A tecnologia a favor da educação continuada no implante coclear / Technology in favor of continuous professional development in cochlear implant

RESUMO Objetivo avaliar a teleconsulta de forma síncrona no mapeamento do implante coclear (IC) como ferramenta de educação continuada para fonoaudiólogos em capacitação e treinamento. Métodos estudo prospectivo longitudinal, na modalidade de preceptorado clínico, com teleconsulta de forma síncrona direcionada ao atendimento de mapeamento dos usuários de IC. A educação continuada foi oferecida aos fonoaudiólogos aprimorandos em um hospital e o fonoaudiólogo tutor, em unidade remota. A plataforma utilizada permitiu ao tutor visualizar e realizar intervenções na tela de mapeamento do IC. Foram aplicados três questionários abrangendo os marcadores de ensino; qualidade e importância da teleconsulta; interação entre os profissionais e autoavaliação sobre a confiança na realização das etapas do mapeamento antes e após as teleconsultas. Resultados participaram sete fonoaudiólogos e foram analisados 268 atendimentos, ao longo de três anos. Os marcadores clínicos mostraram, na média e individualmente, que houve correlação estatística com diminuição do número de intervenções totais, nas intervenções do mapeamento do IC e raciocínio clínico, no decorrer das sessões. A média das notas nas avaliações da importância da teleconsulta foi 9,7 e a interação com o tutor, 9,3. Na autoavaliação, todos os aprimorandos responderam que estavam "nada/pouco confiantes" para as etapas do mapeamento antes da intervenção e, ao final do curso, responderam "moderadamente/muito confiantes" para as mesmas etapas. Conclusão o uso da teleconsulta síncrona foi viável e eficiente como ferramenta de ensino para fonoaudiólogos. Foi possível observar a diminuição do número de intervenções ao longo do tempo, evidenciando a curva de aprendizado.

ABSTRACT Purpose To evaluate the teleconsultation synchronously in the mapping of the cochlear implant (CI) as an ongoing professional development tool in training programmes for audiologists. Methods It was a prospective longitudinal study, in the form of clinical preceptor with teleconsultation in a synchronous way directed at assisting the mapping of CI users. Distance learning was offered to fellow audiologists in a hospital and the audiology tutor in the remote unit. The chosen platform allowed the tutor to view and perform interventions on the CI mapping screen. Three questionnaires covering teaching markers were applied; the quality and importance of teleconsultation; interaction between professionals; and self-assessment of confidence in carrying out the mapping steps before and after teleconsultations. Results Seven audiologists participated; 268 consultations were analyzed over three years. The clinical markers showed, on average and individually, that there is a statistical correlation with a decrease in the number of total interventions, in the interventions of CI mapping and clinical reasoning throughout the sessions. The average of the scores of the importance of teleconsultation was 9.7 and the interaction with the tutor was 9.3. In the self-assessment, all audiologists responded that they were "not at all/not very confident" for the mapping steps before the intervention, and at the end of the course they responded "moderately/very confident" for the same steps. Conclusion The use of synchronous teleconsultation was feasible and efficient as a teaching tool for audiologists. It was possible to observe the decrease in the number of interventions over time, evidencing the learning curve.

Application of remote sensing technology in medicinal plant resources / 中国中药杂志

The sustainable use of medicinal plants is the foundation of the inheritance of traditional Chinese medicine(TCM) and the acquisition of information on medicinal plants is the basis for the development of TCM. The traditional methods of investigating medicinal plant resources are disadvantageous in strong subjectivity and poor timeliness, making it difficult to real-time monitor medicinal plant resources. In recent years, remote sensing technology has become an important means of obtaining information on medicinal plants. The application of this technology has made up for the shortcomings of traditional methods. The open-access remote sensing data with medium spatial resolution satellites provide an opportunity for extracting information on medicinal plant resources. This study firstly introduced the principles of remote sensing technology, summarized the satellites and the parameters commonly used in the field of medicinal plant resources, and compared the survey methods of remote sensing technology with traditional methods. Secondly, it reviewed the applications of remote sensing technology in the extraction of information on the cultivation of medicinal plants and the common methods for extracting the planting structure information of medicinal plants based on remote sensing technology. Thirdly, the applications of remote sensing technology in the investigation and monitoring of medicinal plants were further analyzed with the research objects divided into wild and cultivated medicinal plants according to the characteristics of the habitats. Finally, it pointed out the key unsolved technical problems in the remote sensing monitoring of medicinal plant resources, and proposed solutions for the intelligent information processing of medicinal plants based on remote sensing big data, which is expected to provide references for the development of remote sensing technology in derivative application in medicinal plant resources.

Progress of spatial epidemiology applied to prevention and control of schistosomiasis / 中国血吸虫病防治杂志

Schistosomiasis is one of the key diseases of surveillance and prevention in China. The elimination of schistosomiasis is of great significance to people’s health and social economy. With the development of spatial epidemiology, progress has been made in the spatial distribution of schistosomiasis, the prediction of spatial and temporal trends, and analysis of the environmental factors. This paper reviews the application of spatial epidemiology in the control and prevention of schistosomiasis and introduces the spatio-temporal distribution methods, spatial model, and application of remote sensing technology.

Internet of Things Applied in Healthcare Based on Open Hardware with Low-Energy Consumption / 대한의료정보학회지

OBJECTIVES: The Internet of Things (IoT) and its applications are growing simultaneously. These applications need new intelligent devices along heterogeneous networking. Which makes them costly to implement indeed. Platforms and open devices designed for open-source hardware are possible solutions. This research was conducted under an IoT design, implementation, and assessment model for the remote monitoring of pulse oximetry via oxygen partial saturation (SpO2) and heart rate (HR) with low-energy consumption. METHODS: This study focused on the development of SpO2 and HR measurements that will allow the monitoring and estimation in real time of the user's state and health related to the established parameters. Measurements were acquired and recorded using a remote web server that recorded the acquired variables for further processing. The statistical analysis data allows comparison of the registered data measured with theoretical models. RESULTS: The IoT model was developed use Bluetooth low-energy devices, which comply with low-cost and open-hardware solutions operated via ‘HTTP requests’ for data transmission and reception from a cloud server to an edge device. Network performance assessment was conducted to guarantee the availability and integrity of the acquired values and signals. The system measured SpO2 and HR variables. The most significant result was to achieve energy consumption 20% lower than that of devices in the market. CONCLUSIONS: In summary, the acquired data validation based on the IoT model had a transmission error of 0.001% which proves its applicability in healthcare.

Usefulness of remote Monitoring of Pediatric Patients with Cardiac implantable electronic devices / Utilidad de los dispositivos cardíaco-eléctricos con monitoreo a distancia en pacientes pediátricos

ABSTRACT: Background: The aim of this study is to evaluate the usefulness of cardiac implantable electronic devices with remote monitoring system in a pediatric population and the limitations of its implementation in Argentina. Methods: Twenty-seven patients receiving a cardiac implantable electronic device with remote monitoring system at Hospital Nacional Garrahan and Hospital Italiano de Buenos Aires were included in the study. The rate of events, complications and device-related therapies were evaluated. The anticipated actions taken in response to alert notifications were described. Mean follow-up was 46.6 ± 32.1 months. results: Median age was 12.2 years (IQR: 8.75-13.3). An implantable cardioverter defibrillator device was placed in 7 patients (25.9%) and 20 (74%) underwent pacemaker implant. Five patients (18.5%) presented seven red alerts: 3 due to ventricular arrhyth-mia in monitoring zone of ventricular fibrillation and 4 due to lead dysfunction. Twelve patients (44%) presented a yellow alert: 6 due to lead dysfunction, 4 due to deactivation of the monitoring system because of lack of signal reception, one due to ventricular tachycardia and another with sinus tachycardia in monitoring zone of ventricular tachycardia. Active actions were taken in 9 pa-tients (33.3%) to manage the alert notification: the atrial lead was replaced in one patient and the ventricular in lead in another; in 2 patients non-compliance with pharmacological treatment and exercise limitation were detected and in the rest of the patients, the device was reprogrammed according to the abnormalities observed in the recording or capture. Conclusions: Remote monitoring of cardiac implantable electronic devices is very useful in the pediatric population, allowing for the rapid detection and management of device failure or significant arrhythmias.

RESUMEN: Objetivo: Evaluar la utilidad de los dispositivos cardíacos eléctricos con sistema de monitoreo a distancia en una población pediátrica y las limitaciones de su implementación en la República Argentina. Material y métodos: Se incluyeron 27 pacientes a quienes se le implantó un dispositivo cardíaco-eléctrico implantable con sistema de monitoreo a distancia en el Hospital Nacional Garrahan y en el Hospital Italiano de Bs. As. Se evaluó la tasa de eventos, complicaciones y terapias por parte de los dispositivos. Se describieron las conductas anticipadas según la alerta recibida. Se realizó un seguimiento medio de 46,6 meses ± 32,1. resultados: La edad fue 12,2 años (RIC: 8,75-13,3), a 7 pacientes (28%) se les implantó un cardiodesfibrilador implantable y 20 pacientes (78%) un marcapaso endocavitario. Cinco pacientes (18,5%) presentaron 7 alertas rojas: 3 por arritmia ventricular en rango de fibrilación ventricular y 4 por alteraciones en alguno de los cables. Doce pacientes (44%) presentaron una alerta amarilla: 6, por alteraciones en los cables; 4, por desactivación del sistema por falta de recepción de señal; 1, por taquicardia ventricular; y 1, por taquicardia sinusal en rango de taquicardia ventricular. En 9 pacientes (33,3%) se tomó una conducta activa para resolver el aviso de alerta: en 2 pacientes se realizó recambio de cable auricular en uno y ventricular en otro, en 2 pacientes se detectó incumplimiento del tratamiento farmacológico y en la limitación del ejercicio, en el resto se reprogramó el dispositivo, según el tipo de alteración en el registro o la captura. Conclusiones: El sistema de monitoreo remoto de los dispositivos cardíaco-eléctricos implantables es muy útil en la población pediátrica, lo que permite una rápida detección y acción cuando se produce un fallo en el dispositivo o un evento arrítmico de relevancia clínica.

Uso e cobertura do solo e prevalência de leishmaniose visceral canina em Teresina, Piauí, Brasil: uma abordagem utilizando sensoriamento remoto orbital / Uso y cobertura del suelo y prevalencia de leishmaniosis visceral canina en Teresina, Piauí, Brasil: un enfoque utilizando teledetección / Land use, land cover, and prevalence of canine visceral leishmaniasis in Teresina, Piauí State, Brazil: an approach using orbital remote sensing

Resumo: Este estudo examina a associação entre uso e cobertura do solo e a ocorrência de leishmaniose visceral (LV) canina. Estudo caso-controle em que casos foram residências com cães soropositivos para LV canina e controles, as residências com cães soronegativos. Utilizaram-se imagens de sensoriamento remoto (CBERS: 2/CCD e 2B/HRC) para descrever o uso e cobertura do solo em quadrículas de 625m2 na região do estudo. A chance da LV canina foi duas vezes maior em domicílios localizados em quadrículas com área ≤ 25m2 coberta por estruturas residenciais com pouca vegetação em comparação com aquelas em que essa cobertura alcançou ≥ 600m2. Domicílios localizados em quadrículas com até metade da área coberta por estruturas residenciais com muita vegetação tiveram chances 65% menores de LV canina em comparação com aquelas situadas em áreas quase totalmente cobertas por essa característica. Como a infecção canina costuma preceder a ocorrência de casos humanos, a identificação de características de uso e cobertura do solo associadas à LV canina pode contribuir para a delimitação de áreas de risco para LV humana.

Resumen: Este estudio examina la asociación entre uso y cobertura del suelo y la ocurrencia de leishmaniosis visceral (LV) canina. Es un estudio de caso-control, donde los casos fueron analizados en residencias con perros seropositivos para LV canina y controles, además de residencias con perros seronegativos. Se utilizaron imágenes de teledetección (CBERS: 2/CCD e 2B/HRC) para describir el uso y cobertura del suelo en cuadrículas de 625m2 en la región del estudio. La oportunidad de la LV canina fue dos veces mayor en domicilios localizados en cuadrículas con un área ≤ 25m2, cubierta por estructuras residenciales con poca vegetación, en comparación con aquellas donde esa cobertura alcanzó ≥ 600m2. Los domicilios localizados en cuadrículas con hasta la mitad del área cubierta por estructuras residenciales con mucha vegetación tuvieron oportunidades un 65% menores de LV canina, en comparación con aquellas situadas en áreas casi totalmente cubiertas por esa característica. Como la infección canina acostumbra preceder la ocurrencia de casos humanos, la identificación de las características de uso y cobertura del suelo, asociadas a la LV canina, puede contribuir a la delimitación de áreas de riesgo para LV humana.

Abstract: This study examines the association between land use and land cover and the occurrence of canine visceral leishmaniasis (VL). This is a case-control study in which cases were households with seropositive dogs for canine VL and controls were households with seronegative dogs. We used remote sensing images (CBERS: 2/CCD and 2B/HRC) to describe land use and cover in squares of 625m2 in the study area. Odds of canine VL were twice as high in households located in squares with an area ≤ 25m2 covered by residential structures with little vegetation in comparison to those where the cover reached ≥ 600m2. Households located in squares with up to half of the area covered by residential structures with extensive vegetation showed 65% lower odds of canine VL in comparison to those situated in areas almost totally covered by this characteristic. Since canine infection usually precedes the occurrence de human cases, identification of the characteristics of land use and cover associated with canine VL can contribute to the demarcation of risk areas for human VL.

Propuesta de una solución tecnológica como alternativa a los problemas de saturación en las salas de urgencias de Bogotá, Colombia / Proposal of a technological solution to overcrowding in emergency departments of Bogotá, Colombia

En este trabajo ofrecemos una propuesta de solución tecnológica al problema asociado a la saturación de las salas de urgencias en Bogotá. Se realizó un estudio diagnóstico durante el primer semestre del año 2015 en tres servicios de urgencias de Bogotá. Del estudio realizado se pudo determinar que existen elevados tiempos de atención y asimetrías de información entre los diferentes actores del sistema. Asimismo, se observó que el sistema de atención primaria no está coordinado con el de atención de urgencias, lo que crea incentivos para acudir directamente a este servicio. La solución propuesta consiste en un sistema no invasivo al sistema de urgencias, que se compone principalmente de: 1) dispositivos inteligentes de medición de signos vitales, 2) un sistema de telecomunicaciones, 3) un servidor para el procesamiento y análisis de los datos y generación de alertas. Con esta solución se busca contribuir con la reducción de la asimetría de información.

A proposal is presented of a technological solution to overcrowding in emergency departments of Bogotá. A diagnostic study was conducted at three emergency departments of Bogotá during the first semester of the year 2015. The study revealed that waiting times are long and there is information asymmetry between the various actors in the system. It was also found that the primary care system is not well coordinated with the emergency services, creating an incentive for patients to go directly to the latter. The solution proposed is a non-invasive system to support the emergency service, which is mainly composed of: 1) smart devices for the measurement of vital signs, 2) a telecommunications system, 3) a server for data processing and analysis, and alert generation. This solution is expected to contribute to reduce information asymmetry.

Anopheles fauna of coastal Cayenne, French Guiana: modelling and mapping of species presence using remotely sensed land cover data

Little is known about the Anopheles species of the coastal areas of French Guiana, or their spatiotemporal distribution or environmental determinants. The present study aimed to (1) document the distribution of Anopheles fauna in the coastal area around Cayenne, and (2) investigate the use of remotely sensed land cover data as proxies of Anopheles presence. To characterise the Anopheles fauna, we combined the findings of two entomological surveys that were conducted during the period 2007-2009 and in 2014 at 37 sites. Satellite imagery data were processed to extract land cover variables potentially related to Anopheles ecology. Based on these data, a methodology was formed to estimate a statistical predictive model of the spatial-seasonal variations in the presence of Anopheles in the Cayenne region. Two Anopheles species, known as main malaria vectors in South America, were identified, including the more dominant An. aquasalis near town and rural sites, and An. darlingi only found in inland sites. Furthermore, a cross-validated model of An. aquasalis presence that integrated marsh and forest surface area was extrapolated to generate predictive maps. The present study supports the use of satellite imagery by health authorities for the surveillance of malaria vectors and planning of control strategies.

Uma abordagem para a transmissão de sinal cardíaco através de bluetooth e servidor em nuvem / An approach to the transmission of cardiac signals through bluetooth and cloud server

O mundo de hoje vive uma revolução nos conceitos que envolvem a disponibilidade de informação em qualquer lugar, a qualquer tempo, para qualquer plataforma. Muitos sistemas de monitoramento fazem uso destas novas técnicas a fim de melhorar a vida de pacientes e otimizar o tempo na rotina dos profissionais da saúde. Já há alguns anos, diferentes tipos de tecnologias de comunicação sem fio de curta distância vêm sendo desenvolvidas para trabalharem com sinais fisiológicos, de modo a ser possível transmitir os dados para um dispositivo móvel. De outro lado, dispositivos móveis sofreram uma revolução invisível na última década com a implantação na quase maioria deles de sistemas operacionais embarcados como o Android, suficientemente rápidos para o processamento necessário aos aplicativos de hoje. Atualmente pode-se também armazenar dados em servidores remotos, de forma a possibilitar o processamento a posteriori das informações. Dentre os aplicativos que podem fazer uso combinado destas técnicas estão os aplicativos para a área da engenharia médica e hospitalar. Este trabalho apresenta uma solução tecnológica embarcada que utiliza todas estas novas tecnologias em um único produto final que visa uma solução para receber o sinal de eletrocardiografia(ECG), até tratá-lo, transmití-lo localmente com controle de fluxo de dados, visualizá-los na tela e transmití-los para um servidor remoto.

The world today faces a revolution concerning many new concepts in different areas that can be used fore Health in order to make the information available any where, anytime as well as to multiple platform systems. Over the years many technological solutions have been developed to improve systems responsible for patient´s quality of life and to optimize the daily routine for doctors, nurses and all related professionals. In one hand there have been developed recent short range low power wireless transmission technologies suitable for the local transmission of physiological signals from patients to nearby mobile devices. On the other hand there have been huge advances in mobile systems concerning their operational systems as well as their embedded hardware. Also new ways of turning the information available have become suitable for the new technologies in what concerns the web. Among all types of mobile applications that may use those new technological resources are the ones related to medical and health care systems. This paper presents a solution for local transmissions of an ECG signal over Bluetooth with flow and error control, and alsoits transmission over the internet to a remote application. This paper had the concern with the timeline signal, so that lost packages, due to eventual lost of Bluetooth transmissions, can be tracked. The developed system sends the signal for an online or offline read of it, as the signals itself is stored in a remote cloud server.

Systemic Hemodynamic Atherothrombotic Syndrome and Resonance Hypothesis of Blood Pressure Variability: Triggering Cardiovascular Events

Blood pressure (BP) exhibits different variabilities and surges with different time phases, from the shortest beat-by-beat to longest yearly changes. We hypothesized that the synergistic resonance of these BP variabilites generates an extraordinarily large dynamic surge in BP and triggers cardiovascular events (the resonance hypothesis). The power of pulses is transmitted to the peripheral sites without attenuation by the large arteries, in individuals with stiffened arteries. Thus, the effect of a BP surge on cardiovascular risk would be especially exaggerated in high-risk patients with vascular disease. Based on this concept, our group recently proposed a new theory of systemic hemodynamic atherothromboltic syndrome (SHATS), a vicious cycle of hemodynamic stress and vascular disease that advances organ damage and triggers cardiovascular disease. Clinical phenotypes of SHATS are large-artery atherothombotic diseases such as stroke, coronary artery disease, and aortic and pheripheral artery disease; small-artery diseases, and microcirculation-related disease such as vascular cognitive dysfunction, heart failure, and chronic kidney disease. The careful consideration of BP variability and vascular diseases such as SHATS, and the early detection and management of SHATS, will achieve more effective individualized cardiovascular protection. In the near future, information and communication technology-based 'anticipation medicine' predicted by the changes of individual BP values could be a promising approach to achieving zero cardiovascular events.

Systemic Hemodynamic Atherothrombotic Syndrome and Resonance Hypothesis of Blood Pressure Variability: Triggering Cardiovascular Events

Blood pressure (BP) exhibits different variabilities and surges with different time phases, from the shortest beat-by-beat to longest yearly changes. We hypothesized that the synergistic resonance of these BP variabilites generates an extraordinarily large dynamic surge in BP and triggers cardiovascular events (the resonance hypothesis). The power of pulses is transmitted to the peripheral sites without attenuation by the large arteries, in individuals with stiffened arteries. Thus, the effect of a BP surge on cardiovascular risk would be especially exaggerated in high-risk patients with vascular disease. Based on this concept, our group recently proposed a new theory of systemic hemodynamic atherothromboltic syndrome (SHATS), a vicious cycle of hemodynamic stress and vascular disease that advances organ damage and triggers cardiovascular disease. Clinical phenotypes of SHATS are large-artery atherothombotic diseases such as stroke, coronary artery disease, and aortic and pheripheral artery disease; small-artery diseases, and microcirculation-related disease such as vascular cognitive dysfunction, heart failure, and chronic kidney disease. The careful consideration of BP variability and vascular diseases such as SHATS, and the early detection and management of SHATS, will achieve more effective individualized cardiovascular protection. In the near future, information and communication technology-based 'anticipation medicine' predicted by the changes of individual BP values could be a promising approach to achieving zero cardiovascular events.

Classificação orientada a objeto de imagens de sensoriamento remoto em estudos epidemiológicos sobre leishmaniose visceral em área urbana / Object-oriented remote sensing image classification in epidemiological studies of visceral leishmaniasis in urban areas / Clasificación orientada a objetos procedentes de imágenes satélite en los estudios epidemiológicos sobre leishmaniasis visceral en zonas urbanas

Neste estudo, explorou-se o uso da classificação orientada a objeto de imagens de sensoriamento remoto em estudos epidemiológicos sobre leishmaniose visceral (LV) em áreas urbanas. A classificação orientada a objeto foi aplicada a cenas Landsat 5 TM da cidade de Teresina, Piauí, Brasil, para obtenção de informações ambientais e temperatura. Para o período de 1993-1996, a taxa de incidência de LV nos setores censitários da cidade foi positivamente correlacionada com a área do setor censitário coberta por vegetação densa, rasteira e solo exposto e negativamente com a área coberta por água e áreas densamente ocupadas. No período de 2001-2006, foram encontradas correlações positivas com vegetação densa, rasteira, solo exposto e áreas densamente ocupadas e negativas com áreas urbanas com alguma vegetação. A temperatura da superfície terrestre foi negativamente associada à incidência de LV nos dois períodos. A classificação orientada a objeto pode ser útil para caracterizar paisagens associadas à ocorrência da LV em áreas urbanas e delimitar áreas de risco para definição de prioridades na implementação de intervenções.

This study explored the use of object-oriented classification of remote sensing imagery in epidemiological studies of visceral leishmaniasis (VL) in urban areas. To obtain temperature and environmental information, an object-oriented classification approach was applied to Landsat 5 TM scenes from the city of Teresina, Piauí State, Brazil. For 1993-1996, VL incidence rates correlated positively with census tracts covered by dense vegetation, grass/pasture, and bare soil and negatively with areas covered by water and densely populated areas. In 2001-2006, positive correlations were found with dense vegetation, grass/pasture, bare soil, and densely populated areas and negative correlations with occupied urban areas with some vegetation. Land surface temperature correlated negatively with VL incidence in both periods. Object-oriented classification can be useful to characterize landscape features associated with VL in urban areas and to help identify risk areas in order to prioritize interventions.

Este estudio investigó el uso de la clasificación orientada a objetos de imágenes satélite en estudios epidemiológicos acerca de la leishmaniasis visceral (LV) en zonas urbanas. Se aplicó la clasificación orientada a objetos en escenas Landsat 5 TM de la ciudad de Teresina, Piauí, Brasil, para obtener información ambiental y temperatura. De 1993 a 1996, la tasa de incidencia de LV en los sectores censales de la ciudad se correlacionó positivamente con el área del sector censal cubierto por vegetación densa, pastos y suelo desnudo, y negativamente con el área cubierta por agua y zonas densamente pobladas. De 2001 a 2006 se han encontrado correlaciones positivas con vegetación densa, vegetación tipo maleza, suelo desnudo y zonas densamente pobladas; y negativas con áreas urbanas con poca vegetación. La temperatura se asoció negativamente con la incidencia de la LV en ambos períodos. La clasificación orientada a objetos puede ser útil para caracterizar los paisajes asociados a la ocurrencia de la LV en áreas urbanas y delimitar zonas de riesgo para establecer prioridades de intervención.