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BACKGROUND: Simple radiography in conjunction with pertinent medical history and a comprehensive physical examination is typically adequate for diagnosing chronic osteomyelitis (CO). However, radiographic manifestations of CO lack specificity; therefore, the concordance among specialists in this regard has not been systematically assessed. This study aimed to compare and evaluate the proficiency of orthopedic surgeons and radiologists in identifying radiographic indicators present in simple radiographs for diagnosing CO. METHODS: This cross-sectional study was a correlational investigation utilizing plain radiographs obtained from a cohort of 60 patients diagnosed with CO. Comprehensive assessments of the demographic and clinical characteristics, comorbidities, and microbiological parameters were conducted. Additional variables included the anatomical location of the CO, existence of fistulas, disease duration, and presence of pseudoarthrosis. This study meticulously documented the presence or absence of six specific findings: bone destruction, which incorporates erosion and radiolucencies around implants; bone sclerosis; cortical thinning concomitant with erosion; cortical thickening; sequestrum formation; and soft-tissue swelling. RESULTS: Most patients were men (75%), with a mean age of 45.1 years. Hematogenous etiology of CO represented 23%. Bone sclerosis (71.3%) and cortical thickening (67.7%) were the most common radiographic findings, followed by soft-tissue swelling (51.3%), sequestration (47.3%), bone destruction (33.3%), and cortical erosion (30.3%). The mean agreement was 74.2%, showing a marked disagreement rate of 25.8% among all radiographic findings. The presence or absence of soft tissue edema, a prominent radiographic finding that was more important than the other findings, showed the greatest disagreement. CONCLUSIONS: Radiographic findings in CO were universally observed in all patients, demonstrating a high degree of concordance among specialists, with the exception of soft tissue swelling.

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INTRODUCTION: Pseudomonas aeruginosa respiratory infections are challenging, and the risk of recurrence is a frequent problem. The aim of this study was to investigate the risk factors associated with the presence of P. aeruginosa, and the risk factors related to the recurrence and death of lower airway infections in inpatients in a Brazilian hospital. METHODS: Retrospective cohort with inpatients that had a sample of airways culture (tracheal aspirate or bronchoalveolar lavage) with the detection of P. aeruginosa. The patients with clinical criteria of infection were classified as ventilator-associated, hospital-acquired, or community-acquired pneumonia. P. aeruginosa in respiratory samples without symptoms was considered colonization. The antimicrobial treatment adequacy and the clinical data were evaluated. Outcome variables included mortality and recurrence. RESULTS: One hundred and fifty-four patients were included in the study, most of them were men, and the majority (102) were considered infected. The average length of stay was superior to 30 days. Previous pulmonary disease was associated with the occurrence of colonization. Aminoglycosides were the most active drug according to susceptibility tests and were successfully used as monotherapy. Septic shock was a risk factor for death in the infected patients. The use of adequate antimicrobial therapy was associated with major survival, independent of the infection classification. CONCLUSION: It is possible to evaluate clinical data associated with recurrence and mortality in patients with different lung infections by P. aeruginosa. Aminoglycoside monotherapy is safe and effective in P. aeruginosa respiratory infections.

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PURPOSE OF THE STUDY: The performance of a clinical procedural skill by an individual student is associated with their use of Self-Regulated Learning (SRL) processes. However, previous research has not identified if an individual student has a similarity in their use of SRL processes across different clinical procedural skill tasks and at a time interval. The aim of this pilot study was to explore the similarity in the use of SRL processes by individual students across different clinical procedural skill tasks and at a time interval. METHODS: SRL-microanalysis was used to collect within-subject data on undergraduate physiotherapy students' use of the two key SRL processes (planning and monitoring) during their performance of different goniometry clinical procedural skills tasks and also at a fourth month interval. RESULTS: An individual student's use of key SRL processes across different clinical procedural skill tasks and at a time interval was similar. Also, this similarity was identified for students with initial successful and unsuccessful performances. CONCLUSION: Our findings have implications for the future wider practical implementation of SRL microanalysis to inform personalised SRL feedback for developing the clinical procedural skills of individual students. Further research with a greater number of students and across a wider range of clinical procedural skills will be required to confirm our findings, and also its effectiveness on feedback and future performance.

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The objective of this work was to evaluate the use of an ultrafine bubble generator of own manufacture for oxygenation of Nile tilapia (Oreochromis niloticus) breeding tanks in a recirculating water system. The research was divided into two steps: 1) oxygen saturation test; 2) application of ultrafine bubble production technology for the breeding of Nile tilapia. In the first step, the water of a 2.0 m3 test tank was completely deoxygenated and the ultrafine bubble generator was turned on for 60 min. In the second step, the generator was connected to the water recirculating system for breeding of Nile tilapia to compare the overall performance of this system with other under conventional aeration system. The ultrafine bubble generator could reach 100% oxygen saturation in the test tank (27.8 °C) in approximately 21 min and, at the end of 60 min, the concentration was 21.8 mg L-1 (277.52% saturation). The results showed significant difference (p<0.05) between the mean dissolved oxygen concentration in the treatment with ultrafine bubbles (9.80 ±3.68 mg L-1) and the treatment with conventional aeration (3.47 ± 0.88 mg L-1). No significant difference (p>0.05) was found for the zootechnical performance parameters evaluated. The conclusion was that the ultrafine bubble generator is more efficient to maintain a high dissolved oxygen concentration in the recirculating water in Nile tilapia breeding tanks than the conventional aeration system

O objetivo da presente pesquisa foi avaliar a utilização do gerador de bolhas ultrafinas (fabricação própria) para oxigenação de tanques de criação de tilápia do Nilo em sistema de recirculação de água. A pesquisa foi dividida em duas etapas: 1) teste de saturação de oxigênio; 2) aplicação da tecnologia de produção de bolhas ultrafinas na criação da tilápia do Nilo. Na primeira, a água de um tanque teste (2,0 m³) foi completamente desoxigenada e o gerador de bolhas ultrafinas acionado por um período de 60 min. Na segunda, o gerador foi ligado a um sistema de recirculação para criação de tilápia para comparar o desempenho geral desse sistema ao de outro no qual utilizou-se aeração convencional. O gerador de bolhas ultrafinas foi capaz de atingir 100% de saturação de oxigênio no tanque teste (27,8 °C) em aproximadamente 21 min e, ao final de 60 min, a concentração foi 21,8 mg/L (saturação 277,52%). Foi observada diferença significativa (p<0,05) entre a concentração média de oxigênio dissolvido no tratamento com bolhas ultrafinas (9,80 ± 3,68 mg/L) e o tratamento com aeração convencional (3,47 ± 0,88 mg/L). Não foi observada diferença significativa (p>0,05) para nenhum dos parâmetros de desempenho zootécnico avaliados. Pode-se concluir que o gerador de bolhas ultrafinas é mais eficiente em manter alta a concentração de oxigênio dissolvido em tanques de criação de tilápia em sistema de recirculação de água quando comparado ao sistema convencional de aeração

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Introducción: La obesidad y la COVID-19 son pandemias de alcance global constituyen un importante problema de salud en la actualidad y elevan las tasas de mortalidad, afectan a todos los grupos poblacionales, sobre todo a los más vulnerables y demuestran que no existe sistema de salud lo suficientemente bien preparado, que pueda contrarrestar los efectos de la coexistencia de ambas. Objetivo: explorar sobre las relaciones entre la obesidad y la morbilidad-mortalidad en pacientes con COVID-19. Material y Métodos: Se revisaron un total de 47 fuentes en las bases de datos PubMed, Lilacs, SciELO y Cumed, de las cuales se utilizaron 28 citas en idioma inglés y español. Se utilizaron los términos de búsqueda "obesidad y COVID-19", "Mortalidad", "Morbilidad y COVID-19", "obesidad y SARS-CoV-2". Desarrollo: La evidencia científica actual muestra que los eventos relacionados con la enfermedad COVID-19 son peores en las personas con obesidad y que esta afecta la mayoría de los procesos fisiológicos y funciones de los sistemas, conllevando a un agravamiento de los pacientes con coronavirus SARS-Cov-2. Conclusiones: La obesidad es un factor de riesgo de mortalidad en los pacientes con COVID-19. Las comorbilidades asociadas, insulino resistencia, hipercoagulabilidad y estado protrombótico, limitaciones de las funciones respiratorias y el déficit de vitamina D, entre otros constituyen factores que conllevan a una peor evolución y mortalidad.

Introduction: Obesity and COVID-19 are global pandemics that constitute a major health problem at present, raising mortality rates and affecting all population groups, especially the most vulnerable, demonstrating that there is no sufficiently well prepared health system that can counteract the effects of their coexistence. Objective: To investigate the relationship between obesity and morbidity and mortality in patients with COVID-19. Material and Methods: A total of 47 sources were reviewed in the PubMed, Lilacs, SciELO and Cumed databases, of which 28 citations in english and spanish versions were used. The search terms "obesity and COVID-19", "Mortality", "Morbidity and COVID-19", "obesity and SARS-CoV-2" were also used. Development: Current scientific evidence shows that the events related to the COVID-19 disease are worse in people with obesity and that it affects most physiological processes and system functions, leading to a worsening of patients with SARS-CoV-2 coronavirus. Conclusions: Obesity is a risk factor for mortality in patients with COVID-19. Associated comorbidities, insulin resistance, hypercoagulability and prothrombotic state, limitations of respiratory functions and vitamin D deficiency, among others, are factors that lead to worse evolution and mortality.

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This experiment evaluated the interactive effects among xylanase (XL; 0, 8,000, 16,000, and 32,000 BXU/kg), amino acid density (AA; high and low 10% difference), and additional fat (AF; 0 or +1.17%) applied postpellet in corn-soybean meal diets with dried distillers grains with solubles on performance, energy utilization, digestibility, and carcass traits in Ross 708 male broilers. A completely randomized block (pen location) design with 16 treatments arranged factorially (4 XL levels, 2 AA, and 2 AF) was analyzed using mixed models. No significant interactions or main effects were observed for feed intake at 49 d (P > 0.05) but chicks were heavier when consuming diets containing 0 or 8,000 BXU/kg (P = 0.015), high AA (P < 0.001), and 1.17% AF (P < 0.001). Feed efficiency did not vary with XL supplementation (P > 0.05) but was improved in broilers fed the higher AA and AF diet (P = 0.015 for AA × AF). AME, GE, and CP digestibility were assessed at days 17 and 42. There were multiple interactions observed at day 17 with a significant three-way showing that AME and CP digestibility improved when increasing the XL and AF levels in the high AA fed birds compared with the low-density diets. At day 42, XL and AF significantly affected AMEn, GE, or CP digestibility; however, there was a significant interaction between XL and AF. Diets supplemented with 1.17% AF improved AMEn significantly in broilers fed the highest XL level. Breast yield was not affected by treatments, but wing yield decreased with high AA density when diets contained 16,000 BXU/kg without differences for the other diets (P = 0.04 for XL × AA). Effects of XL, AA, and AF interactions on performance and cut-up-part yields have to be considered until day 42 for most of the variables studied. However, at 49 d of age, the dietary AA density and AF did not markedly influence the response to XL in maize-based diets.

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Learning metabolic pathways is vital for understanding biochemical processes and all of their implications for life. Their learning in the virtual environment is complex and generative learning strategies, such as the construction of online conceptual maps, can help in this process. This article presents a proposal for the collaborative construction of virtual concept maps on metabolism by students in the CMap Cloud browser application (free). A sequence of steps is suggested, which include online group brainstorming and discussions, peer assessment, and teachers feedback. This proposal is flexible and can be adapted to the didactic and technological reality of each teacher.

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Virtual laboratory simulations can contribute to the educational objectives related to practical classes, especially in situations of online or hybrid teaching. We present a proposal for laboratory activity involving the quantification of proteins with the biuret reaction and measurement by visible light spectrometry. The student will be able to develop the procedures and obtain the absorbance values for calculations and discussions using the ProtVirt software, integrating its use with the teacher's pedagogical proposal.

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Imbalance in nutrients can affect digestibility of amino acids by altering gene expression of amino acid transporters. We investigated digestibility and molecular transporters of essential amino acids in chickens fed a methionine-deficient diet. A total of 40 chicks (23 D old) were randomly assigned to either a control (0.49% methionine) or a deficient (0.28%) diet until 41 D when they were sampled for Pectoralis (P.) major, kidney, ileum, and hypothalamus for mRNA expression analysis. The ileal content was collected for apparent ileal digestibility (AID) analysis. Birds fed the deficient diet had reduced growth and worse feed efficiency compared to control. The AID of methionine was similar between both groups. The AID of other essential amino acids was higher in the deficient group than control. mRNA expression of b0,+ AT and LAT4 were upregulated in the ileum and kidney but LAT1 was downregulated only in kidney of the deficient group compared to control. In the P. major, SNAT1, SNAT2, and CAT1 were upregulated in the deficient group compared to control. A diet deficiency in methionine affects digestibility of essential amino acids and cysteine, but not the digestibility of methionine. The change in digestibility is reflected in the mRNA expression of amino acid transporters across different tissues.

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BACKGROUND: One of the factors known to influence performance in the learning process is student motivation. In turn, students' motivation can be regulated by a large number of variables relating to the individual (such as sex, age and socioeconomic status) or to aspects of the academic life. OBJECTIVE: The primary aim of this study was to evaluate the influence of curriculum changes involving reduction in content overload and increased early exposure to clinical settings, on motivation towards learning among Year 1 medical students. Secondarily, the aim was to ascertain whether this influence on motivation remained stable until the undergraduate program ended (Year 6). DESIGN AND SETTING: Prospective study on two student cohorts at a Brazilian state-owned university. METHODS: Two consecutive student cohorts were assessed: one with a traditional curriculum (n = 87) and the other with a reformed curriculum (n = 63), at the same medical school. Participants in both cohorts gave responses on four scales in Years 1 and 6: the Academic Motivation Scale, containing subscales for autonomous and controlled motivation, and lack of motivation towards learning; Beck's Anxiety and Depression Inventories; Spielberger's State-Trait Anxiety Inventory; and the Social Adjustment Scale. In Year 6, 68% of the initial sample (66 students with the traditional curriculum and 36 with the reformed curriculum) was reassessed. RESULTS: No differences between Year 1 cohorts were found regarding demographic and social background, social adjustment, depression or anxiety. Students with the reformed curriculum scored significantly higher regarding autonomous and controlled motivation than those with the traditional curriculum. Comparison between Year 6 and Year 1 showed increases in controlled motivation only for the traditional curriculum cohort. CONCLUSION: Curriculum changes were associated with increased motivation towards learning in Year 1, which persisted until Year 6.

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OBJECTIVES: This study investigated the associations between self-assessed empathy levels by physicians in training and empathy levels as perceived by their patients after clinical encounters. The authors also examined whether patient assessments were valid and reliable tools to measure empathy in physicians in training. DESIGN: A multicentric, observational, cross-sectional study. SETTING: This study was conducted in three public teaching hospitals in Brazil. PARTICIPANTS: From the 668 patients invited to participate in this research, 566 (84.7%) agreed. Of these, 238 (42%) were male and 328 (58%) were female. From the invited 112 physicians in training, 86 (76.8%) agreed. Of the 86 physicians in training, 35 (41%) were final-year medical students and 51 (59%) were residents from clinical and surgical specialties. The gender distribution was 39 (45%) males and 47 (51%) females. PRIMARY AND SECONDARY OUTCOME MEASURES: Physicians in training filled the Jefferson Scale of Physician Empathy (JSE) and the Interpersonal Reactivity Index. Patients answered the Jefferson Scale of Patient's Perceptions of Physician Empathy (JSPPPE) and the Consultation and Relational Empathy Scale (CARE). RESULTS: This study found non-significant correlations between patient and physicians-in-training self-assessments, except for a weak correlation (0.241, p<0.01) between the JSPPPE score and the JSE compassionate care subscore. CARE and JSPPPE scales proved to be valid and reliable instruments. CONCLUSIONS: Physicians-in-training self-assessments of empathy differ from patient assessments. Knowledge about empathy derived from self-assessment studies probably does not capture the perspective of the patients, who are key stakeholders in patient-centred care. Future research on the development of physician empathy or on outcomes of educational interventions to foster empathy should include patient perspectives.

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ABSTRACT BACKGROUND: One of the factors known to influence performance in the learning process is student motivation. In turn, students' motivation can be regulated by a large number of variables relating to the individual (such as sex, age and socioeconomic status) or to aspects of the academic life. OBJECTIVE: The primary aim of this study was to evaluate the influence of curriculum changes involving reduction in content overload and increased early exposure to clinical settings, on motivation towards learning among Year 1 medical students. Secondarily, the aim was to ascertain whether this influence on motivation remained stable until the undergraduate program ended (Year 6). DESIGN AND SETTING: Prospective study on two student cohorts at a Brazilian state-owned university. METHODS: Two consecutive student cohorts were assessed: one with a traditional curriculum (n = 87) and the other with a reformed curriculum (n = 63), at the same medical school. Participants in both cohorts gave responses on four scales in Years 1 and 6: the Academic Motivation Scale, containing subscales for autonomous and controlled motivation, and lack of motivation towards learning; Beck's Anxiety and Depression Inventories; Spielberger's State-Trait Anxiety Inventory; and the Social Adjustment Scale. In Year 6, 68% of the initial sample (66 students with the traditional curriculum and 36 with the reformed curriculum) was reassessed. RESULTS: No differences between Year 1 cohorts were found regarding demographic and social background, social adjustment, depression or anxiety. Students with the reformed curriculum scored significantly higher regarding autonomous and controlled motivation than those with the traditional curriculum. Comparison between Year 6 and Year 1 showed increases in controlled motivation only for the traditional curriculum cohort. CONCLUSION: Curriculum changes were associated with increased motivation towards learning in Year 1, which persisted until Year 6.

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PURPOSE: Understanding medical student empathy is important to future patient care; however, the definition and development of clinical empathy remain unclear. The authors sought to examine the underlying constructs of two of the most widely used self-report instruments-Davis's Interpersonal Reactivity Index (IRI) and the Jefferson Scale of Empathy version for medical students (JSE-S)-plus, the distinctions and associations between these instruments. METHOD: Between 2007 and 2014, the authors administered the IRI and JSE-S in three separate studies in five countries, (Brazil, Ireland, New Zealand, Portugal, and the United Kingdom). They collected data from 3,069 undergraduate medical students and performed exploratory factor analyses, correlation analyses, and multiple linear regression analyses. RESULTS: Exploratory factor analysis yielded identical results in each country, confirming the subscale structures of each instrument. Results of correlation analyses indicated significant but weak correlations (r = 0.313) between the total IRI and JSE-S scores. All intercorrelations of IRI and JSE-S subscale scores were statistically significant but weak (range r = -0.040 to 0.306). Multiple linear regression models revealed that the IRI subscales were weak predictors of all JSE-S subscale and total scores. The IRI subscales explained between 9.0% and 15.3% of variance for JSE-S subscales and 19.5% for JSE-S total score. CONCLUSIONS: The IRI and JSE-S are only weakly related, suggesting that they may measure different constructs. To better understand this distinction, more studies using both instruments and involving students at different stages in their medical education, as well as more longitudinal and qualitative studies, are needed.

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El paraganglioma es un tumor neuroendocrino poco frecuente que puede desarrollarse en diversos sitios del organismo. Alrededor del 97 por ciento son benignos y se curan mediante la extirpación quirúrgica, y el restante 3 por ciento son malignos, y provocar metástasis a distancia. Alrededor del 75 por ciento son esporádicos y el restante 25 por ciento son hereditarios (y tienen una mayor probabilidad de ser múltiples y de desarrollo a una edad temprana). Pueden tener predisposición genética asociada a síndromes tumorales familiares, como la neoplasia endocrina múltiple tipo 2, el síndrome de Von Hippel-Lindau y la neurofibromatosis tipo 1, o mutaciones específicas relacionadas solamente con el desarrollo de paragangliomas. Comparado con la forma de aparición esporádica, la presentación familiar tiene tendencia a aparecer en edades más jóvenes, y a tener múltiple localización. Por la poca disponibilidad de recursos y lo costoso de las investigaciones utilizadas, son de difícil diagnóstico en nuestro medio, por lo cual no se excluye que exista un subregistro en el número de casos que se puedan presentar, razón por la que es importante siempre -ante la sospecha clínica- pensar en su probable confirmación diagnóstica y situación. Los estudios de imágenes y la medición de la producción no fisiológica de catecolaminas, pueden ayudar en el diagnóstico de esta entidad. Las principales modalidades de tratamiento son: la cirugía, la embolización y la radioterapia. Con el objetivo de actualizar y sugerir una guía de tratamiento se realizó la presente revisión(AU)

Paraganglioma is a rare neuroendocrine tumor that may occur in several parts of the body. Roughly 97 percent of these tumors are benign and can be excised through surgery whereas 3 percent of them are malignant and cause distant metastasis. Almost 75 percent are sporadic and the remaining 25 percent are hereditary (more likely to be multiple and developed at early ages). They may be genetically predisposed and associated to family tumor syndromes such as type 2 multiple endocrine neoplasia, Von Hippel-Lindau syndrome and type 1 neurofibromatosis or specific mutations related to development of paragangliomas. When compared to the sporadic occurrence, the family presentation tends to appear at younger ages, with multiple locations. Owing to the low resource availability and the high cost of research, these tumors are difficult to be diagnosed in our conditions, so there may be failures in registering the real number of cases; this is the reason why it is always important to think on possible diagnostic confirmation when clinical suspicion of paraganglioma arises. Imaging studies and measurement of the non-physiological production of catecholamines may help in the diagnosis of this disease. The main therapeutical modalities are surgery, embolization and radiotherapy. The present review was intended to update this topic and to submit a treatment guideline(AU)

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The aim of this study was to assess the psychometric properties (validity and reliability) of the Portuguese adaptation of the NEO Five-Factor Inventory (NEO-FFI) and to compare the obtained structure to the original North American version. The methods of analysis used for cross-validation of the factorial structure were the Principal Axis Factoring (PAF) and the Confirmatory Factor Analysis (CFA). PAF reproduced the original structure of NEO-FFI and CFA revealed a satisfactory fit of single-factor models for the five dimensions. The reliability analysis showed high values of internal consistency which are congruent with previous international adaptations of the NEO-FFI. Multidimensional analysis showed significant main effects of gender and academic qualifications on personality using age as covariant. The findings suggest that the Portuguese version of the NEO-FFI is a reliable instrument to measure the five dimensions of personality. (AU)

O objetivo deste estudo foi avaliar as propriedades psicométricas (validade e fidelidade) da adaptação portuguesa do NEO-FFI e comparar a estrutura obtida com a versão original americana. Como métodos para a validação cruzada da estrutura fatorial foram usados a Análise Fatorial de Eixos Principais (PAF) e uma Análise Fatorial Confirmatória (CFA). A PAF reproduziu a estrutura original do NEO-FFI e a CFA revelou modelos uni-factoriais de ajustamento satisfatório para cada uma das cinco dimensões. A análise de fidelidade revelou elevados valores de consistência interna, congruentes com as adaptações prévias internacionais do NEO-FFI. A análise multidimensional revelou efeitos principais significativos do género e das qualificações académicas na personalidade, usando a idade como co-variante. Os resultados sugerem que a versão portuguesa do NEO-FFI é um instrumento fiável para medir as cinco dimensões da personalidade. (AU)

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O trabalho em pequenos grupos está presente em muitas agendas para a reforma da educação e tem vindo a transformar-se numa espécie de mito. De facto, é generalizada a crença na eficácia e na infalibilidade de organizar os alunos em grupos para atingir objetivos específicos ou para desenvolver certos tipos de atividades. Essa crença carece de sustentação empírica tendo mesmo sido batizada como “o romance das equipes”. É necessário e urgente entender o que caracteriza um grupo eficaz e quais as circunstâncias necessárias para garantir tal eficácia, de forma a evitar erros comuns em muitas reformas académicas. Por exemplo, é inadequado adotar de raíz o trabalho em pequenos grupos numa disciplina,usando os materiais, a organização das atividades letivas e a avaliação desenhada para um modelo tradicional da disciplina. A adoção de trabalho em pequenos grupos deve respeitar um conjunto de princípios essenciais e garantir as condições apropriadas para o transformação dos grupos em equipas eficazes. Este artigo apresenta uma revisão crítica e avaliação do uso de pequenos grupos na educação, identifica os fatores-chave no trabalho em grupo pequenos e discute o papel da aprendizagem em pequenos grupos no ensino superior. Para o efeito, percorre alguma da evidência decorrente de pesquisa sobre a eficácia do trabalho em pequenos grupos.

Working in small groups is present in many agendas for education reform and has become a kind of myth. Indeed, there is a generalized belief in the efficacy and infallibility of organizing students into groups to achieve specific goals or to develop certain types of activities. Such belief lacks empirical support and has even been dubbed as “the romance of teams.” It is necessary and urgent to understand what characterizes an effective group and what the necessary conditions to ensure such effectiveness to avoid common mistakes in many academic reforms. For example, it is inappropriate to base a whole course on small group work, if the materials, the organization of activities and assessment program have been drawn fora traditional model of the discipline. The adoption of small group work requires that a set of core principles are met and also appropriate conditions for the development of groups into effective teams. This article presents a critical review and evaluation of the use of small groups in education, identifies the key factors in small group work and discusses the role of learning in small groups in higher education. To this end, the article builds on some of the evidence arising from research on the effectiveness of small group work.

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The Guayana Shield is one of the oldest territories in the planet and has millions of years subjected to leaching and erosion processes that produce oligotrophic soils. This scarcity of nutrients has not avoided the development of high, diverse and magnificent forests, where plants have adaptations to survive these difficult conditions. The aim of this work was to characterize the physical and chemical parameters of the soils in different forest communities of the Imataca Forest Reserve (IFR), to establish some interpretations on their origin, and some relationships between the edaphic components and the inhabitant species. Terrestrial journeys were carried out and two pathways were traced for the interpretation of forest communities. In each community, three plots (100m x 100m) for the ecological survey were established. In each plot, all trees, palms, and lianas were measured (dbh> or =10cm; dbh: diameter at breast height); four 10m x 10m understory sub-plots were evaluated, and a census of all the spermatophyta species (dbh< 10cm) was made. Soils were evaluated by means of a trial pit in each community, and a bore in each one understory sub-plot. The obtained data were analyzed by both a detrended and a canonical correspondence analysis. Results from a total of 15 plots allowed us to identify three communities: a forest dominated by Mora excelsa located in a narrow valley with high content of silt; a swamp forest dominated by Catostemma commune in a sandy broad valley, and a forest in clay hills dominated by Alexa imperatricis. Most of the soils had a pH between 3.1 and 4.5. Nutrients were in very low concentrations (N: 0-0.2%; P: 0-14ppm; K: 0-0.3 Cmol/kg) and A1 in toxicity quantities. We observed that Ca/A1 relationship greater than 1 meant a neutralization of the toxic effect of Al. Besides, basal area ranged from 20.4 to 32.3m2/ha; the highest level (top local forest development) corresponded with the C. commune community with a Ca/A1 value of 2.5. This research found an adequate relationship between soil and vegetation, as it was able to identify three communities into three distinct soil conditions. Nevertheless, edaphic constraints indicated that high forest cover must be maintained as an essential element for the conservation of these communities.

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The Guayana Shield is one of the oldest territories in the planet and has millions of years subjected to leaching and erosion processes that produce oligotrophic soils. This scarcity of nutrients has not avoided the development of high, diverse and magnificent forests, where plants have adaptations to survive these difficult conditions. The aim of this work was to characterize the physical and chemical parameters of the soils in different forest communities of the Imataca Forest Reserve (IFR), to establish some interpretations on their origin, and some relationships between the edaphic components and the inhabitant species. Terrestrial journeys were carried out and two path-ways were traced for the interpretation of forest communities. In each community, three plots (100m x 100m) for the ecological survey were established. In each plot, all trees, palms, and lianas were measured (dbh≥10cm; dbh: diameter at breast height); four 10m x 10m understory sub-plots were evaluated, and a census of all the spermatophyta species (dbh<10cm) was made. Soils were evaluated by means of a trial pit in each community, and a bore in each one understory sub-plot. The obtained data were analyzed by both a detrended and a canonical correspondence analysis. Results from a total of 15 plots allowed us to identify three communities: a forest dominated by Mora excelsa located in a narrow valley with high content of silt; a swamp forest dominated by Catostemma commune in a sandy broad valley, and a forest in clay hills dominated by Alexa imperatricis. Most of the soils had a pH between 3.1 and 4.5. Nutrients were in very low concentrations (N: 0-0.2%; P: 0-14ppm; K: 0-0.3Cmol/kg) and Al in toxicity quantities. We observed that Ca/Al relationship greater than 1 meant a neutralization of the toxic effect of Al. Besides, basal area ranged from 20.4 to 32.3m²/ha; the highest level (top local forest development) corresponded with the C. commune community with a Ca/Al value of 2.5. This research found an adequate relationship between soil and vegetation, as it was able to identify three communities into three distinct soil conditions. Nevertheless, edaphic constraints indicated that high forest cover must be maintained as an essential element for the conservation of these communities.

El Escudo Guayanés es uno de los territorios más antiguos del planeta; tiene millones de años sometido a procesos de lixiviación y erosión que dejan suelos oligotróficos. El objetivo de este trabajo fue hacer la caracterización de los parámetros físicos y químicos de los suelos, en diferentes comunidades boscosas de la Reserva Forestal Imataca, e identificar ciertas relaciones entre los componentes edáficos y las especies que allí se presentan. Se realizó un inventario de todos los individuos mayores a 10cm dap (diámetro a la altura del pecho) en 15 parcelas (1ha); en cada una de esas parcelas se evaluaron cuatro sub-parcelas de sotobosque (100m²) para contabilizar todas las espermatofitas; los suelos se evaluaron mediante una calicata por comunidad y un barreno en cada sub-parcela de sotobosque. La mayoría de los suelos tienen un pH muy ácido (3.1-4.5), los nutrientes están en concentraciones muy bajas (N: 0-0.2%; P: 0-14ppm; K: 0-0.3Cmol/kg) y el Al en concentraciones tóxicas. Esto coincide con otros estudios realizados en esta región, pero en este trabajo se encontró que la relación Ca/Al con valores superiores a 1, lo que implica una neutralización del efecto tóxico del Al y permite un mejor desarrollo de las comunidades boscosas.

Assuntos

RESUMO

La interrelación existente entre obesidad y diabetes mellitus tipo 2 tiene gran importancia clínico-epidemiológica. Con el objetivo de evaluar en pacientes diabéticos tipo 2 la asociación entre el nivel de riesgo vascular de las variables antropométricas, índice de masa corporal y circunferencia abdominal con relación a la presencia de complicaciones crónicas vasculares en éstos. Se estudiaron 120 pacientes, de 40 a 79 años, que asistieron a la consulta de diabetes mellitus del "Hospital "Hermanos Ameijeiras", de octubre de 2009 a septiembre del año 2010. Se evaluaron antecedentes, complementarios, y se realizó examen clínico general. Se determinaron índice de masa corporal y circunferencia abdominal, insulinemia y péptido C. Se consideró alto riesgo la obesidad (IMC= de 30 kg/m² sc) y CA aumentada (CAA Hombres>102 cm y Mujeres>88) y se relacionaron con las complicaciones vasculares y los niveles de péptido C e insulinemia en ayunas. Los resultados se analizaron estadísticamente con significación de p<0.05. Prevalecieron la obesidad (48,3 %) y la CAA (67,5 %). Tanto en los obesos como en pacientes con CAA tuvieron valores elevados de péptido C e insulinemia, sin diferencias entre ellos. Se concluyó que en los diabéticos tipo 2 con obesidad y aumento de grasa abdominal predominaron las complicaciones crónicas vasculares.

The interrelation between obesity and type-2 diabetes mellitus is very important from the clinical and epidemiological view point. This study was aimed at assessing the association between the vascular risk and the anthropometric variables in patients with type-2 diabetes mellitus, where the body-mass index and the abdominal size were evaluated in relation to the presence of chronic vascular complications in these patients. One hundred twenty (120) patients from 40 to 79 years old, attending to the diabetes mellitus office at "Hermanos Ameijeiras" University Hospital from October 2009 to September 2010 were included in the study considering the medical history, complementary and general clinical examinations. Body-mass index, abdominal size (AS), insulinemia and C-peptide were also determined; (IMC ? de 30 kg/m² sc) was taken as obesity risk and the augmented abdominal size (in men >102 cm and in women > 88) and these values were related to vascular complications together with C-peptide and insulinemia on empty stomach. Results were statistically analyzed having a significance of p<0.05. Obesity (48,3%) and abdominal size (67,5%) prevailed. Both, the obese ones and those presenting high C-peptide values and insulinemia showed no differences among them. Vascular chronic complications prevailed in type-2 diabetic patients and in those with augmentation of the abdominal fat.