Telessaúde como ferramenta de apoio à atenção primária à saúde: um olhar sobre as teleconsultorias em cardiologia

In order to qualify Primary Health Care in Brazil, the Ministry of Health implemented the Brazilian Telehealth Program to provide health support (telecare) and permanent health education (tele-education). In this respect, one of the primary services offered is teleconsultation. As part of the national expansion of the program, a local Telehealth Center, called Telehealth/RN, was created in Rio Grande do Norte state. The aim of this study was to describe the implementation of cardiological teleconsultations at Telehealth/RN, and analyze the characteristics of the teleconsultations in cardiology requested. Formative Second Opinions in cardiology, available at the web site of the Brazilian Telehealth Program, were also examined. This is a quantitative study with a descriptive, observational design. A total of 56 Formative Second Opinions in cardiology were identified, a majority related to hypertension (29%), focused on treatment support (30%), and requested by doctors (59%). At Telehealth/RN, 47 teleconsultations in cardiology were carried out, a majority also related to hypertension (50%), requested by community health workers (45%) and focused directly on treatment (52%). Cardiological teleconsultation, implemented at the Telehealth/RN in April 2014, is a practical and efficient strategy capable of ensuring health services and reaching those who live in remote areas. Knowing the demand for teleconsultations is extremely important, given that they provide the information needed to correct existing inadequacies related to care, management and/or education, as well as providing the basis for public policies that meet the demands of teleconsultation.

Elaboração de ferramenta computacional para aprendizado da anatomia do pescoço

The teaching-learning process requires a constant search on the part of educators for didatic innovations aimed at improving learning. Among these are technological innovations our students are familiar with. In human anatomy teaching, these innovations are increasingly important, since the need for “mechanizing” many structures may make learning tiresome and nonstimulating for students. The search for new technologies may make this process simpler. Another important issue is the need to constantly emphasize applying the knowledge in question, in order for students to better understand the meaning of learning. Accordingly, this project aims to develop an interactive tablet application for neck anatomy. This application will function as a guide to dissection, containing text, photographs, drawings and videos, distributed systematically, with a script emphasizing the clinical and surgical importance of neck anatomy.

Utilização de mapas conceituais como ferramenta de ensino para o desenvolvimento do raciocínio clínico no curso de medicina da Universidade Federal do Rio Grande do Norte

BACKGROUND: Among the wide range of skills displayed by a medical doctor is undoubtedly the need to use cohesive and well grounded clinical reasoning in order for medical care to be indeed effective. It is in this respect that conceptual maps emerge; these are a methodological innovation that allows a comprehensive, panoramic and associative outlook of theoretical content, making it more practical and applicable to the reality of clinical observation. Promoting learning, learning resources and a feedback system between professor and students, as well as assessing and monitoring the performance of students during their academic training, are the main features of this tool. OBJETIVE: Assess the use of conceptual maps as a teaching-learning tool in the training of undergraduate medical students at Universidade Federal do Rio Grande do Norte (UFRN). METHODOLOGY: Interventional, randomized, cross-sectional study conducted with students from the 3rd and 5th periods of the medical course at UFRN, during the second semester of 2014, totaling 86 participants, divided into two groups: GI (intervention – clinical case resolution with a conceptual map) and GII (control – clinical case resolution without a conceptual map) in each period. RESULTS: The use of conceptual maps to teach liver failure syndrome resulted in a statistically significant cognitive gain for G1 students from the 5th period (GI: 6.8±1.6 and 8.0±1.5, p = 0.024; GII: 7.2±2.1 and 8.0±1.7, p = 0.125, pre and post-intermediate means, respectively), a result not observed in the period 3rd (GI: 7.7±1.3 and 8.0±1.4, p = 0.501; GII: 6.7±1.8 and 7.8±1.8; p=0.068, pre and post-intermediate means, respectively). Students in the 3 rd period gave better responses to the first clinical case, with a larger number of suitable concepts and crosslinks, when they used conceptual maps (GI: 91.3±13.15 and GII: 64.84±22.84, p=0,002). Students in the 5th period exhibited better clinical reasoning and more complete responses using the tool (p=0,01). Most of the students were not aware of the tool (53.8% from the 3rd period and 65.3% from the 5th period). Among those who knew about conceptual maps, most (59.3%) had only used them during high school, 14.8% had never used them and only seven students (25.9%) used them during the medical course. Analysis of open responses, obtained in process assessment showed clear satisfaction and enthusiasm with learning about the new tool, and frequent suggestions to use it at other moments in the course. Assessment of learning profile, using the VARK questionnaire, showed that most students from both periods exhibited a multimodal style. CONCLUSION: Despite their scant knowledge regarding the tool, good acceptability and understanding was observed in the study participants. The conceptual maps allowed cognitive gains, better responses and clinical reasoning in teaching liver failure syndrome to 5th period students.

Classificador máquina de suporte vetorial com análise de Fourier aplicada em dados de EEG e EMG

The classifier support vector machine is used in several problems in various areas of knowledge. Basically the method used in this classier is to end the hyperplane that maximizes the distance between the groups, to increase the generalization of the classifier. In this work, we treated some problems of binary classification of data obtained by electroencephalography (EEG) and electromyography (EMG) using Support Vector Machine with some complementary techniques, such as: Principal Component Analysis to identify the active regions of the brain, the periodogram method which is obtained by Fourier analysis to help discriminate between groups and Simple Moving Average to eliminate some of the existing noise in the data. It was developed two functions in the software R, for the realization of training tasks and classification. Also, it was proposed two weights systems and a summarized measure to help on deciding in classification of groups. The application of these techniques, weights and the summarized measure in the classier, showed quite satisfactory results, where the best results were an average rate of 95.31% to visual stimuli data, 100% of correct classification for epilepsy data and rates of 91.22% and 96.89% to object motion data for two subjects.

Foraminíferos como ferramenta de estudo na geologia ambiental do estuário do Rio Potengi e da plataforma interna, RN, Brasil

The Potengi River estuary has been affected by various anthropogenic factors over the years, as periodic dredging, industrial and domestic waste, traffic and other factors, causing various environmental disasters, including the notorious ecological accident in July 2007, which covered the municipalities of São Gonçalo do Amarante, Macaíba and Natal. Foraminifera serve as viable study tools in these environments; they are able to identify ecologically stressed environments, pointing out hydrographic changes and depositional environments in estuaries. The necessity to check the differences in environmental gradients in places anthropically impacted in Potengi River and adjacent inner shelf through species of foraminifera, and, the responses of these organisms to physical, chemical and geological factors is to provide baseline in the diagnosis of environments. The results show the dominance of opportunistic Ammonia tepida, Bolivina striatula, Quinqueloculina patagonica and Q. miletti especially in regions close to shrimp farms and Baldo Channel sewage in fine grain environments; and Q. lamarckiana indicates penetration of the saline waters in Potengi River. The occurrence of low-salinity tolerant foraminiferal species typical of mangrove environments as Trochammina inflata and T. squamata in Potengi River Channel suggest they probably could have been transported from mangrove area near the Potengi river mouth to the inner shelf regions. These findings suggest Potengi River is able to export mixohaline and mangrove organisms to inner shelf. Two distinct environments were observed, the outermost area is more influenced by marine influence and the innermost area is less influenced. Calcareous and agglutinated species dominate Potengi River, while mouth and inner shelf areas are dominated by calcareous, agglutinated and porcelaneous species, which are typical of highly saline and hydrodynamic environments and the contributive factors that controls foraminiferal distribution were balance of marine and freshwater currents, grain size, availability of CaCO3 and organic matter.

Foraminíferos como ferramenta de estudo na geologia ambiental do estuário do Rio Potengi e da plataforma interna, RN, Brasil

The Potengi River estuary has been affected by various anthropogenic factors over the years, as periodic dredging, industrial and domestic waste, traffic and other factors, causing various environmental disasters, including the notorious ecological accident in July 2007, which covered the municipalities of São Gonçalo do Amarante, Macaíba and Natal. Foraminifera serve as viable study tools in these environments; they are able to identify ecologically stressed environments, pointing out hydrographic changes and depositional environments in estuaries. The necessity to check the differences in environmental gradients in places anthropically impacted in Potengi River and adjacent inner shelf through species of foraminifera, and, the responses of these organisms to physical, chemical and geological factors is to provide baseline in the diagnosis of environments. The results show the dominance of opportunistic Ammonia tepida, Bolivina striatula, Quinqueloculina patagonica and Q. miletti especially in regions close to shrimp farms and Baldo Channel sewage in fine grain environments; and Q. lamarckiana indicates penetration of the saline waters in Potengi River. The occurrence of low-salinity tolerant foraminiferal species typical of mangrove environments as Trochammina inflata and T. squamata in Potengi River Channel suggest they probably could have been transported from mangrove area near the Potengi river mouth to the inner shelf regions. These findings suggest Potengi River is able to export mixohaline and mangrove organisms to inner shelf. Two distinct environments were observed, the outermost area is more influenced by marine influence and the innermost area is less influenced. Calcareous and agglutinated species dominate Potengi River, while mouth and inner shelf areas are dominated by calcareous, agglutinated and porcelaneous species, which are typical of highly saline and hydrodynamic environments and the contributive factors that controls foraminiferal distribution were balance of marine and freshwater currents, grain size, availability of CaCO3 and organic matter.

Reconstrução e reconhecimento de imagens binárias utilizando o algoritmo Máquina de Boltzmann

The objective of this work is to use algorithms known as Boltzmann Machine to rebuild and classify patterns as images. This algorithm has a similar structure to that of an Artificial Neural Network but network nodes have stochastic and probabilistic decisions. This work presents the theoretical framework of the main Artificial Neural Networks, General Boltzmann Machine algorithm and a variation of this algorithm known as Restricted Boltzmann Machine. Computer simulations are performed comparing algorithms Artificial Neural Network Backpropagation with these algorithms Boltzmann General Machine and Machine Restricted Boltzmann. Through computer simulations are analyzed executions times of the different described algorithms and bit hit percentage of trained patterns that are later reconstructed. Finally, they used binary images with and without noise in training Restricted Boltzmann Machine algorithm, these images are reconstructed and classified according to the bit hit percentage in the reconstruction of the images. The Boltzmann machine algorithms were able to classify patterns trained and showed excellent results in the reconstruction of the standards code faster runtime and thus can be used in applications such as image recognition.

Jogos de negócio : o que leva o docente de cursos da área de Ciências Sociais Aplicadas a adotar a ferramenta de ensino

The Business Games are a growing teaching strategy and alternative to the academic front through the new process of Teaching and Learning. Through literature review and semi-structured interviews, this work addresses the teachers considering their subjectivity in deciding JN as the three profiles suggested by Faria and Wellington (2004): those who use it, those who stopped using and those who do not. The research corpus is limited to contributions of 22 respondents between master and doctors teachers of Applied Social Sciences area courses in colleges of Brasília (DF), Goiânia (GO), Ribeirão Preto (SP) and Uberlandia (MG). The content analysis of the interviews allowed to infer that: (1) join the teaching strategy is a commitment to a complex planning, with constant training and proactivity related to student feedback; (2) abandons the practice is becoming less common, because managers tend to recommend it and there are more and more software available for specific disciplines. Its discussed also other contributions (motivations) given by respondents of the three groups that were not found in the literature. It is hoped that this work will serve (1) incentive to teachers on the use of Business Games as a teaching strategy (2) consultation by managers when they decide about purchasing simulation software. Finally, stands out that the educational success of JN depends not only on the various motivations of teachers, as well as the interest and commitment of the student.

Projeto iterativo, simulação, análise e otimização de máquina a relutância variável monofásica

Variable reluctance motors have been increasingly used as an alternative for variable speed and high speed drives in many industrial applications, due to many advantages like the simplicity of construction, robustness, and low cost. The most common applications in recent years are related to aeronautics, electric and hybrid vehicles and wind power generation. This paper explores the theory, operation, design procedures and analysis of a variable reluctance machine. An iterative design methodology is introduced and used to design a 1.25 kW prototype. For the analysis of the machine two methods are used, an analytical method and the finite element simulation. The results obtained by both methods are compared. The results of finite element simulation are used to determine the inductance profiles and torque of the prototype. The magnetic saturation is examined visually and numerically in four critical points of the machine. The data collected in the simulation allow the verification of design and operating limits for the prototype. Moreover, the behavior of the output quantities is analyzed (inductance, torque and magnetic saturation) by variation of physical dimensions of the motor. Finally, a multiobjective optimization using Differential Evolution algorithms and Genetic Algorithms for switched reluctance machine design is proposed. The optimized variables are rotor and stator polar arcs, and the goals are to maximize the average torque, the average torque per copper losses and the average torque per core volume. Finally, the initial design and optimized design are compared.

Percepção ambiental como ferramenta diagnóstica para o processo de integração entre uma unidade de conservação e a comunidade do entorno

It is remarkable the current planet’s situation of degradation and modification of natural assets and the considerable loss of the recovery power inherent to the ecosystems. Concomitant with this, all communities and species are suffering the consequences of these changes without planning. The creation of conservation units (UCs) through the National System of Conservation Units (SNUC) was a concrete action on the deliberateness of halting these processes, which, on the other hand, generated socio-environmental, geo-economical and cultural-political conflict of interests between traditional communities in the vicinity of these units, institutions, governmental entities and society in general. The country’s National Program of Environmental Education (ProNEA) provides the integration of the communities and UCs’ managers in a co-participative administration to solve these conflicts. The principles of Environmental Education (EA) leads the methodology found to change the socio-educational paradigms of traditional teaching, still existing in our society and intrinsically related to environmental problems, which are contrary to the dialogic pedagogy from Paulo Freire, that valorize popular knowledge, pro-active citizenship, as well as contrary to Ecopedagogy, that re-integrate human being on its natural environment, the Earth. One of the tools for starting environmental sensitization is the diagnosis by environmental perception of individuals. In this context, the objective of our work was to identify the environmental perception of Tenda do Moreno community located nearby Pau Furado State Park (PEPF) in Uberlândia – MG. To reach this objective, the research sought, in a first moment, to evaluate the environmental perception of residents of this community through semi-structured interviews applied in their homes and, in a second moment, we evaluated the environmental perception of community’ school students and made Environmental Education intervention activities with the intention to make children aware of the importance of conservation and function of PEPF. Using the Content analysis methodology, we found in nearly 60% of the 118 residents a systemic perception of nature, while approximately 32% expressed an anthropocentric perception. Mixed perceptions were found in 21%. A considerable part of the residents (47 individuals) indicated not knowing the park, although many of them recognize its importance. Among the 46 interviewed students, half expressed an anthropocentric perception of nature, while almost 36% had a systemic view. Seventeen children said they did not know the park and almost half of the students recognize some aspect of the importance of its existence. During the intervention activities, we had huge participation and dedication of students, beyond the massive expression of their personal views and daily experiences. In relation to the ten students that subjected the second evaluation about their environmental perception after the intervention, 80% showed systemic perception and emphasized the importance of conservation and of park. We believe that the continuity of the intervention activities could generate positive perspectives of socio-environmental effective changes in the daily school. Activities lead by Ecopedagogy and that encourage the citizen leadership in the young students are fundamental, while in the community, closer ties and dialog by UC’s managers would be important elements to generate effective change.

Classificação de atividade eletromiográfia facial de indivíduos saudáveis e com hanseníese por meio de máquina de vetores de suporte

A number of studies in the areas of Biomedical Engineering and Health Sciences have employed machine learning tools to develop methods capable of identifying patterns in different sets of data. Despite its extinction in many countries of the developed world, Hansen’s disease is still a disease that affects a huge part of the population in countries such as India and Brazil. In this context, this research proposes to develop a method that makes it possible to understand in the future how Hansen’s disease affects facial muscles. By using surface electromyography, a system was adapted so as to capture the signals from the largest possible number of facial muscles. We have first looked upon the literature to learn about the way researchers around the globe have been working with diseases that affect the peripheral neural system and how electromyography has acted to contribute to the understanding of these diseases. From these data, a protocol was proposed to collect facial surface electromyographic (sEMG) signals so that these signals presented a high signal to noise ratio. After collecting the signals, we looked for a method that would enable the visualization of this information in a way to make it possible to guarantee that the method used presented satisfactory results. After identifying the method's efficiency, we tried to understand which information could be extracted from the electromyographic signal representing the collected data. Once studies demonstrating which information could contribute to a better understanding of this pathology were not to be found in literature, parameters of amplitude, frequency and entropy were extracted from the signal and a feature selection was made in order to look for the features that better distinguish a healthy individual from a pathological one. After, we tried to identify the classifier that best discriminates distinct individuals from different groups, and also the set of parameters of this classifier that would bring the best outcome. It was identified that the protocol proposed in this study and the adaptation with disposable electrodes available in market proved their effectiveness and capability of being used in different studies whose intention is to collect data from facial electromyography. The feature selection algorithm also showed that not all of the features extracted from the signal are significant for data classification, with some more relevant than others. The classifier Support Vector Machine (SVM) proved itself efficient when the adequate Kernel function was used with the muscle from which information was to be extracted. Each investigated muscle presented different results when the classifier used linear, radial and polynomial kernel functions. Even though we have focused on Hansen’s disease, the method applied here can be used to study facial electromyography in other pathologies.

Classificação de atividade eletromiográfia facial de indivíduos saudáveis e com hanseníase por meio de máquina de vetores de suporte

A number of studies in the areas of Biomedical Engineering and Health Sciences have employed machine learning tools to develop methods capable of identifying patterns in different sets of data. Despite its extinction in many countries of the developed world, Hansen’s disease is still a disease that affects a huge part of the population in countries such as India and Brazil. In this context, this research proposes to develop a method that makes it possible to understand in the future how Hansen’s disease affects facial muscles. By using surface electromyography, a system was adapted so as to capture the signals from the largest possible number of facial muscles. We have first looked upon the literature to learn about the way researchers around the globe have been working with diseases that affect the peripheral neural system and how electromyography has acted to contribute to the understanding of these diseases. From these data, a protocol was proposed to collect facial surface electromyographic (sEMG) signals so that these signals presented a high signal to noise ratio. After collecting the signals, we looked for a method that would enable the visualization of this information in a way to make it possible to guarantee that the method used presented satisfactory results. After identifying the method's efficiency, we tried to understand which information could be extracted from the electromyographic signal representing the collected data. Once studies demonstrating which information could contribute to a better understanding of this pathology were not to be found in literature, parameters of amplitude, frequency and entropy were extracted from the signal and a feature selection was made in order to look for the features that better distinguish a healthy individual from a pathological one. After, we tried to identify the classifier that best discriminates distinct individuals from different groups, and also the set of parameters of this classifier that would bring the best outcome. It was identified that the protocol proposed in this study and the adaptation with disposable electrodes available in market proved their effectiveness and capability of being used in different studies whose intention is to collect data from facial electromyography. The feature selection algorithm also showed that not all of the features extracted from the signal are significant for data classification, with some more relevant than others. The classifier Support Vector Machine (SVM) proved itself efficient when the adequate Kernel function was used with the muscle from which information was to be extracted. Each investigated muscle presented different results when the classifier used linear, radial and polynomial kernel functions. Even though we have focused on Hansen’s disease, the method applied here can be used to study facial electromyography in other pathologies.

Manipulação gênica do protozoário Neospora caninum como ferramenta para o estudo das interações parasito-hospedeiro

Neospora caninum is an obligate intracellular parasite classified in the phylum Apicomplexa, characterized by the presence of the apical complex composed by micronemes proteins, rhoptries and dense granules, used by parasite during the adhesion and invasion process of the host cell. This is the mean event in infection pathogenesis generated by N. caninum and other parasites from the phylum Apicomplexa, promoting influence in the parasite biology and the interface between the parasite and its host. Therefore, molecular tools have been developed in order to identify and characterize these possible virulence factors. Thus, the present study sought to establish a specific system of genetic manipulation of N. caninum, searching for the improvement of the genetics manipulation of this parasite. So, we developed genetically depleted N. caninum to Rop9 rhoptry using the pU6-Universal CRISPR-Cas9 plasmid of T. gondii modified by the insertion of Ku80. The Rop9 depleted parasite showed important during initial phase of invasion and replication of the parasite, however it was not characterized as a potential virulence fator for N. caninum. Furthermore, T. gondii proteins were expressed in N. caninum by the use of specific vectors for this parasite, showing an heterologous system for the study of Toxoplasma proteins, due to the fact that Gra15 or Gra24 of type II T. gondii and Rop16 of type I T. gondii were expressed in N. caninum tachyzoites in a stable way and keept its biological phenotype, as already presented the former parasite, that naturaly expresses these proteins. In addition, it was observed that N. caninum induced an inflammasome activation through NLRP3, ASC and Caspase-1. IL-1R/MyD88 demonstrated an indirect pathway in the control of parasite replication. Furthermore, it was observed that this activation is dependent of the potassium efflux and that different strains of N. caninum keep this activation profile. However, T. gondii strains block this activation, making necessary a prior signal in order to active the inflamosome pathway. Type I T. gondii Rop16 was identified as responsible for blocking this activation, in a dependent way to the STAT3 activation. Therefore, the development of molecular tools and their application in N. caninum may prove to be useful to identify and characterize virulent factors involved in the pathogenesis by these two protozoans.

Conceção e desenvolvimento de produto, ferramenta e célula de produção

O trabalho apresentado descreve todo o processo de conceção e desenvolvimento de um produto, ferramenta e célula de fabrico, realizado numa empresa de moldes situada na zona da Marinha Grande e denominada por Moldes RP – Indústria Moldes, Sociedade Unipessoal, Lda. Com o desenvolvimento deste novo produto, a empresa pretende atingir novos mercados, alargando a sua cadeia de valor a jusante do fabrico de moldes, integrando a componente de moldação por injeção e sopro, como forma de cimentar a sua posição no mercado global e assumir a conceção e desenvolvimentos de produtos como um eixo estratégico de negócios. Uma das formas de despoletar processos de desenvolvimento de produtos reside na identificação de oportunidades. Neste âmbito, e no respeitante ao produto em foco neste trabalho, verifica-se uma tendência para a proibição de utilização de copos de vidro em espaços públicos, nomeadamente concertos, eventos desportivos e praias, entre outros, o que força os promotores e consumidores a consumir bebidas em copos que respeitem estas condições.Neste contexto, foi identificada como oportunidade o desenvolvimento e produção de um copo de formas complexas e que respeite as condições descritas, tendo por base uma metodologia de conceção e desenvolvimento de produto eficaz. Para tal, o processo adotado como suporte ao desenvolvimento deste produto envolveu, desde os conceitos iniciais de identificação da ideia, pesquisa do estado da arte, análise do meio envolvente e a identificação de vantagens competitivas, até à definição clara de requisitos do produto para a geração do modelo. Complementarmente, e ao nível da produção do produto desenvolvido foi desenvolvida uma tecnologia que permite a obtenção do produto idealizado, através da integração da moldação por injeção sobreposta e moldação por sopro. De destacar que este desenvolvimento culminou num pedido de patente. Por último, e tendo em consideração a análise da viabilidade financeira do produto e processo de produção, é ainda efetuada uma estimativa inicial do custo do produto e o cálculo final do produto tendo em conta as condicionantes relativas ao processo de fabrico.