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La autoevaluación es necesaria para el aprendizaje efectivo, mejorar la autoeficacia, y el desempeño académico. Dentro de los instrumentos de autoevaluación existe el Knowledge and Prior Study Inventory (KPSI) con cualidades metacognitivas. El objetivo de este trabajo fue examinar los resultados de la aplicación de KPSI en un curso de Interculturalidad y Salud y recoger la percepción de estudiantes respecto a su uso en medicina. Este fue un trabajo de naturaleza mixta. La etapa cuantitativa evaluó los puntajes del instrumento autoaplicado al inicio y al final de la asignatura, arrojando el delta promedio del curso. La etapa cualitativa exploró las percepciones del uso y utilidad en el aprendizaje del instrumento. Se realizaron dos grupos focales, se transcribieron los audios siguiendo el principio de verbatim. Se realizó análisis de contenido. La participación voluntaria y anónima. El puntaje promedio del test al inicio del curso fue de 1,7 puntos elevándose a 3,6 durante la segunda aplicación. Las preguntas con menor puntaje diferencial consideran contenidos integrados en asignaturas previas al curso, mientras que las preguntas con mayor puntaje diferencial estaban integradas por contenidos de aporte exclusivo de la asignatura. Los resultados cualitativos son claramente positivos en la percepción de aprendizaje, ayuda a identificar las fortalezas y debilidades individuales durante el proceso de aprender. Por otro lado, los invita a hacer evidente la metacognición, vale decir, cuestionarse el propio proceso de aprendizaje y lo difícil que son los procesos evaluativos en general. Las autoevaluaciones formativas con enfoque metacognitivo son positivas para el aprendizaje y se recomienda su incorporación en carreras de la salud. Es fundamental para el trabajo en el sistema de salud con la diversidad cultural de Chile que médicos desarrollen la competencia intercultural propiciada a través de la metacognición.

Self-assessment is necessary for effective learning, self-efficacy improvement, and academic performance. Among the self-assessment instruments, there is the Knowledge and Prior Study Inventory (KPSI) with metacognitive attributes. This work aimed to examine the results from the KPSI application in an Interculturality and Health course and to collect the students perception regarding its use in medicine. This was mixed nature work. The quantitative stage assessed the scores from the instrument self-administered at the beginning and the end of the course, giving the average delta of the course. The qualitative stage explored the use and utility perception in instrument learning. Two focal groups were made, the audios were transcribed following the verbatim principle. A content analysis was performed. Participation was voluntary and anonymous. The test average score at the beginning of the course was 1.7 increasing to 3.6 during the second application. The questions with fewer differential scores consider integrated contents in subjects before the course, while the questions with greater differential scores were integrated by the content of the exclusive contribution of the subject. The qualitative results were positive in the learning perception, assists to identify the individual strengths and weaknesses during the learning process. On the other side, they are invited to make clear the metacognition, meaning, question the own learning process, and the difficulty of the assessment process in general. The formative self-assess with metacognitive focus is positive for learning and their addition is recommended for health careers. It is key for the work in the health system with cultural diversity from Chile that clinicians develop the intercultural competence promoted by metacognition.

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El objetivo fue conocer las plantas utilizadas en la medicina tradicional de cuatro comunidades de la Selva Zoque, Chiapas, México. En cada comunidad, se aplicaron 30 entrevistas semiestructuras. El listado florístico medicinal estuvo conformado por 113 especies, 96 géneros y 50 familias. Asteraceae, Fabaceae y Lamiaceae fueron las más representativas. Se obtuvieron 84 indicaciones de uso medicinal, clasificadas en 13 enfermedades, gastrointestinales, dermatológicas y respiratorias, fueron las más frecuentes. La hoja es la estructura de la planta más empleada (72%). El cocimiento es la manera más común de preparar a las plantas, y la vía oral es la forma más frecuente de administrar la medicina. El uso de plantas medicinales es resultado de la experiencia e íntimo contacto con la naturaleza que la sociedad ha acumulado por generaciones. Este saber ha permitido que sobrevivan comunidades que habitan en lugares apartados, donde hay carencias de servicios médicos.

The objective was to know the useful plants in the traditional medicine of four communities of Selva Zoque, Chiapas. In each community, 30 semi-structured interviews were applied. The medicinal floristic listing consisted of 114 species, 97 genera and 50 families. Asteraceae, Fabaceae and Lamiaceae were the most representative. There were 84 indications for medicinal use, classified in 13 diseases, gastrointestinal, dermatological and respiratory, were the most frequent. The leaf is the structure of the most used plant (72%). Cooking is the most common way to prepare plants, and the oral route is the most frequent way to administer medicine. The use of medicinal plants is the result of experience and intimate contact with nature that society has accumulated for generations. This knowledge has allowed communities that live in remote places to survive, where there are shortages of medical services.

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The number of nesting leatherback turtles (Dermochelys coriacea) in the eastern Pacific Ocean has declined dramatically since the late 1980s. This decline has been attributed to egg poaching and interactions with fisheries. However, it is not clear how much of the decline should also be ascribed to variability in the physical characteristics of the ocean. We used data on individually marked turtles that nest at Playa Grande, Costa Rica, to address whether climatic variability affects survival and inter-breeding interval. Because some turtles might nest undetected, we used capture-recapture models to model survival probability accounting for a detection failure. In addition, as the probability of reproduction is constrained by past nesting events, we formulated a new parameterization to estimate inter-breeding intervals and contrast hypotheses on the role of climatic covariates on reproductive frequency. Average annual survival for the period 1993-2011 was low (0.78) and varied over time ranging from 0.49 to 0.99 with a negative temporal trend mainly due to the high mortality values registered after 2004. Survival probability was not associated with the Multivariate ENSO Index of the South Pacific Ocean (MEI) but this index explained 24% of the temporal variability in the reproductive frequency. The probability of a turtle to permanently leave after the first encounter was 26%. This high proportion of transients might be associated with a high mortality cost of the first reproduction or with a long-distance nesting dispersal after the first nesting season. Although current data do not allow separating these two hypotheses, low encounter rate at other locations and high investment in reproduction, supports the first hypothesis. The low and variable annual survival probability has largely contributed to the decline of this leatherback population. The lack of correlation between survival probability and the most important climatic driver of oceanic processes in the Pacific discards a climate-related decline and point to anthropogenic sources of mortality as the main causes responsible for the observed population decline.

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A visita médica é uma das rotinas mais importantes na Unidade de Emergência, onde o profissional informa a evolução, discute indicações de realização e/ou interpretação de exames e procedimentos, permitindo o raciocínio clínico com a eventual decisão da conduta a ser tomada. Desta forma, as visitas médicas geram uma enorme quantidade de informações para o diagnóstico e tratamento mais precisos. OBJETIVO: Desenvolver um protótipo adaptável a diferentes dispositivos para a informatização da visita médica na Divisão de Cirurgia de Urgência e Trauma da UE­HC/FMRP da USP. MÉTODO: Realizado em fases: Levantamento de requisitos através de reuniões e visitas aos diversos setores hospitalares, elaboração de uma ficha modelo para destacar as necessidades no momento da visita, adaptação desta ficha para um protótipo informatizado, e aplicação de testes "in loco". RESULTADOS E DISCUSSÃO: O protótipo foi testado por residentes da UE­HC/FMRP levando em consideração usabilidade e fluxo dos dados durante os atendimentos. Obtivemos os resultados esperados e feedbacks de idéias para a melhoria da plataforma em estudos futuros.

A medical visit is one of the most important routines in the Emergency Unit, where staff informs evolution, discusses indications of achievement and / or interpretation of tests and procedures, allowing clinical reasoning with any decision on the action to be taken. Thus, the medical visits generate an enormous amount of information for more accurate diagnosis and treatment. OBJECTIVE: To develop an adaptable prototype to different devices for the computerization of medical visit in the Emergency and Trauma Surgery Division UE-HC / FMRP USP. METHOD: Conducted in phases: Requirements elicitation through meetings and visits to the various hospital departments, developing a model form to highlight the needs at the time of the visit, adaptation of this form for a computerized prototype, and applicationtesting "in loco". RESULTS AND DISCUSSION: The prototype was tested by residents of UE-HC / FMRP taking intoaccount usability and flow of data during the calls. We obtained the expected results and feedbacks of ideas to improvethe platform in future studies.

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Os atendimentos em situação de urgência e emergência abrangem grande parcela das ocorrências médicas no mundo. Dentro de uma unidade de emergência o cenário se torna cada vez mais delicado e conforme o nível de complexidade de cada atendimento aumenta as taxas de erros são maiores. Para um atendimento seguro e de qualidade, a consistência das informações relacionadas ao atendimento e a facilidade de acesso a elas são fundamentais. OBJETIVO: Desenvolver um sistema web para a informatização da admissão e internação hospitalar, e seguimento ambulatorial de pacientes vítimas de trauma na Unidade de Emergência do Hospital das Clinicas da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo. MÉTODO: Realizado em fases: Levantamento de requisitos através de reuniões e visitas aos diversos setores hospitalares, desenvolvimento do sistema em versões funcionais, e aplicação de testes "in loco". RESULTADOS E DISCUSSÃO: O protótipo foi testado por residentes da UE­HC/FMRP considerando usabilidade e fluxo dos dados durante os atendimentos e obtivemos resultados significantes e idéias para a melhoria da plataforma em estudos futuros.

The calls for urgent and emergency situation cover large portion of medical occurrences in the world. Within an emergency unit the scenario becomes increasingly delicate and as the level of complexity of each service increases error rates are higher. For a safe and quality service, the consistency of the information related to compliance and ease of access to them are key. OBJECTIVE: Develop a web system for the computerization of admission and hospitalization, and outpatient follow-up trauma patients at the Emergency Unit of the Hospital of Ribeirão Preto Medical School Clinical, University of Sao Paulo. METHOD: Conducted in phases: Requirements elicitation through meetings and visits to the various hospital departments, development of the system in functional versions, and application testing "in loco". RESULTS AND DISCUSSION: The prototype was tested by residents of EU-HC / FMRP considering usability and flow of data during the calls and obtained significant results and ideas to improve the platform in future studies.

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Estudo com objetivo de identificar, analisar e sintetizar os achados disponíveis na literatura sobre a composição das equipes e das condições de trabalho nos serviços de Atendimento Pré-Hospitalar (APH) móvel. Revisão integrativa com buscas na Base de Dados de Enfermagem (BDEnf), Cumulative Index to Nursing and Allied Health Literature (CINAHL), Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS), PubMed, SCOPUS, Web of Science e o portal de periódicos Scientific Eletronic Library Online (SciELO). Foram selecionados 18 artigos que atenderam aos critérios de inclusão. A composição das equipes dos serviços de APH é diversificada no cenário internacional, sendo retratado o acréscimo de responsabilidades assumidas por paramédicos, os benefícios da presença do enfermeiro e do médico especializado nas equipes, os quais são escassos em alguns países. As condições de trabalho revelam locais arriscados de atuação, demandas psicológicas intensas, sobrecarga de trabalho, insatisfação e recursos insuficientes na maioria dos serviços.

Study to identify, analyze and summarize the findings available in the literature on the composition of teams and working conditions in Mobile Pre-Hospital Care Services (PHC). Integrative review to search the Base de Dados de Enfermagem [Nursing Database] (BDEnf), the Cumulative Index to Nursing and Allied Health Literature (CINAHL), the Latin American and Caribbean Health Sciences Literature (LILACS), PubMed, SCOPUS, Web of Science and the portal of journals from the Scientific Electronic Library Online (SciELO). Eighteen articles met the inclusion criteria and were selected. The composition of the teams for PHC services is diversified on the international stage, with the increase in responsibilities assumed by paramedics and the benefits of the specialized nurse's and doctor's presence in the teams being portrayed, which are scarce in some countries. Working conditions reveal risky places of work, intense psychological demands, work overload, dissatisfaction and inadequate resources in most services.

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Global climate models suggest enhanced warming of the tropical mid and upper troposphere, with larger temperature rise rates at higher elevations. Changes in fire activity are amongst the most significant ecological consequences of rising temperatures and changing hydrological properties in mountainous ecosystems, and there is a global evidence of increased fire activity with elevation. Whilst fire research has become popular in the tropical lowlands, much less is known of the tropical high Andean region (>2000 masl, from Colombia to Bolivia). This study examines fire trends in the high Andes for three ecosystems, the Puna, the Paramo and the Yungas, for the period 1982-2006. We pose three questions: (i) is there an increased fire response with elevation? (ii) does the El Niño- Southern Oscillation control fire activity in this region? (iii) are the observed fire trends human driven (e.g., human practices and their effects on fuel build-up) or climate driven? We did not find evidence of increased fire activity with elevation but, instead, a quasicyclic and synchronous fire response in Ecuador, Peru and Bolivia, suggesting the influence of high-frequency climate forcing on fire responses on a subcontinental scale, in the high Andes. ENSO variability did not show a significant relation to fire activity for these three countries, partly because ENSO variability did not significantly relate to precipitation extremes, although it strongly did to temperature extremes. Whilst ENSO did not individually lead the observed regional fire trends, our results suggest a climate influence on fire activity, mainly through a sawtooth pattern of precipitation (increased rainfall before fire-peak seasons (t-1) followed by drought spells and unusual low temperatures (t0), which is particularly common where fire is carried by low fuel loads (e.g., grasslands and fine fuel). This climatic sawtooth appeared as the main driver of fire trends, above local human influences and fuel build-up cyclicity.

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