Reconhecimento de seqüências de atividades funcionais em pacientes com acidente cascular encefálico

During the motor rehabilitation of patients with neurological pathologies, there are many factors that have an influence on the therapeutical process. It is possible that the demonstration using videotapes or photographs of movements that will be learned can assist the codification, classification and reorganization of the elements of the task in familiar diagrams and thus facilitate the process of motor rehabilitation. The aim of this study was to analyze the performance in the test of recognition of sequences of functional activities such as water drinking and hair combing presented partially (by photos) and completely (by video) to the patients with encephalic vascular accident . The sample was generated from 12 patients (62 ± 8 years) and 10 healthy subjects (53 ± 5 years), of both sex, divided in two groups for which 5 functional activities were presented partially and completely, in 4 sequences that varied between reached and not reached objectives and correct and incorrect movements, during 24 trials. The test t'Student was applied to verify differences in the recognition time between the groups, and to compare the performance between the tests carried through at 9:00 am and retests at 9:00 am and 4:00 pm. To compare the frequency between the types of reply, the test Qui-square was used. It was verified that the patients presented a greater recognition time and a lower number of correct answers than the healthy subjects, and had better performances in the recognition of the complete sequence than the partial one. Bigger frequency was observed in the reply that the objective and the movement were being presented correctly, however the healthy subjects had soon indicated the correct reply in the first trials. An improvement tendency was observed in the performance, when the stages of tests and retests had been carried through in the same schedule. According to the results, it is suggested that the patients with stroke can better recognize the correct movements of a functional activity when it is presented completely in video form, what can influence the choice of the therapeutical strategy during the process of motor rehabilitation

Investigação da capacidade intelectiva de pacientes pediátricos diagnosticados com tumores de fossa posterior

Central Nervous System are the most common pediatric solid tumors. 60% of these tumors arise in posterior fossa, mainly in cerebellum. The first therapeutic approach is surgical resection. Malignant tumors require additional strategies - chemotherapy and radiotherapy. The increasing survival evidences that childhood brain tumors result in academic and social difficulties that compromise the quality of life of the patients. This study investigated the intellectual functioning of children between 7 to 15 years diagnosed with posterior fossa tumors and treated at CEHOPE - Recife / PE. 21 children were eligible - including 13 children with pilocytic astrocytoma (G1) who underwent only surgery resection, and eight children with medulloblastoma (G2) - submitted to surgical resection, chemotherapy and craniospinal radiotherapy. Participants were evaluated by the Wechsler Intelligence Scale for Children - WISC-III. Children of G1 scored better than children of G2. Inferential tools (Mann-Whitney Ü Test) identified significant diferences (p ≤ 0.05) between the Performance IQ (PIQ) and Processing Speed Index (PSI) as a function of treatment modality; Full Scale IQ (FSIQ), PIQ and PSI as a function of parental educational level; PIQ, FSIQ, IVP and Freedom from Distractibility (FDI) as a function of time between diagnosis and evaluation. These results showed the late and progressive impact of radiotherapy on white matter and information processing speed. Furthermore, children whose parents have higher educational level showed better intellectual performance, indicating the influence of xxii socio-cultural variables on cognitive development. The impact of cancer and its treatment on cognitive development and learning should not be underestimated. These results support the need to increase the understanding of such effects in order to propose therapeutic strategies which ensure that, in addition to the cure, the full development of children with this pathology

Qualidade de vida de pacientes com deformidade dentofacial

In the last decade, an increasing number of studies focusing on the impact of oral deformities on quality of life have been published. However, the evaluation of patients at different phases of the treatment has not been performed. Therefore, the purpose of this study was to determine the impact that dentofacial deformities have on patients` quality of life, as well as the influence exerted by social, economic, demographic and orthodontic factors, type and severity of malocclusion. A bicentric study - of the cross-sectional type of repeated panels - involving two cities - Natal and Rio de Janeiro - was carried out. A total of 227 patients participated in the study: 71 patients in the initial phase of the treatment (before any orthosurgical procedure), 115 patients in the pre-surgical (with braces) phase and 41 patients in the postoperative phase. The quality of life was measured using the Orthognatic Quality of Life Questionnnaire - OQLQ, translated and validated into Portuguese. The normative and aesthetic need for treatment was assessed with the Index of Orthodontic Treatment Need (IOTN) and the Dental Aesthetic Index (DAI); the social, economic and demographic factors, the type of service and malocclusion were also assessed. The data were analyzed through χ2/ Fisher`s exact test to seek the association between the nominal categorical variables in the three phases of treatment, Mann Whitney and Kruskal-Wallis test for gauging the existence of significant differences between two and three groups regarding each domain of OQLQ, respectively. For all tests, it was adopted a significance level of 5%. There was a statistically significant difference (p <0.001) in the general scores of OQLQ and in the domains of social aspects, facial aesthetics and oral function, when the "postoperative group" was compared to the "initial" and "orthodontic preparation" groups. Women, single, aged between 31 and 59 and living in Natal had the greatest impact on quality of life among patients in the "orthodontic preparation" group. Only the variable "income" (2 to 3 minimum wages), for the "initial" group, and gender (female) for the "postoperative" group, showed significant association with quality of life. The normative variable IOTN (DHC and AC) showed significant association with the OQLQ for the "initial" group, and the IOTN-AC-auto in the group of orthodontic preparation, being less important to women. We conclude that the ortho-surgical therapy has positive effects on quality of life after orthognathic surgery

Eficiência mastigatória e impacto da saúde oral na qualidade de vida em pacientes reabilitados com próteses totais removíveis implanto-suportadas

Edentulous patients with complaint about mandibular conventional denture might experience poor masticatory function and negative impact of oral health on quality of life. The aim of this controlled clinical trial was to evaluate the effect of mandibular overdenture on oral health-related quality of life and masticatory efficacy in patients wearing mandibular complete dentures. The edentulous patients (n=16) were rehabilitated with new maxillary and mandibular complete dentures and, after 3 months, mandibular overdentures retained by 2 implants (bar-clip system) were fabricated. The Brazilian version of OHIP-Edent questionnaire was used to assess the oral healthrelated quality of life. Masticatory efficacy was evaluated through a colorimetric method with chewing capsules. The mean OHIP-Edent score was 8.5 with conventional dentures and 2.0 with mandibular overdenture, which means a positive impact of oral health on quality of life with overdentures (p=0.001). The mean absorbance for masticatory efficacy was 0.025 for conventional dentures and 0.073 for overdentures. There was statistically significant difference for masticatory efficacy before and after implants rehabilitation (p=0.003). However, there was no correlation between masticatory efficacy and OHIP (p>0.05). So, mandibular overdenture retained by 2 implants improved the quality of life and masticatory efficacy of edentulous patients with complaint about mandibular conventional complete dentures

Aplicação de ontologias para métodos de negociação de um sistema multiagente para o reconhecimento de padrões

The use of intelligent agents in multi-classifier systems appeared in order to making the centralized decision process of a multi-classifier system into a distributed, flexible and incremental one. Based on this, the NeurAge (Neural Agents) system (Abreu et al 2004) was proposed. This system has a superior performance to some combination-centered methods (Abreu, Canuto, and Santana 2005). The negotiation is important to the multiagent system performance, but most of negotiations are defined informaly. A way to formalize the negotiation process is using an ontology. In the context of classification tasks, the ontology provides an approach to formalize the concepts and rules that manage the relations between these concepts. This work aims at using ontologies to make a formal description of the negotiation methods of a multi-agent system for classification tasks, more specifically the NeurAge system. Through ontologies, we intend to make the NeurAge system more formal and open, allowing that new agents can be part of such system during the negotiation. In this sense, the NeurAge System will be studied on the basis of its functioning and reaching, mainly, the negotiation methods used by the same ones. After that, some negotiation ontologies found in literature will be studied, and then those that were chosen for this work will be adapted to the negotiation methods used in the NeurAge.

A saúde ambiental e os resíduos de serviços de saúde nos três níveis de complexidade do Sistema Único de Saúde - SUS

The environmental management in the health establishments is a reality still little explored in the health sector in Brazil, especially concerning its wastes. The management of wastes of health services is established in the valid legislation through the National Council of Environment and Sanitary Vigilance Agency (358/2005 and 304/2004 respectively). The present work is about a descriptive work about the environmental health in the health services. The used criterion was to diagnose the environmental management in twelve establishments of health inserted in the three levels of complexity of the Unique Health System (Sistema Ùnico de Saúde SUS). Among the sub criteria used the waste management is the one of bigger concern. The one referring to the water quality is considered good. The analysis of data reveals that 66% of the establishments got a poor environmental ranking, 17% critical and 17% appropriate, showing that the health establishments in the three levels of complexity of the SUS need urgent structural, environmental and educational interventions

Aplicação do Sensoriamento Remoto e do Sistema de Informações Geográficas na Detecção de Manchas de Óleo na Região do Pólo de Exploração de Guamaré, R.N.

Objective to establish a methodology for the oil spill monitoring on the sea surface, located at the Submerged Exploration Area of the Polo Region of Guamaré, in the State of Rio Grande do Norte, using orbital images of Synthetic Aperture Radar (SAR integrated with meteoceanographycs products. This methodology was applied in the following stages: (1) the creation of a base map of the Exploration Area; (2) the processing of NOAA/AVHRR and ERS-2 images for generation of meteoceanographycs products; (3) the processing of RADARSAT-1 images for monitoring of oil spills; (4) the integration of RADARSAT-1 images with NOAA/AVHRR and ERS-2 image products; and (5) the structuring of a data base. The Integration of RADARSAT-1 image of the Potiguar Basin of day 21.05.99 with the base map of the Exploration Area of the Polo Region of Guamaré for the identification of the probable sources of the oil spots, was used successfully in the detention of the probable spot of oil detected next to the exit to the submarine emissary in the Exploration Area of the Polo Region of Guamaré. To support the integration of RADARSAT-1 images with NOAA/AVHRR and ERS-2 image products, a methodology was developed for the classification of oil spills identified by RADARSAT-1 images. For this, the following algorithms of classification not supervised were tested: K-means, Fuzzy k-means and Isodata. These algorithms are part of the PCI Geomatics software, which was used for the filtering of RADARSAT-1 images. For validation of the results, the oil spills submitted to the unsupervised classification were compared to the results of the Semivariogram Textural Classifier (STC). The mentioned classifier was developed especially for oil spill classification purposes and requires PCI software for the whole processing of RADARSAT-1 images. After all, the results of the classifications were analyzed through Visual Analysis; Calculation of Proportionality of Largeness and Analysis Statistics. Amongst the three algorithms of classifications tested, it was noted that there were no significant alterations in relation to the spills classified with the STC, in all of the analyses taken into consideration. Therefore, considering all the procedures, it has been shown that the described methodology can be successfully applied using the unsupervised classifiers tested, resulting in a decrease of time in the identification and classification processing of oil spills, if compared with the utilization of the STC classifier

Proposição e aplicação de um core set da classificação internacional de funcionalidade, incapacidade e saúde (CIF) para saúde física de idosos

Para aumentar a viabilidade do uso da Classificação Internacional de Funcionalidade, Incapacidade e Saúde (CIF), core sets começaram a ser desenvolvidos, e objetivam estabelecer uma seleção de categorias adaptada para representar os padrões de avaliação multiprofissional de grupos específicos de pacientes. Com o objetivo de propor um core set da CIF para classificar a saúde física de idosos, formou-se uma comissão de especialistas para julgar o instrumento por meio da técnica Delphi, o que mostra a interface multidisciplinar do projeto. Finalizada a participação da comissão, o core set foi proposto contendo 30 categorias. Após aplicação em uma amostra com 340 idosos dos municípios de Natal/RN e Santa Cruz/RN, o core set foi submetido à análise fatorial, tendo ficado com 19 categorias. A análise ainda proporcionou gerar uma pontuação para cada idoso por meio do escore fatorial, tendo provado ser uma forma fidedigna e confiável de se pontuar um core set.

Técnica para segmentação automática de imagens microscópicas de componentes sanguíneos e classificação diferencial de leucócitos baseada em lógica fuzzy

Automatic detection of blood components is an important topic in the field of hematology. The segmentation is an important stage because it allows components to be grouped into common areas and processed separately and leukocyte differential classification enables them to be analyzed separately. With the auto-segmentation and differential classification, this work is contributing to the analysis process of blood components by providing tools that reduce the manual labor and increasing its accuracy and efficiency. Using techniques of digital image processing associated with a generic and automatic fuzzy approach, this work proposes two Fuzzy Inference Systems, defined as I and II, for autosegmentation of blood components and leukocyte differential classification, respectively, in microscopic images smears. Using the Fuzzy Inference System I, the proposed technique performs the segmentation of the image in four regions: the leukocyte’s nucleus and cytoplasm, erythrocyte and plasma area and using the Fuzzy Inference System II and the segmented leukocyte (nucleus and cytoplasm) classify them differentially in five types: basophils, eosinophils, lymphocytes, monocytes and neutrophils. Were used for testing 530 images containing microscopic samples of blood smears with different methods. The images were processed and its accuracy indices and Gold Standards were calculated and compared with the manual results and other results found at literature for the same problems. Regarding segmentation, a technique developed showed percentages of accuracy of 97.31% for leukocytes, 95.39% to erythrocytes and 95.06% for blood plasma. As for the differential classification, the percentage varied between 92.98% and 98.39% for the different leukocyte types. In addition to promoting auto-segmentation and differential classification, the proposed technique also contributes to the definition of new descriptors and the construction of an image database using various processes hematological staining

Um sistema inteligente de teleoftalmologia para o auxílio no diagnóstico de catarata

The increasing in world population, with higher proportion of elderly, leads to an increase in the number of individuals with vision loss and cataracts are one of the leading causes of blindness worldwide. Cataract is an eye disease that is the partial or total opacity of the crystalline lens (natural lens of the eye) or its capsule. It can be triggered by several factors such as trauma, age, diabetes mellitus, and medications, among others. It is known that the attendance by ophthalmologists in rural and poor areas in Brazil is less than needed and many patients with treatable diseases such as cataracts are undiagnosed and therefore untreated. In this context, this project presents the development of OPTICA, a system of teleophthalmology using smartphones for ophthalmic emergencies detection, providing a diagnostic aid for cataract using specialists systems and image processing techniques. The images are captured by a cellphone camera and along with a questionnaire filled with patient information are transmitted securely via the platform Mobile SANA to a online server that has an intelligent system available to assist in the diagnosis of cataract and provides ophthalmologists who analyze the information and write back the patient’s report. Thus, the OPTICA provides eye care to the poorest and least favored population, improving the screening of critically ill patients and increasing access to diagnosis and treatment.

Gravidade do olho seco em pacientes internados em unidade de terapia intensiva: análise de conceito e construção de definições

Dry eye syndrome is a multifactorial disease of the tear film, resulting from the instability of the lacrimal functional unit that produces volume change, up or tear distribution. In patients in intensive care the cause is enhanced due to various risk factors, such as mechanical ventilation, sedation, lagophthalmos, low temperatures, among others. The study's purpose is to build an assessment tool of Dry Eye Severity in patients in intensive care units based on the systematization of nursing care and their classification systems. The aim of this study is to build an assessment tool of Dry Eye Severity in hospitalized patients in Care Unit Intensiva.Trata is a methodological study conducted in three stages, namely: context analysis, concept analysis, construction of operational definitions and magnitudes of nursing outcome. For the first step we used the methodological framework for Hinds, Chaves and Cypress (1992). For the second step we used the model of Walker and Avant and an integrative review Whitemore seconds, Knalf (2005). This step enabled the identification of the concept of attributes, background and consequent ground and the construction of the settings for the result of nursing severity of dry eye. For the construction of settings and operational magnitudes, it was used Psicometria proposed by Pasquali (1999). As a result of context analysis, visualized from the reflection that the matter should be discussed and that nursing needs to pay attention to the problem of eye injury, so minimizing strategies are created this event with a high prevalence. With the integrative review were located from the crosses 19 853 titles, selected 215, and from the abstracts 96 articles were read in full. From reading 10 were excluded culminating in the sample of 86 articles that were used to analyze the concept and construction of settings. Selected articles were found in greater numbers in the Scopus database (55.82%), performed in the United States (39.53%), and published mainly in the last five years (48.82). Regarding the concept of analysis were identified as antecedents: age, lagophthalmos, environmental factors, medication use, systemic diseases, mechanical ventilation and ophthalmic surgery. As attributes: TBUT <10s, Schimer I test <5 mm in Schimer II test <10mm, reduced osmolarity. As consequential: the ocular surface damage, ocular discomfort, visual instability. The settings were built and added indicators such as: decreased blink mechanism and eyestrain.

Mapeamento, interações e gerenciamento do fluxo de pacientes da Maternidade Escola Januário Cicco - MEJC

The process mapping is an important tool in the management of organizations, allowing better levels of productivity, quality and reciprocity concerning the implementation and decision-making. It benefits in a clear way the process organization and assures the manager a macro vision of the system. In this sense, the objective of this study is to describe the mapping process as it occurs in the Januario Cicco Maternity School–MEJC. The bibliographic and descriptive research included interviews, observations and researches in many databases. The study analyzed the limiting points of the detected flow trying to find a better comprehension of the flow of patients in the maternity in order to offer the gestors the information necessary to improve the quality of the assistance as well as a general view of the flow of patients and any change detected there. As a result, we believe that the process mapping may become a relevant factor to the organizational management of MEJC, in view that it is an element that can contribute to ease up the management of information studied, considering that the perfect change of information inside a complex system will produce improvements in all spheres of this institution.

LCD-OpenPACS: sistema integrado de telerradiologia com auxílio ao diagnóstico de nódulos pulmonares em exames de tomografia computadorizada

Lung cancer is one of the most common types of cancer and has the highest mortality rate. Patient survival is highly correlated with early detection. Computed Tomography technology services the early detection of lung cancer tremendously by offering aminimally invasive medical diagnostic tool. However, the large amount of data per examination makes the interpretation difficult. This leads to omission of nodules by human radiologist. This thesis presents a development of a computer-aided diagnosis system (CADe) tool for the detection of lung nodules in Computed Tomography study. The system, called LCD-OpenPACS (Lung Cancer Detection - OpenPACS) should be integrated into the OpenPACS system and have all the requirements for use in the workflow of health facilities belonging to the SUS (Brazilian health system). The LCD-OpenPACS made use of image processing techniques (Region Growing and Watershed), feature extraction (Histogram of Gradient Oriented), dimensionality reduction (Principal Component Analysis) and classifier (Support Vector Machine). System was tested on 220 cases, totaling 296 pulmonary nodules, with sensitivity of 94.4% and 7.04 false positives per case. The total time for processing was approximately 10 minutes per case. The system has detected pulmonary nodules (solitary, juxtavascular, ground-glass opacity and juxtapleural) between 3 mm and 30 mm.

Fuzzy angel: uma arquitetura distribuída de telemedicina para monitoramento de pacientes com esclerose lateral amiotrófica

The Amyotrophic Lateral Sclerosis (ALS) is a neurodegenerative disease characterized by progressive muscle weakness that leads the patient to death, usually due to respiratory complications. Thus, as the disease progresses the patient will require noninvasive ventilation (NIV) and constant monitoring. This paper presents a distributed architecture for homecare monitoring of nocturnal NIV in patients with ALS. The implementation of this architecture used single board computers and mobile devices placed in patient’s homes, to display alert messages for caregivers and a web server for remote monitoring by the healthcare staff. The architecture used a software based on fuzzy logic and computer vision to capture data from a mechanical ventilator screen and generate alert messages with instructions for caregivers. The monitoring was performed on 29 patients for 7 con-tinuous hours daily during 5 days generating a total of 126000 samples for each variable monitored at a sampling rate of one sample per second. The system was evaluated regarding the rate of hits for character recognition and its correction through an algorithm for the detection and correction of errors. Furthermore, a healthcare team evaluated regarding the time intervals at which the alert messages were generated and the correctness of such messages. Thus, the system showed an average hit rate of 98.72%, and in the worst case 98.39%. As for the message to be generated, the system also agreed 100% to the overall assessment, and there was disagreement in only 2 cases with one of the physician evaluators.

Fuzzy angel: uma arquitetura distribuída de telemedicina para monitoramento de pacientes com esclerose lateral amiotrófica

The Amyotrophic Lateral Sclerosis (ALS) is a neurodegenerative disease characterized by progressive muscle weakness that leads the patient to death, usually due to respiratory complications. Thus, as the disease progresses the patient will require noninvasive ventilation (NIV) and constant monitoring. This paper presents a distributed architecture for homecare monitoring of nocturnal NIV in patients with ALS. The implementation of this architecture used single board computers and mobile devices placed in patient’s homes, to display alert messages for caregivers and a web server for remote monitoring by the healthcare staff. The architecture used a software based on fuzzy logic and computer vision to capture data from a mechanical ventilator screen and generate alert messages with instructions for caregivers. The monitoring was performed on 29 patients for 7 con-tinuous hours daily during 5 days generating a total of 126000 samples for each variable monitored at a sampling rate of one sample per second. The system was evaluated regarding the rate of hits for character recognition and its correction through an algorithm for the detection and correction of errors. Furthermore, a healthcare team evaluated regarding the time intervals at which the alert messages were generated and the correctness of such messages. Thus, the system showed an average hit rate of 98.72%, and in the worst case 98.39%. As for the message to be generated, the system also agreed 100% to the overall assessment, and there was disagreement in only 2 cases with one of the physician evaluators.