22.7% (46 casos) presentó en el reporte histopatológico gastritis por Helicobacter pylori. En los pacientes con reflujo duodenogástrico y sin gastritis biliar (n=256), el 92.57% (237 casos) presentó gastritis por Helicobacter pylori en el reporte histopatológico. Discusión: Existe una asociación alta de tipo indirecto entre la gastritis biliar y gastritis por Helicobacter pylori en pacientes con reflujo duodenogástrico o biliar. Aproximadamente la mitad de los pacientes con reflujo duodenogástrico presentan gastritis biliar con el riesgo de desarrollar metaplasia intestinal. La gastropatía mixta (gastritis biliar y por Helicobacter pylori) es un factor de riesgo para mayor daño a la mucosa gástrica, como es la expresión de metaplasia intestinal.

Abstract Introduction: This research is oriented to know if there is an association (direct or indirect) between duodenogastric reflux and chronic gastritis by Helicobacter pylori. Material and Method: We collected data from patients who underwent diagnostic panendoscopy in the endoscopy department of the Central Military Hospital from March 2018 to February 2019, through a clinical interview and a data collection sheet. Results: Of the group evaluated with duodenogastric reflux, 44.1% (202 cases) presented chemical gastritis due to histopathological report. In the group of patients with duodenogastric reflux and chemical or biliary gastritis (n = 202), 22.7% (46 cases) presented gastritis due to Helicobacter pylori in the histopathological report. In patients with duodenogastric reflux and without biliary gastritis (n = 256), 92.57% (237 cases) presented gastritis due to Helicobacter pylori in the histopathological report. Discussion: There is a high association of indirect type between biliary gastritis and gastritis due to Helicobacter pylori in patients with duodenogastric or biliary reflux. Approximately half of the patients with duodenogastric reflux present biliary gastritis with the risk of developing intestinal metaplasia. Mixed gastropathy (biliary gastritis and Helicobacter pylori) is a risk factor for greater damage to the gastric mucosa, such as the expression of intestinal metaplasia.