Evaluation of Inertial Sensor Data by a Comparison with Optical Motion Capture Data of Guitar Strumming Gestures.

Computing technologies have opened up a myriad of possibilities for expanding the sonic capabilities of acoustic musical instruments. Musicians nowadays employ a variety of rather inexpensive, wireless sensor-based systems to obtain refined control of interactive musical performances in actual musical situations like live music concerts. It is essential though to clearly understand the capabilities and limitations of such acquisition systems and their potential influence on high-level control of musical processes. In this study, we evaluate one such system composed of an inertial sensor (MetaMotionR) and a hexaphonic nylon guitar for capturing strumming gestures. To characterize this system, we compared it with a high-end commercial motion capture system (Qualisys) typically used in the controlled environments of research laboratories, in two complementary tasks: comparisons of rotational and translational data. For the rotations, we were able to compare our results with those that are found in the literature, obtaining RMSE below 10° for 88% of the curves. The translations were compared in two ways: by double derivation of positional data from the mocap and by double integration of IMU acceleration data. For the task of estimating displacements from acceleration data, we developed a compensative-integration method to deal with the oscillatory character of the strumming, whose approximative results are very dependent on the type of gestures and segmentation; a value of 0.77 was obtained for the average of the normalized covariance coefficients of the displacement magnitudes. Although not in the ideal range, these results point to a clearly acceptable trade-off between the flexibility, portability and low cost of the proposed system when compared to the limited use and cost of the high-end motion capture standard in interactive music setups.

ORBDA: An openEHR benchmark dataset for performance assessment of electronic health record servers.

The openEHR specifications are designed to support implementation of flexible and interoperable Electronic Health Record (EHR) systems. Despite the increasing number of solutions based on the openEHR specifications, it is difficult to find publicly available healthcare datasets in the openEHR format that can be used to test, compare and validate different data persistence mechanisms for openEHR. To foster research on openEHR servers, we present the openEHR Benchmark Dataset, ORBDA, a very large healthcare benchmark dataset encoded using the openEHR formalism. To construct ORBDA, we extracted and cleaned a de-identified dataset from the Brazilian National Healthcare System (SUS) containing hospitalisation and high complexity procedures information and formalised it using a set of openEHR archetypes and templates. Then, we implemented a tool to enrich the raw relational data and convert it into the openEHR model using the openEHR Java reference model library. The ORBDA dataset is available in composition, versioned composition and EHR openEHR representations in XML and JSON formats. In total, the dataset contains more than 150 million composition records. We describe the dataset and provide means to access it. Additionally, we demonstrate the usage of ORBDA for evaluating inserting throughput and query latency performances of some NoSQL database management systems. We believe that ORBDA is a valuable asset for assessing storage models for openEHR-based information systems during the software engineering process. It may also be a suitable component in future standardised benchmarking of available openEHR storage platforms.

AD-SISCOLO: a decision-support tool to aid the management of a cervical cancer screening program

AbstractIntroduction: This paper aims to develop a data warehouse (AD-SISCOLO) in order to support the management of the cervical cancer screening program in the municipality of Rio de Janeiro/Brazil. As a part of the management process, the program managers of the municipality perform tedious manual work in order to calculate a series of performance indicators and then take decisions based on them. Methods AD-SISCOLO was implemented using the Pentaho BI Suite Business Intelligence Platform and the MySQL database management system. The indicators to be calculated and visualized in the tool were based on the municipal data of the cytopathology and histopathology tests from January 2012 until December 2014, which was obtained from the Information System of Cervical Cancer (SISCOLO) after a record linkage process. The follow-up indicators were based on a simplified version of the Brazilian guidelines for the cervical cancer screening. Results AD-SISCOLO allows the visualization of a set of test-based and follow-up indicators from different views and dimensions, which enable managers to monitor all the phases of the screening process and to identify the process' failures. Conclusions Compared with the current available environments in Brazil, AD-SISCOLO is unique in its visualization of the follow-up indicators of groups of women, according to their test results and age. Thereby it provides presentation flexibility to suit the program manager's needs.

Comparing the Performance of NoSQL Approaches for Managing Archetype-Based Electronic Health Record Data.

This study provides an experimental performance evaluation on population-based queries of NoSQL databases storing archetype-based Electronic Health Record (EHR) data. There are few published studies regarding the performance of persistence mechanisms for systems that use multilevel modelling approaches, especially when the focus is on population-based queries. A healthcare dataset with 4.2 million records stored in a relational database (MySQL) was used to generate XML and JSON documents based on the openEHR reference model. Six datasets with different sizes were created from these documents and imported into three single machine XML databases (BaseX, eXistdb and Berkeley DB XML) and into a distributed NoSQL database system based on the MapReduce approach, Couchbase, deployed in different cluster configurations of 1, 2, 4, 8 and 12 machines. Population-based queries were submitted to those databases and to the original relational database. Database size and query response times are presented. The XML databases were considerably slower and required much more space than Couchbase. Overall, Couchbase had better response times than MySQL, especially for larger datasets. However, Couchbase requires indexing for each differently formulated query and the indexing time increases with the size of the datasets. The performances of the clusters with 2, 4, 8 and 12 nodes were not better than the single node cluster in relation to the query response time, but the indexing time was reduced proportionally to the number of nodes. The tested XML databases had acceptable performance for openEHR-based data in some querying use cases and small datasets, but were generally much slower than Couchbase. Couchbase also outperformed the response times of the relational database, but required more disk space and had a much longer indexing time. Systems like Couchbase are thus interesting research targets for scalable storage and querying of archetype-based EHR data when population-based use cases are of interest.

Integrating Brazilian health information systems in order to support the building of data warehouses

AbstractIntroductionThis paper's aim is to develop a data warehouse from the integration of the files of three Brazilian health information systems concerned with the production of ambulatory and hospital procedures for cancer care, and cancer mortality. These systems do not have a unique patient identification, which makes their integration difficult even within a single system.MethodsData from the Brazilian Public Hospital Information System (SIH-SUS), the Oncology Module for the Outpatient Information System (APAC-ONCO) and the Mortality Information System (SIM) for the State of Rio de Janeiro, in the period from January 2000 to December 2004 were used. Each of the systems has the monthly data production compiled in dbase files (dbf). All the files pertaining to the same system were then read into a corresponding table in a MySQL Server 5.1. The SIH-SUS and APAC-ONCO tables were linked internally and with one another through record linkage methods. The APAC-ONCO table was linked to the SIM table. Afterwards a data warehouse was built using Pentaho and the MySQL database management system.ResultsThe sensitivities and specificities of the linkage processes were above 95% and close to 100% respectively. The data warehouse provided several analytical views that are accessed through the Pentaho Schema Workbench.ConclusionThis study presented a proposal for the integration of Brazilian Health Systems to support the building of data warehouses and provide information beyond those currently available with the individual systems.

Systematization of information for identifying similar cardiovascular implantable devices

Introduction The lack of a terminology to compare medical devices together with the arbitrary and opaque nature of product registration systems are major obstacles to a more informed decision process regarding the use and acquisition of new medical devices. This paper describes the systematization of information to help in the identification of similar cardiovascular implantable devices. Methods The systematization was developed in four stages: definition of the technical attributes of each device group; classification of a sample of devices; implementation of the proposed systematization in Protégé; and evaluation of the application. The systematization dealt with a set of common attributes – indication of use, anatomic location, manufacturer, device model and lifetime; and a set of attributes specific for each type of device. Results The systematization was performed by means of a hierarchy of classes with the respective properties in Protégé, which support three basic functions: data entry, query, and maintenance. 38 queries were designed to allow the identification of similar devices according to their technical characteristics. The users’ evaluation showed that the application fulfilled the requirements to monitor the price of these devices on the market. Conclusions Protégé was a useful tool for the systematization of cardiovascular implantable devices that can be used for the post-market vigilance of medical device safety. To better fulfill this aim, other attributes may be incorporated to better characterize the safety aspects of these devices.

Name segmentation using hidden Markov models and its application in record linkage.

This study aimed to evaluate the use of hidden Markov models (HMM) for the segmentation of person names and its influence on record linkage. A HMM was applied to the segmentation of patient's and mother's names in the databases of the Mortality Information System (SIM), Information Subsystem for High Complexity Procedures (APAC), and Hospital Information System (AIH). A sample of 200 patients from each database was segmented via HMM, and the results were compared to those from segmentation by the authors. The APAC-SIM and APAC-AIH databases were linked using three different segmentation strategies, one of which used HMM. Conformity of segmentation via HMM varied from 90.5% to 92.5%. The different segmentation strategies yielded similar results in the record linkage process. This study suggests that segmentation of Brazilian names via HMM is no more effective than traditional segmentation approaches in the linkage process.

A record linkage process of a cervical cancer screening database.

This paper aims at to present the integration of the files of the Brazilian Cervical Cancer Information System (SISCOLO) in order to identify all women in the system. SISCOLO has the exam as the unit of observation and the women are not uniquely identified. It has two main tables: histology and cytology, containing the histological and cytological examinations of women, respectively. In this study, data from June 2006 to December 2009 were used. Each table was linked with itself and with the other through record linkage methods. The integration identified 6236 women in the histology table and 1,678,993 in the cytology table. 5324 women from the histology table had records in the cytology table. The sensitivities were above 90% and the specificities and precisions near 100%. This study showed that it is possible to integrate SISCOLO to produce indicators for the evaluation of the cervical cancer screening programme taking the woman as the unit of observation.

Modeling healthcare authorization and claim submissions using the openEHR dual-model approach.

BACKGROUND: The TISS standard is a set of mandatory forms and electronic messages for healthcare authorization and claim submissions among healthcare plans and providers in Brazil. It is not based on formal models as the new generation of health informatics standards suggests. The objective of this paper is to model the TISS in terms of the openEHR archetype-based approach and integrate it into a patient-centered EHR architecture. METHODS: Three approaches were adopted to model TISS. In the first approach, a set of archetypes was designed using ENTRY subclasses. In the second one, a set of archetypes was designed using exclusively ADMIN_ENTRY and CLUSTERs as their root classes. In the third approach, the openEHR ADMIN_ENTRY is extended with classes designed for authorization and claim submissions, and an ISM_TRANSITION attribute is added to the COMPOSITION class. Another set of archetypes was designed based on this model. For all three approaches, templates were designed to represent the TISS forms. RESULTS: The archetypes based on the openEHR RM (Reference Model) can represent all TISS data structures. The extended model adds subclasses and an attribute to the COMPOSITION class to represent information on authorization and claim submissions. The archetypes based on all three approaches have similar structures, although rooted in different classes. The extended openEHR RM model is more semantically aligned with the concepts involved in a claim submission, but may disrupt interoperability with other systems and the current tools must be adapted to deal with it. CONCLUSIONS: Modeling the TISS standard by means of the openEHR approach makes it aligned with ISO recommendations and provides a solid foundation on which the TISS can evolve. Although there are few administrative archetypes available, the openEHR RM is expressive enough to represent the TISS standard. This paper focuses on the TISS but its results may be extended to other billing processes. A complete communication architecture to simulate the exchange of TISS data between systems according to the openEHR approach still needs to be designed and implemented.

[An information system to integrate outpatient cancer care data in the Unified National Health System]. / Sistema de informação para integrar os dados da assistência oncológica ambulatorial do Sistema Unico de Saúde.

This study focuses on the development of a system to integrate monthly outpatient cancer care data in the Unified National Health System (SUS). The system was modeled to retrace the treatment evolution in each cancer case and services output, with the following advantage: the system focuses on the cancer case, does not require knowledge by the user in order to handle the database, and allows updating the base as new data emerge. The results of direct queries in the system were identical to those obtained from direct inspection of the original database and those from another integration approach. The use of a tool with these characteristics by public administrators can help improve the quality of outpatient cancer care provided by the National Health System.

Sistema de informação para integrar os dados da assistência oncológica ambulatorial do Sistema Único de Saúde / An information system to integrate outpatient cancer care data in the Unified National Health System

Este trabalho visa ao desenvolvimento de um sistema para integrar os dados da produção mensal da assistência oncológica ambulatorial no Sistema Único de Saúde (SUS). O sistema foi modelado para recuperar a evolução do tratamento de cada caso de câncer e a produção dos serviços, tendo como vantagens: ser orientado ao caso de câncer, não requerer do usuário conhecimentos para a manipulação de bancos de dados e permitir a atualização da base à medida que novos dados vão surgindo. Os resultados das consultas ao sistema, quando comparados com os obtidos na inspeção direta da base original e com os obtidos com outra rotina de integração, foram idênticos. A utilização de uma ferramenta com essas características pelos gestores públicos pode contribuir para a melhoria da gestão da assistência oncológica ambulatorial prestada pelo SUS.

This study focuses on the development of a system to integrate monthly outpatient cancer care data in the Unified National Health System (SUS). The system was modeled to retrace the treatment evolution in each cancer case and services output, with the following advantage: the system focuses on the cancer case, does not require knowledge by the user in order to handle the database, and allows updating the base as new data emerge. The results of direct queries in the system were identical to those obtained from direct inspection of the original database and those from another integration approach. The use of a tool with these characteristics by public administrators can help improve the quality of outpatient cancer care provided by the National Health System.

Conceitos demográficos e suas representações nos sistemas de informação em saúde. / Demographic concepts and their representations in Health Information Systems.

Este artigo tem como objetivo apresentar um conjunto de conceitos demográficos e uma proposta de representação destes conceitos em sistemas de informação por meio de arquétipos.Foram analisados as normas internacionais ISO TR 20514, TS 22220 e ISO TS 27527, e diversos modelos demográficos da fundação openEHR, e avaliados os atributos para representar as informações demográficas de diversos sistemas de informação públicos do país, bem como opadrão TISS utilizado na troca de informação da saúde suplementar. A partir dessas análises, é proposto um conjunto de arquétipos que permitem a representação dos conceitos demográficos em sistemas de informação de modo a satisfazer os requisitos das normas nacionais e internacionais.Os arquétipos permitem a evolução dos sistemas sem necessidade de reformular seus modelos demográficos.

This article aims at presenting a set of demographic concepts and a proposal of archetypes for representing these concepts in information systems. The international standards ISO TR 20514, TS 22220 and ISO TS 27527, along with several demographic models were studied, as well ashow the demographic information is represented in several Brazilian public information systems, as well as the TISS standard, used on Brazilian supplementary health services information exchange. From these analyses, a set of archetypes were designed to allow the representation of demographic concepts in health information systems so that they meet the national and international standards requirements. The archetypes allow the evolution of information systems without demanding reformulation of their demographic models.

Relação entre índice de resistência obtido pela ultra-sonografia Doppler transfortanela e o neurodesenvolvimento até o primeiro ano de vida em recém-nascidos a termo com encefalopatia hipóxico-isquêmica leve e moderada / Relation between the resistance index obtained by the transfontanellar Doppler ultrasonography and the neurological development until the first year of life in term infants with mild or moderate hypoxic-ischaemic encephalopathy

OBJETIVO: Avaliar a relação do índice de resistência (IR) obtido pela ultra-sonografia Doppler transfontanela com o neurodesenvolvimento até um ano de idade, em recém-nascidos (RN) a termo com encefalopatia hipóxica-isquêmica (EHI) leve a moderada, secundária à asfixia intra-parto. MÉTODO: Estudo prospectivo em 20 RN com EHI leve a moderada, IR elevado no primeiro exame de Doppler, e sem doenças associadas ou anormalidades morfológicas cerebrais. Foram realizados exames seriados bimensais de Doppler transfontanela a partir do sétimo dia de vida, e avaliações clínicas mensais do neurodesenvolvimento no primeiro ano de vida. RESULTADOS: Houve normalização progressiva dos valores de IR até o último exame realizado. Cinco pacientes apresentaram normalização clínico-neurológica no período neonatal, após o primeiro exame de Doppler. Quinze lactentes apresentaram alterações neurológicas com resolução a partir do segundo trimestre de vida. CONCLUSÃO: Houve relação entre os períodos em que ocorreu a normalização dos valores de IR e a melhora clínica-neurológica.

OBJECTIVE: To evaluate the relation between the resistance index (RI) obtained by transfontanellar Doppler ultrasonography, and the neurodevelopment until one year of life, at term newborns with mild or moderate hypoxic-ischaemic encephalopathy due to intrapartum asphyxia. METHOD: 20 term newborns, with mild or moderate hypoxic-ischemic encephalopathy, high values of resistance index in the first exam, and without cerebral morfologic abnormalities or other diseases. They were submitted to serial bimonthly transfontanellar Doppler ultrasonography, from the seventh day of life on, and monthly clinical neurodevelopment assessment until one year of life. RESULTS: There was a progressive normalization of RI values until the last examination. In five cases there were clinical neurologic normalization in the neonatal period after the first Doppler exam. Fifteen infants presented neurologic abnormalities, with normalization after the second trimester of life. CONCLUSION: There was a relation between the normal RI values with the normalization of the clinical assessment.

[Relation between the resistance index obtained by the transfontanellar Doppler ultrasonography and the neurological development until the first year of life in term infants with mild or moderate hypoxic-ischaemic encephalopathy]. / Relação entre índice de resistência obtido pela ultra-sonografia Doppler transfortanela e o neurodesenvolvimento até o primeiro ano de vida em recém-nascidos a termo com encefalopatia hipóxico-isquêmica leve e moderada.

OBJECTIVE: To evaluate the relation between the resistance index (RI) obtained by transfontanellar Doppler ultrasonography, and the neurodevelopment until one year of life, at term newborns with mild or moderate hypoxic-ischaemic encephalopathy due to intrapartum asphyxia. METHOD: 20 term newborns, with mild or moderate hypoxic-ischemic encephalopathy, high values of resistance index in the first exam, and without cerebral morfologic abnormalities or other diseases. They were submitted to serial bimonthly transfontanellar Doppler ultrasonography, from the seventh day of life on, and monthly clinical neurodevelopment assessment until one year of life. RESULTS: There was a progressive normalization of RI values until the last examination. In five cases there were clinical neurologic normalization in the neonatal period after the first Doppler exam. Fifteen infants presented neurologic abnormalities, with normalization after the second trimester of life. CONCLUSION: There was a relation between the normal RI values with the normalization of the clinical assessment.

Marcadores séricos de cartilagem na artrite reumatóide avançada / Serum cartilage biomarkers in late rheumatoid arthritis

O objetivo deste trabalho foi avaliar o valor clínico de dois novos marcadores séricos de cartilagem em pacientes com artrite reumatóide crônica. Cento e quarenta pacientes foram seguidos por um período médio de 12 anos e avaliados para a presença de glicoproteína-39 de cartilagem humana e para matrix de proteína oligomérica sérica e seu respectivo coeficiente de correlação entre os marcadores e um escore de atividade da doença. Os valores médios da matrix de proteína oligomérica sérica e glicoproteína-39 de cartilagem humana foram, respectivamente, 9 ± 6 ug/ml e 36 ± 16 ug/ml (p > 0,001) quando comparados aos controles. Uma correlação positiva foi observada entre os escores de atividade da doença e os biomarcadores (r = 0,67 para a glicoproteína-39 de cartilagem humana e r = 0,83 para a matrix de proteína oligomérica sérica). Conclusão: O presente estudo mostrade maneira inequívoca que pacientes com artrite reumatóide de longa duração mostram valores séricos mais elevados de marcadores bioquímicos do metabolismo da cartilagem e umacorrelação positiva com o escore de atividade da doença.

Avaliação da proteína amilóide A sérica na atividade clínica da artrite reumatóide / Evaluation of the serum amyloid A protein in the rheumatoid arthritis clinical activity

A artrite reumatóide (AR) é uma doença auto-imune, crônica, caracterizada pelo comprometimento inflamatório das articulações sinoviais periféricas. A proteína amilóide A sérica (SAA) é uma das principais proteínas de fase aguda (PFA), porém seu uso na rotina do laboratório clínico ainda é pouco difundido. Objetivo: O objetivo deste trabalho foi analisar a utilidade da SAA na avaliação da atividade clínica da AR. Métodos: Foram estudados 113 pacientes com AR, diagnosticados segundo os critérios do Colégio Americano de Reumatologia. Para a caracterização da atividade de doença, foi utilizado o Índice de Atividade de Doença (IAD), proposto pela Liga Européia Contra o Reumatismo. Resultados: A SAA apresentou correlação positiva, estatisticamente significativa, com a proteína C-Reativa (PCR), tanto como a alfa-1-glicoproteína ácida (AGP), quanto com o IAD. Nossos resultados demonstraram que a SAA apresentou, particularmente, uma maior sensibilidade na determinação da atividade inflamatória da AR, em comparação às outras PFA. Apresentou, também, uma boa capacidade de discriminar os grupos de atividade moderada e alta do IAD. Como o IAD não mede unicamente o componente inflamatório do AR, a dosagem de uma PFA é de grande utilidade para a caracterização da atividade dessa enfermidade. Conclusões: Os resultados deste estudo sugerem que a SAA pode ser de grande valor na determinação da atividade inflamatória da AR

Utilização do processo de enfermagem em centros de terapia intensiva no Rio de Janeiro como subsídio à implantação de prontuário eletrônico / The nursing process and its application in intensive care at Rio de Janeiro as a support to the development of an electronic patient record

Esse estudo teve por objetivo avaliar a utilização do processo de enfermagem em centros de terapia intensiva na região metropolitana do Rio de Janeiro, de modo a identificar as condições potenciais para a informatização dessas unidades. Foram realizadas entrevistas com 27 enfermeiras líderes de equipe, no período de janeiro a julho de 2003. As entrevistas revelaram que: o processo de enfermagem não era utilizado na íntegra, sistematicamente não incluindo o diagnóstico de enfermagem; 13 centros possuíam formulários de prescrição de enfermagem, mas apenas 11 cederam seus formulários; e 5 centros possuíam algum tipo de sistema informatizado. Dos formulários obtidos, foram identificadas 128 diferentes ações de enfermagem com alta variabilidade de uso e inexistência de padrões para o registro da informação. Diante deste quadro, conclui-se que as condições para a informatização do processo de enfermagem nestes centros não são adequadas.

This study aims at evaluating the utilization of the nursing process in intensive care units in the metropolitan area of Rio de Janeiro, in order to identify the potential conditions for the deployment of a computerized system in those units. Interviews with 27 nursing team leaders were performed in the period from January to July 2003. The interviews revealed that: the nursing process was not fully implemented and not systematically including the nursing diagnostic stage; 13 units had nursing prescription forms, but only 11 released them; and, 5 units used some type of computerized information system. From the forms so obtained, 128 different nursing actions were identified with high variability of use and no existence of standards for data recording. In this scenario, it can be concluded that the conditions for a computerized system for the nursing process are not adequate.

Caracterização imunofenotípica dos leucócitos presentes na urina de pacientes com nefropatia lúpica em atividade / Immunophenotypic characterization of leukocytes present in urine of patients with active lupus nephropathy

O objetivo deste estudo foi determinar a expressão fenotípica dos leucócitos presentes na urina de pacientes com lúpus eritematoso sistêmico (LES) e nefrite em atividade. Foram selecionados 12 pacientes com glomerulonefrite membranosa. O critério utilizado para classificação de atividade sistêmica foi o SLEDAI (índice de atividade de doença para o LES), cuja média foi de 18,2 pontos. A presença de nefrite ativa foi definida por critérios histológicos, alterações do sedimento urinário, desenvolvimento recente de proteinúria e/ou perda aguda da função renal. A fenotipagem com anticorpos monoclonais (ACMo) e fosfatase alcalina, aplicada em lâminas com citocentrifugado de amostra da urina, foi o método empregado para a classificação das subpopulações de leucócitos urinários. Encontrou-se predomínio de células CD14 positivas (monócitos/macrófagos) nos pacientes com LES 56,8 por cento dos leucócitos urinários). A segunda subpopulação mais frequente foi a de células CD3 CD14 CD20-CD45 + (a maioria provavelmente granulócitos) e os linfócitos T representaram 8,1 por cento do total de leucócitos (teste de Wilcoxon com correção de Bonferroni - p < 0,016). Evidenciou-se uma associação positiva entre exsudação leucocitária glomerular e excreção urinária de linfócitos CD8 + (p = 0,01). Esses resultados reforçam os indícios sugestivos da participação das células de linhagem macrofágica na fisiopatologia da lesão renal proliferativa no LES