A Educação Física na BNCC: desafios da escola republicana / Physical Education at BNCC: challenges of the republican school / Educación Física en BNCC: desafíos de la escuela republicana

Este estudo consiste em um ensaio teórico que apresenta reflexões acerca das possibilidades e dos desafios impostos pela Base Nacional Comum Curricular. Para tanto, propõe uma discussão sobre república e democracia, localizando a escola como uma instituição formativa necessária para o funcionamento da sociedade. Procura, por fim, analisar o processo de elaboração da base destacando que, embora a efetivação de um currículo comum seja importante para a legitimação da Educação Física como um componente curricular necessário para a escola republicana, o processo final da construção do documento ocorreu de modo pouco democrático, pondo em xeque sua legitimidade.

The present study consists of a theoretical essay that presents reflections on the possibilities and challenges imposed by the National Common Curricular Base. For this, it proposes a discussion on republic and democracy, locating the school as a training institution necessary for the functioning of society. Finally, we seek to analyze the process of preparing the base, highlighting that although the implementation of a common curriculum is important for the legitimation of Physical Education as a necessary curricular component for the republican school, the final process of the construction of the document occurred in an undemocratic way, challenging its legitimacy.

El presente estudio consiste en un ensayo teórico que presenta reflexiones sobre las posibilidades y desafíos que impone la Base Curricular Común Nacional. Para ello propone una discusión sobre república y democracia, ubicando a la escuela como una institución de formación necesaria para el funcionamiento de la sociedad. Finalmente, buscamos analizar el proceso de elaboración de la base, resaltando que, si bien la implementación de un currículo común es importante para la legitimación de la Educación Física como componente curricular necesario para la escuela republicana, se dio el proceso final de construcción del documento. de forma antidemocrática, desafiando su legitimidad.

Comparison of Kinect and Leap Motion for Intraoperative Image Interaction.

Background. Touchless interaction devices have increasingly garnered attention for intraoperative imaging interaction, but there are limited recommendations on which touchless interaction mechanisms should be implemented in the operating room. The objective of this study was to evaluate the efficiency, accuracy, and satisfaction of 2 current touchless interaction mechanisms-hand motion and body motion for intraoperative image interaction. Methods. We used the TedCas plugin for ClearCanvas DICOM viewer to display and manipulate CT images. Ten surgeons performed 5 image interaction tasks-step-through, pan, zoom, circle measure, and line measure-on the 3 input interaction devices-the Microsoft Kinect, the Leap Motion, and a mouse. Results. The Kinect shared similar accuracy with the Leap Motion for most of the tasks. But it had an increased error rate in the step-through task. The Leap Motion led to shorter task completion time than the Kinect and was preferred by the surgeons, especially for the measure tasks. Discussion. Our study suggests that hand tracking devices, such as the Leap Motion, should be used for intraoperative imagining manipulation tasks that require high precision.

Virtual pointer for gaze guidance in laparoscopic surgery.

BACKGROUND: A challenge of laparoscopic surgery is learning how to interpret the indirect view of the operative field. Acquiring professional vision-understanding what to see and which information to attend to, is thereby an essential part of laparoscopic training and one in which trainers exert great effort to convey. We designed a virtual pointer (VP) that enables experts to point or draw free-hand sketches over an intraoperative laparoscopic video for a novice to see. This study aimed to investigate the efficacy of the virtual pointer in guiding novices' gaze patterns. METHODS: We conducted a counter-balanced, within-subject trial to compare the novices' gaze behaviors in laparoscopic training with the virtual pointer compared to a standard training condition, i.e., verbal instruction with un-mediated gestures. In the study, seven trainees performed four simulated laparoscopic tasks guided by an experienced surgeon as the trainer. A Tobii Pro X3-120 eye-tracker was used to capture the trainees' eye movements. The measures include fixation rate, i.e., the frequency of trainees' fixations, saccade amplitude, and fixation concentration, i.e., the closeness of trainees' fixations. RESULTS: No significant difference in fixation rate or saccade amplitude was found between the virtual pointer condition and the standard condition. In the virtual pointer condition, trainees' fixations were more concentrated (p = 0.039) and longer fixations were more clustered, compared to the Standard condition (p = 0.008). CONCLUSIONS: The virtual pointer effectively improved surgical trainees' in-the-moment gaze focus during the laparoscopic training by reducing their gaze dispersion and concentrating their attention on the anatomical target. These results suggest that technologies which support gaze training should be expert-driven and intraoperative to efficiently modify novices' gaze behaviors.

Effects of a Virtual Pointer on Trainees' Cognitive Load and Communication Efficiency in Surgical Training.

We investigated the cognitive load effect of a trainer providing surgical instruction by pointing/drawing over laparoscopic video to a trainee. Results showed that while cognitive load is higher overall with the use of the instructional system, there is a decrease by the second experience of being instructed by the Virtual Pointer. Further analysis showed that trainees were more likely to perform the surgical task and watch/listen to the trainer's instruction at the same time when the instructional system was used. This is thought to be an indication of more efficient communication when using the instructional system. Thus, although there is a small cognitive overload with the instructional system initially, the more efficient communication allows trainees to better integrate the knowledge and instructions being conveyed into the actions they must perform - indicating a better learning environment.

A virtual pointer to support the adoption of professional vision in laparoscopic training.

PURPOSE: To assess a virtual pointer in supporting surgical trainees' development of professional vision in laparoscopic surgery. METHODS: We developed a virtual pointing and telestration system utilizing the Microsoft Kinect movement sensor as an overlay for any imagine system. Training with the application was compared to a standard condition, i.e., verbal instruction with un-mediated gestures, in a laparoscopic training environment. Seven trainees performed four simulated laparoscopic tasks guided by an experienced surgeon as the trainer. Trainee performance was subjectively assessed by the trainee and trainer, and objectively measured by number of errors, time to task completion, and economy of movement. RESULTS: No significant differences in errors and time to task completion were obtained between virtual pointer and standard conditions. Economy of movement in the non-dominant hand was significantly improved when using virtual pointer ([Formula: see text]). The trainers perceived a significant improvement in trainee performance in virtual pointer condition ([Formula: see text]), while the trainees perceived no difference. The trainers' perception of economy of movement was similar between the two conditions in the initial three runs and became significantly improved in virtual pointer condition in the fourth run ([Formula: see text]). CONCLUSIONS: Results show that the virtual pointer system improves the trainer's perception of trainee's performance and this is reflected in the objective performance measures in the third and fourth training runs. The benefit of a virtual pointing and telestration system may be perceived by the trainers early on in training, but this is not evident in objective trainee performance until further mastery has been attained. In addition, the performance improvement of economy of motion specifically shows that the virtual pointer improves the adoption of professional vision- improved ability to see and use laparoscopic video results in more direct instrument movement.

Potential Operating Room Fire Hazard of Bone Cement.

Approximately 600 cases of operating room (OR) fires are reported annually. Despite extensive fire safety education and training, complete elimination of OR fires still has not been achieved. Each fire requires an ignition source, a fuel source, and an oxidizer. In this case report, we describe the potential fire hazard of bone cement in the OR. A total knee arthroplasty was performed with a standard medial parapatellar arthrotomy. Tourniquet control was used. After bone cement was applied to the prepared tibial surface, the surgeon used an electrocautery device to resect residual lateral meniscus tissue-and started a fire in the operative field. The surgeon suffocated the fire with a dry towel and prevented injury to the patient. We performed a PubMed search with a cross-reference search for relevant papers and found no case reports outlining bone cement as a potential fire hazard in the OR. To our knowledge, this is the first case report identifying bone cement as a fire hazard. OR fires related to bone cement can be eliminated by correctly assessing the setting time of the cement and avoiding application sites during electrocautery.

Evaluation of surgical performance during laparoscopic incisional hernia repair: a multicenter study.

BACKGROUND: Laparoscopic incisional hernia repair (LIHR) is a common procedure requiring advanced laparoscopic skills. This study aimed to develop a procedure-specific tool to assess the performance of LIHR and to evaluate its reliability and validity. METHODS: The Global Operative Assessment of Laparoscopic Skills-Incisional Hernia (GOALS-IH) is a 7-item global rating scale developed by experts to evaluate the steps of LIHR (placement of trocars, adhesiolysis, estimation of mesh size and shape, mesh orientation and positioning, mesh fixation, knowledge and autonomy in use of instruments, overall competence), each rated on a 5-point Likert scale. During LIHR, 13 attending surgeons and fellows experienced in minimally invasive surgery (MIS) and 19 novice surgeons (postgraduate years [PGYs], 3-5) were evaluated at four teaching hospitals by the attending surgeon, a trained observer, and self-assessment using GOALS-IH, and by a previously validated 5-item general laparoscopic rating scale (GOALS). Interrater reliability was assessed by intraclass correlation (ICC), and internal consistency of rating items was assessed by Cronbach's alpha. Known-groups construct validity was assessed by using the t-test and by correlating of the number of self-reported LIHR cases with the total score. Concurrent validity was assessed by correlating the GOALS-IH score with the GOALS general rating scale. Data are presented as mean and 95% confidence interval (CI). RESULTS: Interrater reliability for the total GOALS-IH score was 0.79 (95% CI, 0.60-0.89) between observers and attending surgeons, 0.81 (95% CI, 0.58-0.92) between participants and attending surgeons, and 0.89 (95% CI, 0.76-0.96) between participants and observers. Internal consistency was high (Cronbach's alpha, 0.93). Experienced surgeons performed significantly better than novices as assessed by GOALS-IH (31; 95% CI, 29-33 vs. 21; 95% CI, 19-24; p < 0.01). Very good correlation was found between GOALS-IH and previous LIHR experience (r = 0.82; p < 0.01) and strong correlation between GOALS-IH and generic GOALS total scores (r = 0.90; p < 0.01). CONCLUSION: Surgical performance during clinical LIHR can be assessed reliably using GOALS-IH. Results can be used to provide formative feedback to the surgeon and to identify steps of the operation that would benefit from specific educational interventions.

Laparoscopic cholecystectomy poses physical injury risk to surgeons: analysis of hand technique and standing position.

BACKGROUND: This study compares surgical techniques and surgeon's standing position during laparoscopic cholecystectomy (LC), investigating each with respect to surgeons' learning, performance, and ergonomics. Little homogeneity exists in LC performance and training. Variations in standing position (side-standing technique vs. between-standing technique) and hand technique (one-handed vs. two-handed) exist. METHODS: Thirty-two LC procedures performed on a virtual reality simulator were video-recorded and analyzed. Each subject performed four different procedures: one-handed/side-standing, one-handed/between-standing, two-handed/side-standing, and two-handed/between-standing. Physical ergonomics were evaluated using Rapid Upper Limb Assessment (RULA). Mental workload assessment was acquired with the National Aeronautics and Space Administration-Task Load Index (NASA-TLX). Virtual reality (VR) simulator-generated performance evaluation and a subjective survey were analyzed. RESULTS: RULA scores were consistently lower (indicating better ergonomics) for the between-standing technique and higher (indicating worse ergonomics) for the side-standing technique, regardless of whether one- or two-handed. Anatomical scores overall showed side-standing to have a detrimental effect on the upper arms and trunk. The NASA-TLX showed significant association between the side-standing position and high physical demand, effort, and frustration (p<0.05). The two-handed technique in the side-standing position required more effort than the one-handed (p<0.05). No difference in operative time or complication rate was demonstrated among the four procedures. The two-handed/between-standing method was chosen as the best procedure to teach and standardize. CONCLUSIONS: Laparoscopic cholecystectomy poses a risk of physical injury to the surgeon. As LC is currently commonly performed in the United States, the left side-standing position may lead to increased physical demand and effort, resulting in ergonomically unsound conditions for the surgeon. Though further investigations should be conducted, adopting the between-standing position deserves serious consideration as it may be the best short-term ergonomic alternative.

GOALS-incisional hernia: a valid assessment of simulated laparoscopic incisional hernia repair.

The Global Operative Assessment of Laparoscopic Skills (GOALS) is a valid and reliable measure of basic, non-procedure-specific laparoscopic skills. GOALS-incisional hernia (GOALS-IH) was developed to evaluate performance of laparoscopic incisional hernia repair (LIHR). The purpose of this study was to assess the validity and reliability of GOALS-IH during LIHR simulation. GOALS-IH assesses 7 domains with a maximum score of 35. A total of 12 experienced surgeons and 10 novices performed LIHR on the Surgical Abdominal Wall simulator. Performance was assessed by a trained observer and by self-assessment using GOALS-IH, basic GOALS and a visual analog scale (VAS) for overall competence. Both interrater reliability and internal consistency were high (.76 and .95 respectively). Experienced surgeons had higher mean GOALS-IH scores than novices (32.3 ± 2 versus 22.7 ± 5). There was excellent correlation between GOALS-IH and other measures of performance (GOALS r = .93 and VAS r = .93). GOALS-IH is easy to use, valid and reliable for assessment of simulated LIHR.

Performance of simulated laparoscopic incisional hernia repair correlates with operating room performance.

BACKGROUND: the role of simulation for training in procedures such as laparoscopic incisional hernia repair (LIHR) is unknown. The purpose of this study was to determine whether performance in simulated LIHR correlates with operating room (OR) performance. METHODS: subjects performed LIHR in the University of Maryland Surgical Abdominal Wall (SAW) simulator and the OR. Trained observers used a LIHR-specific global rating scale (Global Operative Assessment of Laparoscopic Skills-Incisional Hernia) to assess performance. Global Operative Assessment of Laparoscopic Skills-Incisional Hernia includes 7 domains (trocar placement, adhesiolysis, mesh sizing, mesh positioning, mesh fixation, knowledge and autonomy in instrument use, and overall competence). The correlation between simulator and OR performance was assessed using the Pearson coefficient. RESULTS: fourteen surgeons from 2 surgical departments participated. Experienced surgeons (n = 9) were defined as attending surgeons and minimally invasive surgury (MIS) fellows, and novice surgeons (n = 5) were general surgery residents (postgraduate years 3-5). The correlation between performance in the OR and the simulator for the entire group was .87 (95% confidence interval, .63-.96; P < .001). CONCLUSIONS: there was an excellent correlation between LIHR performance in the simulator and clinical LIHR. This suggests that performance in the SAW simulator may predict performance in the operating room.

Live augmented reality: a new visualization method for laparoscopic surgery using continuous volumetric computed tomography.

BACKGROUND: Current laparoscopic images are rich in surface detail but lack information on deeper structures. This report presents a novel method for highlighting these structures during laparoscopic surgery using continuous multislice computed tomography (CT). This has resulted in a more accurate augmented reality (AR) approach, termed "live AR," which merges three-dimensional (3D) anatomy from live low-dose intraoperative CT with live images from the laparoscope. METHODS: A series of procedures with swine was conducted in a CT room with a fully equipped laparoscopic surgical suite. A 64-slice CT scanner was used to image the surgical field approximately once per second. The procedures began with a contrast-enhanced, diagnostic-quality CT scan (initial CT) of the liver followed by continuous intraoperative CT and laparoscopic imaging with an optically tracked laparoscope. Intraoperative anatomic changes included user-applied deformations and those from breathing. Through deformable image registration, an intermediate image processing step, the initial CT was warped to align spatially with the low-dose intraoperative CT scans. The registered initial CT then was rendered and merged with laparoscopic images to create live AR. RESULTS: Superior compensation for soft tissue deformations using the described method led to more accurate spatial registration between laparoscopic and rendered CT images with live AR than with conventional AR. Moreover, substitution of low-dose CT with registered initial CT helped with continuous visualization of the vasculature and offered the potential of at least an eightfold reduction in intraoperative X-ray dose. CONCLUSIONS: The authors proposed and developed live AR, a new surgical visualization approach that merges rich surface detail from a laparoscope with instantaneous 3D anatomy from continuous CT scanning of the surgical field. Through innovative use of deformable image registration, they also demonstrated the feasibility of continuous visualization of the vasculature and considerable X-ray dose reduction. This study provides motivation for further investigation and development of live AR.

Surgical Abdominal Wall (SAW): a novel simulator for training in ventral hernia repair.

Laparoscopic ventral hernia repair (LVHR) is a relatively common procedure that requires advanced minimally invasive surgical skills to perform. The role for simulation is increasingly supported as an effective way to teach surgical skills and accelerate the learning curve. This article describes The University of Maryland's Surgical Abdominal Wall, an inexpensive procedure-specific physical simulator for LVHR, and summarizes the authors' early experiences using this model in a curriculum for surgery residents.

Novel, Web-based, information-exploration approach for improving operating room logistics and system processes.

Routine clinical information systems now have the ability to gather large amounts of data that surgical managers can access to create a seamless and proactive approach to streamlining operations and minimizing delays. The challenge lies in aggregating and displaying these data in an easily accessible format that provides useful, timely information on current operations. A Web-based, graphical dashboard is described in this study, which can be used to interpret clinical operational data, allow managers to see trends in data, and help identify inefficiencies that were not apparent with more traditional, paper-based approaches. The dashboard provides a visual decision support tool that assists managers in pinpointing areas for continuous quality improvement. The limitations of paper-based techniques, the development of the automated display system, and key performance indicators in analyzing aggregate delays, time, specialties, and teamwork are reviewed. Strengths, weaknesses, opportunities, and threats associated with implementing such a program in the perioperative environment are summarized.

Postural instability does not necessarily correlate to poor performance: case in point.

BACKGROUND: It is very important for surgeons who perform minimally invasive surgery (MIS) to maintain proper postural stability, which kinematic research can determine. Previous studies in surgical ergonomics have shown that postural stability is correlated to instrument type, task difficulty, and skill level. What should also be considered is that surgeons may strategically change stance or joint movement to achieve better surgical outcomes while potentially subjecting themselves to greater risk. Background information about subjects, e.g., joint impairment, should be considered an important surgical ergonomic element. Such information can lead to more realistic and accurate conclusions about postural stability and joint kinematics. METHODS: A highly experienced and skilled right-handed surgeon developing carpal tunnel syndrome in both wrists was recruited into a small (6 subjects) performance study of pegboard transfer and circle-cutting tasks from the Fundamentals of Laparoscopic Surgery (FLS) skill set. Joint kinematics and postural data were collected using two associated force plates and a motion capture system of 12 digital, high-resolution, high-speed, infrared cameras. RESULTS: Each task was completed in less than 90 s. In pegboard transfer, the subject increased shoulder abduction angle to align his hand and forearm and minimize wrist flexion. When circle-cutting required excessive wrist flexion, the subject maintained his lower body position and stance while twisting his torso, a strategy that appeared to stabilize tangential direction related to cutting while maintaining a fixed orientation of forearm, wrist, and hand. In another circle-cutting trial, the subject changed his stance primarily by shifting foot position as necessary to obtain better scissor approach angles. These compensatory, strategic movements caused an increase in overall postural sway but did not represent postural instability. CONCLUSION: This case study indicated that poor joint kinematics or postural stability does not necessarily correlate to poor performance. Instead, they may indicate positive compensatory or strategic movements.

Classification of hiatal hernias using dynamic three-dimensional reconstruction.

Hiatal hernias and paraesophageal hernias are common clinical entities and have a well-known classification system. Multiple modalities have been used to illustrate these hernias, most relying on artists' renderings or two-dimensional radiographic studies. However, surgeons would benefit from a comprehensive graphic representation of hiatal hernias based on current imaging technologies. We have applied polygonal mesh surface modeling techniques to render dynamic three-dimensional computed tomography-based models of the four recognized types of hiatal hernias. The resulting images allow nearly real-time navigation in an intuitive and clinically relevant fashion. This model should clarify and eventually advance the existing classification by applying modern and sophisticated image processing to established concepts.

Radio frequency identification systems technology in the surgical setting.

Radio frequency identification (RFID) is a technology that will have a profound impact on medicine and the operating room of the future. The purpose of this article is to provide an introduction to this exciting technology and a description of the problems in the perioperative environment that RFID might address to improve safety and increase productivity. Although RFID is still a nascent technology, applications are likely to become much more visible in patient care and treatment areas and will raise questions for practitioners. We also address both the current limitations and what appear to be reasonable near-future possibilities.

Inclusion of 3-D computed tomography rendering and immersive VR in a third year medical student surgery curriculum.

Computed tomography (CT) scans are frequently used for preoperative evaluation of patients undergoing complex surgery and are therefore commonly encountered by medical students on their surgical rotations. Interpretation of these CT scan images is therefore an integral component of all medical students' surgical rotations. Additionally, advanced rendering available from modem scanners and registration of multimodal or serial scans require the student to understand how volumetric anatomy relates to cross-sectional anatomy. The utility of three-dimensional (3-D) models for conveying surgical anatomy has been demonstrated. Immersive 3-D VR overcomes many of the conceptual limitations encountered when conveying or teaching 3-D relationships via 2-D images traditionally produced by these scans. We are currently using augmented reality as a teaching tool and have incorporated 3-D immersive environments in the third year medical student Surgery rotation. Initial results suggest that this is an effective tool for teaching third year medical students. 3-D CT rendering and immersive VR provide an effective process for utilizing CT datasets to teach surgical anatomy to medical students.

Wireless live streaming video of laparoscopic surgery: a bandwidth analysis for handheld computers.

Over the last six years, streaming media has emerged as a powerful tool for delivering multimedia content over networks. Concurrently, wireless technology has evolved, freeing users from desktop boundaries and wired infrastructures. At the University of Kentucky Medical Center, we have integrated these technologies to develop a system that can wirelessly transmit live surgery from the operating room to a handheld computer. This study establishes the feasibility of using our system to view surgeries and describes the effect of bandwidth on image quality. A live laparoscopic ventral hernia repair was transmitted to a single handheld computer using five encoding speeds at a constant frame rate, and the quality of the resulting streaming images was evaluated. No video images were rendered when video data were encoded at 28.8 kilobytes per second (Kbps), the slowest encoding bitrate studied. The highest quality images were rendered at encoding speeds greater than or equal to 150 Kbps. Of note, a 15 second transmission delay was experienced using all four encoding schemes that rendered video images. We believe that the wireless transmission of streaming video to handheld computers has tremendous potential to enhance surgical education. For medical students and residents, the ability to view live surgeries, lectures, courses and seminars on handheld computers means a larger number of learning opportunities. In addition, we envision that wireless enabled devices may be used to telemonitor surgical procedures. However, bandwidth availability and streaming delay are major issues that must be addressed before wireless telementoring becomes a reality.

Advancements in immersive VR as a tool for preoperative planning for laparoscopic surgery.

The utility of three-dimensional (3D) models for planning laparoscopic surgery and surgical training has been demonstrated. (1) Computed tomography (CT) scans with oral and intravenous contrast medium are frequently used for preoperative evaluation of patients undergoing complex laparoscopic surgery. Immersive 3D VR overcomes many of the conceptual limitations encountered when conveying or teaching 3D relationships via 2D images traditionally produced by these scans. Over the past year we have made advancements in several areas. First, we have improved the quality of our datasets by utilizing higher resolution multi-detector scans and altering the protocols used. Second, we now register multiple isosurface views with standard axial views and volume textured views to provide additional information and perspective. Third, we now routinely use auto-segmentation techniques to visualize individual structures.