A public health approach to increase treatment of latent TB among household contacts in Brazil.

SETTING: Two consecutive trials were conducted to evaluate the effectiveness of a public health approach to identify and correct problems in the care cascade for household contacts (HHCs) of TB patients in three Brazilian high TB incidence cities.METHODS: In the first trial, 12 clinics underwent standardised evaluation using questionnaires administered to TB patients, HHCs and healthcare workers, and analysis of the cascade of latent TB care among HHCs. Six clinics were then randomised to receive interventions to strengthen management of latent TB infection (LTBI), including in-service training provided by nurses, work process organisation and additional clinic-specific solutions. In the second trial, a similar but streamlined evaluation was conducted in two clinics, who then received initial and subsequent intensive in-service training provided by a physician.RESULTS: In the evaluation phase of both trials, many HHCs were identified, but few started LTBI treatment. After the intervention, the number of HHCs initiating treatment per 100 active TB patients increased by 10 (95%CI - 11 to 30) in the first trial, and by 44 (95%CI 26 to 61) in the second trial.DISCUSSION: A public health approach with standardised evaluation, local decisions for improvements, followed by intensive initial and in-service training appears promising for improved LTBI management.

Composição nutricional e valores energéticos determinados com frangos de corte de coprodutos do processamento do etanol de milho / Nutritional composition and energy values determined with broilers of co-products from the processing of corn ethanol

It was determined by the total collection of excreta method, with broilers from 22 to 32 days of age, the coefficients of apparent metabolism of dry matter, crude protein and crude energy and apparent metabolizable energy corrected for zero nitrogen balance (AMEn) of the ethanol co-products of corn: acid oil and dried distillery grains with soluble (DDGS). The DDGS and corn acid oil presented nutritional metabolization coefficients ranging from 43 to 83% and AMEn equal 2393.5 and 7859.2kcal/kg respectively, and may be food alternatives to soybean meal and soybean oil.(AU)

Clinical Evaluation of Different Delivery Methods of At-Home Bleaching Gels Composed of 10% Hydrogen Peroxide.

OBJECTIVES:: This study aimed to compare the tooth sensitivity, gingival irritation, and bleaching efficacy of at-home whitening performed with 10% hydrogen peroxide (HP) using a conventional tray-delivered system or two different bleaching systems (strips or prefilled disposable trays). METHODS AND MATERIALS:: Sixty patients, with maxillary incisors darker than A2 were selected for this single-blind, parallel randomized clinical trial. Teeth were bleached during 14 days with a 30-minute gel contact with teeth per day. The 10% HP was delivered in a bleaching tray (White Class, FGM) in strips (White Strips, Oral-B) or prefilled disposable trays (Opalescence Go, Ultradent). The color changes were evaluated by subjective (Vita Classical and Vita Bleachedguide) and objective (Easyshade Spectrophotometer) methods at baseline and 30 days after the second bleaching session. Tooth sensitivity was recorded during 14 days with a five-point numeric rating scale (NRS) and 0-10 visual analog scale (VAS). The risk of gingival irritation was also recorded during 14 days on a dichotomous scale. All data were submitted to appropriate statistical analysis (α=0.05). RESULTS:: No significant difference was observed in the risks of tooth sensitivity among groups ( p>0.09). However, the conventional bleaching tray produced a higher intensity of tooth sensitivity when compared with the strips and prefilled disposable tray systems ( p<0.04). Regarding gingival irritation, the prefilled disposable tray system showed a lower risk of gingival irritation when compared with the conventional bleaching tray ( p=0.003). Significant whitening was observed in all groups after 30 days of clinical evaluation with no significant difference between them ( p>0.06). CONCLUSIONS:: All 10% HP bleaching systems showed similar whitening after a 14-day use. However, the strips and prefilled disposable trays produced lower intensity of tooth sensitivity than the conventional bleaching tray system. The prefilled disposable tray produced lower risk of gingival irritation when compared to the conventional bleaching tray.

Combined spinal-epidural anesthesia with non-invasive ventilation during cesarean delivery of a woman with a recent diagnosis of amyotrophic lateral sclerosis.

Amyotrophic lateral sclerosis is the most common neurodegenerative upper and lower motor neuron disease in adults but is not common in women of child-bearing age. We present a case of a pregnant woman who was diagnosed with amyotrophic lateral sclerosis and developed respiratory distress at 32 weeks-of-gestation. She underwent a cesarean delivery under combined spinal-epidural anesthesia with non-invasive ventilation. This resulted in a successful outcome for both the mother and the baby.

Spermatogenesis in a neotropical marsupial species, Philander frenatus (Olfers, 1818).

Despite the singular morphology of the male genital system and the different reproductive strategies of marsupials, little emphasis has been given to the testis morphology and spermatogenic kinetics in this mammalian order. The present study aimed to investigate the testis function and the duration of spermatogenesis in the southeastern four-eyed opossum, Philander frenatus. Testes of six adult males were routinely processed for histological and stereological analyses. In order to determine the duration of spermatogenesis, intratesticular injections of tritiated thymidine were performed 1h, 13days and 21days before the sacrifice. Based on the development of the acrosomic system, ten stages of the seminiferous epithelium cycle were characterized. The mean body and testis weights for the P. frenatus were respectively 326±20g and 0.4±0.05g, providing a gonadosomatic index of 0.3±0.02%. The most advanced germ cell types labeled at 1h, 13days and 21days after thymidine injections were, respectively, preleptotene spermatocytes at stage IV, pachytene spermatocytes at stage IV and diplotene spermatocytes at stage IX. Based on the stages frequencies and the most advanced labeled germ cells, each spermatogenic cycle and the entire spermatogenic process lasted respectively 13.5±0.5 and 60.9±2.4days. When compared to the vast majority of eutherian mammals already investigated, these data indicate that the Philander frenatus presents a relatively long duration of spermatogenesis.

Use of Flowchart for Automation of Clinical Protocols in mHealth.

For healthcare professionals to use mobile applications we need someone who knows software development, provide them. In healthcare institutions, health professionals use clinical protocols to govern care, and sometimes these documents are computerized through mobile applications to assist them. This work aims to present a proposal of an application of flow as a way of describing clinical protocols for automatic generation of mobile applications to assist health professionals. The purpose of this research is to enable health professionals to develop applications from the description of their own clinical protocols. As a result, we developed a web system that automates clinical protocols for an Android platform, and we validated with two clinical protocols used in a Brazilian hospital. Preliminary results of the developed architecture demonstrate the feasibility of this study.

Serious Games for Parkinson's Disease Fine Motor Skills Rehabilitation Using Natural Interfaces.

Parkinson's Disease rehabilitation can be long and boring being difficult to maintain patient engagement on therapy programs. Novel technologies are allowing computer games to be played throught natural interfaces. This paper presents the development and assessment of a system of serious games for fine motor skills rehabilitation using natural interfaces. The games were assessed throught a questionnaire that evaluated the game experience through seven components: immersion, flow, competence, tension, challenge and positive and negative affect. In addition, a conceptual framework for development of serious games for fine motor skills rehabilitation was proposed. The results from the quantitative questionnaire suggested that the player experience was positive on all components assessed. Also, player experience between the three games was statistically the same, implying that the games can be used with consistency in a physical therapy rehabilitation program.

A Case-Based Study with Radiologists Performing Diagnosis Tasks in Virtual Reality.

In radiology diagnosis, medical images are most often visualized slice by slice. At the same time, the visualization based on 3D volumetric rendering of the data is considered useful and has increased its field of application. In this work, we present a case-based study with 16 medical specialists to assess the diagnostic effectiveness of a Virtual Reality interface in fracture identification over 3D volumetric reconstructions. We developed a VR volume viewer compatible with both the Oculus Rift and handheld-based head mounted displays (HMDs). We then performed user experiments to validate the approach in a diagnosis environment. In addition, we assessed the subjects' perception of the 3D reconstruction quality, ease of interaction and ergonomics, and also the users opinion on how VR applications can be useful in healthcare. Among other results, we have found a high level of effectiveness of the VR interface in identifying superficial fractures on head CTs.

Locally Adaptive Operators for Red Lesions Detection in Eye Fundus Images.

One of the major features required by automated software tools of screening for diabetic retinopathy is the detection of red lesions. This paper presents a new automatic method in order to locate red lesions in color eye fundus images. The method relies on mathematical morphology operators and has a coarse and a fine detection stages, respectively. The former detection stage detects structures of low-intensity values in the retina, such as microaneurysms, hemorrhages, blood vessels and the fovea center. Additionally, the latter stage proposes to improve the detection of red lesions identified in the previous stage. For experiments, we use the well-known publicly available DIARETDB1 database. The results indicate that our method detected red lesions with 75.81% and 93.48% of mean sensitivity and mean specificity, respectively.

Automatic Identification of Glaucoma Using Deep Learning Methods.

This paper proposes an automatic classification method to detect glaucoma in fundus images. The method is based on training a neural network using public image databases. The network used in this paper is the GoogLeNet, adapted for this proposal. The methodology was divided into two stages, namely: (1) detection of the region of interest (ROI); (2) image classification. We first used a sliding-window approach combined with the GoogLeNet network. This network was trained using manually extracted ROIs and other fundus image structures. Afterwards, another GoogLeNet model was trained using the previous resulting images. Then those images were used to train another GoogLeNet model to automatically detect glaucoma. To prevent overfitting, data augmentation techniques were used on smaller databases. The results demonstrated that the network had a good accuracy, even with poor quality images found in some databases or generated by the data augmentation algorithm.

CTdBem - A New Protocol for Ultra Low Radiation Dose MDCT.

This study describes a novel method of obtaining low-dose computed tomography (CT) scans followed by imaging postprocessing that provides diagnostic quality to such low-dose exams. In addition, we compared the Total Radiation Doses (DLP) of the 64-channel MDCT x 16-channel MDCT for a new Dental CT - CTdBem protocol for hospital use. DLP data obtained from 20 patients using 16-channel MDCT was compared with 20 other patients using 64-channel MDCT. In both tomographic (Aquilion 64 and Brightspeed 16) FOV was approximately 160(V) x 130(H) mm. An imaging postprocessing algorithm was used to provide diagnostic quality to the obtained low-dose CT scans. Imaging postprocessing included imaging smoothing, multiplanar reconstruction (MPR), and volume rendering (VR), as well as surface rendering (SR) to allow three-dimensional printing of the desired scans. The average DLPs were of 28,5 mGy.cm and 54,65 mGy.cm, using the 64-channel MDCT and 16-channel MDCT, respectively. The effective radiation dose (DLP) from the 64-channel MDCT statistically differs from the DLP data from 16-channel MDCT, resulting in a value of p < 0.05 for all comparisons. A novel low-dose CT protocol for dentomaxillofacial assessment using imaging postprocessing techniques is described. The authors concluded that although the DLP values differ statistically (p < 0.05), both equipment (64 and 16-channel MDCT) produce tomographic images of patients with low radiation doses. The greater the number of detectors, the lower the mAs product and, consequently, the amount of X-radiationproduced.

A Serious Game for Anterior Cruciate Ligament Rehabilitation: Software Development Aspects and Game Engagement Assessment.

This work presents the steps for developing a serious game that allows the interaction through natural gestures, whose main purpose is to contribute to the treatment of individuals who have suffered an injury to the anterior cruciate ligament (ACL). In addition to the serious game development process, the users' gaming experience were performed. Through the evaluation assessment, positive results were obtained in relation to various aspects of the game engagement, proving the playful factor of this activity.

Three Dimensional Virtual Planning Through Cone Beam Computed Tomography for Surgical Guidance Production.

This paper describes a methodology through digital planning and computed tomography for the purpose of making surgical guides for insertion of skeletal anchorage devices in dentistry. Mini-orthodontic screws for anchorage are inserted virtually in the region of interest located between the teeth of the second premolar and first molar bilaterally. DICOM images were converted to STL format and overlaid by scanning the upper plaster model in order to plan the surgical guide virtually.

Modeling a System for Generating Structured Reports.

The purpose of this research is to make the medical report generation process more practical, fast and reliable, both for the health professional and for the patient. We created an ontology and modeling of a structured report (SR) Standard DICOM SR.

Identification of molecular markers for oocyte competence in bovine cumulus cells.

Cumulus cells (CCs) have an important role during oocyte growth, competence acquisition, maturation, ovulation and fertilization. In an attempt to isolate potential biomarkers for bovine in vitro fertilization, we identified genes differentially expressed in bovine CCs from oocytes with different competence statuses, through microarray analysis. The model of follicle size, in which competent cumulus-oocyte complexes (COCs) were recovered from bigger follicles (≥8.0 mm in diameter) and less competent ones from smaller follicles (1-3 mm), was used. We identified 4178 genes that were differentially expressed (P < 0.05) in the two categories of CCs. The list was further enriched, through the use of a 2.5-fold change in gene expression as a cutoff value, to include 143 up-regulated and 80 down-regulated genes in CCs of competent COCs compared to incompetent COCs. These genes were screened according to their cellular roles, most of which were related to cell cycle, DNA repair, energy metabolism, metabolism of amino acids, cell signaling, meiosis, ovulation and inflammation. Three candidate genes up-regulated (FGF11, IGFBP4, SPRY1) and three down-regulated (ARHGAP22, COL18A1 and GPC4) in CCs from COCs of big follicles (≥8.1 mm) were selected for qPCR analysis. The selected genes showed the same expression patterns by qPCR and microarray analysis. These genes may be potential genetic markers that predict oocyte competence in in vitro fertilization routines.

An Optimized Superpixel Clustering Approach for High-Resolution Chest CT Image Segmentation.

Lung segmentation is a fundamental step in many image analysis applications for lung diseases and abnormalities in thoracic computed tomography (CT). However, due to the large variations in pathology that may be present in thoracic CT images, it is difficult to extract the lung regions accurately. A major insight to deal with this problem is the existence of new approaches to cope with quality and performance. This poster presents an optimized superpixel clustering approach for high-resolution chest CT segmentation. The proposed algorithm is compared against some super-pixel algorithms while a performance evaluation is carried out in terms of boundary recall and under-segmentation error metrics. The over-segmentation results on a CT Emphysema Database demonstrate that our approach shows better performance than other three state-of-the-art superpixel methods.

Automated Image Retrieval of Chest CT Images Based on Local Grey Scale Invariant Features.

Textual-based tools are regularly employed to retrieve medical images for reading and interpretation using current retrieval Picture Archiving and Communication Systems (PACS) but pose some drawbacks. All-purpose content-based image retrieval (CBIR) systems are limited when dealing with medical images and do not fit well into PACS workflow and clinical practice. This paper presents an automated image retrieval approach for chest CT images based local grey scale invariant features from a local database. Performance was measured in terms of precision and recall, average retrieval precision (ARP), and average retrieval rate (ARR). Preliminary results have shown the effectiveness of the proposed approach. The prototype is also a useful tool for radiology research and education, providing valuable information to the medical and broader healthcare community.

A Serious Game for Upper Limb Stroke Rehabilitation Using Biofeedback and Mirror-Neurons Based Training.

Upper limb stroke rehabilitation requires early, intensive and repetitive practice to be effective. Consequently, it is often difficult to keep patients committed to their rehabilitation regimen. In addition to direct measures of rehabilitation achievable through targeted assessments, other factors can indirectly lead to rehabilitation. Current levels of integration between commodity graphics software, hardware, and body-tracking devices have provided a reliable tool to build what are referred to as serious games, focusing on the rehabilitation paradigm. More specifically, serious games can captivate and engage players for a specific purpose such as developing new knowledge or skills. This paper discusses a serious game application with a focus on upper limb rehabilitation in patients with hemiplegia or hemiparesis. The game makes use of biofeedback and mirror-neurons to enhance the patient's engagement. Results from the application of a quantitative self-report instrument to assess in-game engagement suggest that the serious game is a viable instructional approach rather than an entertaining novelty and, furthermore, demonstrates the future potential for dual action therapy-focused games.

Evaluating the Impact of Player Experience in the Design of a Serious Game for Upper Extremity Stroke Rehabilitation.

Video games have become a major entertainment industry and one of the most popular leisure forms, ranging from laboratory experiments to a mainstream cultural medium. Indeed, current games are multimodal and multidimensional products, relying on sophisticated features including not only a narrative-driven story but also impressive graphics and detailed settings. All of these elements helped to create a seamless and appealing product that have resulted in a growing number of players and in the number of game genres. Although video games have been used in education, simulation, and training, another application that exploits serious gaming is the exploration of player experience in the context of game research. Recent advances in the natural user interfaces and player experience have brought new perspectives on the in-game assessment of serious games. This paper evaluates the impact of player experience in the design of a serious game for upper extremity stroke rehabilitation. The game combines biofeedback and mirror neurons both in single and multiplayer mode. Results have shown that the game is a feasible solution to integrate serious games into the physical therapy routine.

Local form-motion interactions influence global form perception.

Object motion perception depends on the integration of form and motion information into a unified neural representation. Historically, form and motion perception are thought to be independent processes; however, research has demonstrated that these processes interact in numerous and complex ways. For example, an object's orientation relative to its direction of motion will influence its perceived speed (Georges, Seriès, Frégnac, & Lorenceau, Vision Research 42:2757-2772, 2002). Here, we investigated whether this local form-motion interaction influences global form processing. In Experiment 1, we replicated the effect of orientation-dependent modulation of speed. In Experiment 2, we investigated whether the perceived speed of local elements could influence the perceived shape of a global object constructed from grouping of those elements. The results indicated that the orientation of local elements indeed influenced the perceived shape of a global object. We propose that inputs from local form-motion processes are one of perhaps many neural mechanisms underlying global form integration.