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1.
Occup Med (Lond) ; 73(9): 581-583, 2023 12 30.
Artigo em Inglês | MEDLINE | ID: mdl-38016183

RESUMO

Occupational asthma triggered by inhaling fish-derived aerosols is estimated to affect 2-8% of exposed individuals. This primarily affects workers in the fish processing industry. Fishmongers, rarely experience this issue, as recent research found no significant difference in asthma rates compared to a control group. We report the case of a fishmonger who presented with a 1-year history of rhinoconjunctivitis and asthma. The patient attributed these symptoms to his occupational exposure within the fish market environment, which worsened in the cold storage warehouse. Symptoms improved during holidays. Diagnosis involved skin-prick tests, sIgE (ImmunoCAP-specific IgE) measurements, and bronchial challenge tests, confirming occupational asthma from fish bioaerosol exposure. Parvalbumins, common fish proteins, share structural similarities, leading to cross-reactivity in fish allergy sufferers. In this case, sensitivity to rGad c1 (cod parvalbumin) was identified as the primary trigger for the patient's asthma, and responsible for sensitizations observed across various tested fish species.


Assuntos
Asma Ocupacional , Hipersensibilidade Alimentar , Doenças Profissionais , Exposição Ocupacional , Humanos , Asma Ocupacional/induzido quimicamente , Asma Ocupacional/diagnóstico , Imunoglobulina E , Testes Cutâneos , Parvalbuminas , Testes de Provocação Brônquica , Exposição Ocupacional/efeitos adversos , Doenças Profissionais/diagnóstico , Doenças Profissionais/etiologia , Alérgenos/efeitos adversos
2.
Sci Rep ; 12(1): 6451, 2022 04 25.
Artigo em Inglês | MEDLINE | ID: mdl-35468982

RESUMO

Probainognathia is a derived lineage of cynodonts which encompass Mammalia as their crown-group. The rich record of probainognathians from the Carnian of Argentina contrasts with their Norian representation, with only one named species. Here we describe a new probainognathian, Tessellatia bonapartei gen. et sp. nov., from the Norian Los Colorados Formation of the Ischigualasto-Villa Unión Basin of Argentina. The new taxon, represented by a partial cranium with associated lower jaws, was analyzed through neutron and X-rays micro-tomography (µCT). The high-resolution neutron µCT data allowed the identification of a unique character combination, including features inaccessible through traditional techniques. We constructed the largest phylogenetic data matrix of non-mammalian cynodonts. The new species and its sister taxon, the Brazilian Therioherpeton cargnini, are recovered as probainognathians, closely related to Mammaliamorpha. We conducted the first quantitative paleobiogeographic analysis of non-mammalian cynodonts, focusing in probainognathians. The results indicate that Probainognathia and Mammaliamorpha originated in southwestern Gondwana (in the Brazilian Paraná Basin), which was an important center of diversification during the Triassic. Finally, the Chinese Lufeng Basin is identified as the ancestral area of Mammaliaformes. These new findings, besides adding to the knowledge of the poorly represented Norian cynodonts from the Los Colorados Formation, are significant to improve our understanding of probainognathian diversity, evolution, and paleobiogeographic history.


Assuntos
Fósseis , Mamíferos , Animais , Argentina , Brasil , Colorado , Filogenia
4.
Physiol Meas ; 36(10): 2171-87, 2015 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-26365469

RESUMO

Determination of body fluids is a useful common practice in determination of disease mechanisms and treatments. Bioimpedance spectroscopy (BIS) methods are non-invasive, inexpensive and rapid alternatives to reference methods such as tracer dilution. However, they are indirect and their robustness and validity are unclear. In this article, state of the art methods are reviewed, their drawbacks identified and new methods are proposed. All methods were tested on a clinical database of patients receiving growth hormone replacement therapy. Results indicated that most BIS methods are similarly accurate (e.g. < 0.5 ± 3.0% mean percentage difference for total body water) for estimation of body fluids. A new model for calculation is proposed that performs equally well for all fluid compartments (total body water, extra- and intracellular water). It is suggested that the main source of error in extracellular water estimation is due to anisotropy, in total body water estimation to the uncertainty associated with intracellular resistivity and in determination of intracellular water a combination of both.


Assuntos
Líquidos Corporais/química , Espectroscopia Dielétrica/métodos , Composição Corporal , Espaço Extracelular/química , Humanos , Espaço Intracelular/química , Água/análise
5.
Artigo em Inglês | MEDLINE | ID: mdl-26736953

RESUMO

Heart rate variability (HRV) biofeedback is a method based on paced breathing at specific rate called resonance frequency by giving online feedbacks from user respiration and its effect on HRV. Since the HRV is also influence by different factors like stress and emotions, stress related to an unfamiliar measurement device, cables and skin electrodes may cover the underling effect of such kind of intervention. Wearable systems are usually considered as intuitive solutions which are more familiar to the end-user and can help to improve usability and hence reducing the stress. In this work, a prototype of a knitted garment using intarsia technique is developed and evaluated. Results show the satisfactory level of quality for Electrocardiogram and thoracic electrical bioimpedance i.e. for respiration monitoring as a part of HRV biofeedback system. Using intarsia technique and conductive yarn for making the connection instead of cables will reduce the complexity of fabrication in textile production and hence reduce the final costs in a final commercial product. Further development of garment and Android application is ongoing and usability and efficiency of final prototype will be evaluated in detail.


Assuntos
Biorretroalimentação Psicológica/métodos , Vestuário , Frequência Cardíaca/fisiologia , Impedância Elétrica , Eletrocardiografia , Humanos , Respiração , Fatores de Tempo
6.
Annu Int Conf IEEE Eng Med Biol Soc ; 2015: 3707-10, 2015 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-26737098

RESUMO

Electrical bioimpedance has been used for several decades to assess body fluid distribution and body composition by using single frequency and bioimpedance spectroscopic (BIS) techniques. It remains uncertain whether BIS methods have better performance compare to single frequency regression equations. In this work the performance of two BIS methods and four different 50 kHz single frequency prediction equations was studied in a data set of wrist-to-ankle tetrapolar BIS measurements (5-1000 kHz) together with reference values of total body water obtained by tritium dilution in 92 patients. Data were compared using regression techniques and Bland-Altman plots. The results of this study showed that all methods produced similarly high correlation and concordance coefficients, indicating good accuracy as a method. Limits of agreement analysis indicated that the population level performance of Sun's prediction equations was very similar to the performance of both BIS methods. However, BIS methods in practice have slightly better predictive performance than the single-frequency equations as judged by higher correlation and the limits of agreement from the Bland-Altman analysis. In any case, the authors believe that an accurate evaluation of performance of the methods cannot be done as long as the evaluation is done using Bland-Altman analysis, the commonly accepted technique for this kind of performance comparisons.


Assuntos
Água Corporal , Espectroscopia Dielétrica/métodos , Idoso , Tornozelo/fisiologia , Artefatos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Análise de Regressão , Trítio , Punho/fisiologia
7.
Physiol Meas ; 35(7): 1373-95, 2014 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-24854791

RESUMO

The estimation of body fluids is a useful and common practice for assessment of disease status and therapy outcomes. Electrical bioimpedance spectroscopy (EBIS) methods are noninvasive, inexpensive and efficient alternatives for determination of body fluids. One of the main source of errors in EBIS measurements in the estimation of body fluids is capacitive coupling. In this paper an analysis of capacitive coupling in EBIS measurements was performed and the robustness of the different immittance spectra against it tested. On simulations the conductance (G) spectrum presented the smallest overall error, among all immittance spectra, in the estimation of the impedance parameters used to estimate body fluids. Afterwards the frequency range of 10-500 kHz showed to be the most robust band of the G spectrum. The accuracy of body fluid estimations from the resulting parameters that utilized G spectrum and parameters provided by the measuring device were tested on EBIS clinical measurements from growth hormone replacement therapy patients against estimations performed with dilution methods. Regarding extracellular fluid, the correlation between each EBIS method and dilution was 0.93 with limits of agreement of 1.06 ± 2.95 l for the device, 1.10 ± 2.94 l for G [10-500 kHz] and 1.04 ± 2.94 l for G [5-1000 kHz]. Regarding intracellular fluid, the correlation between dilution and the device was 0.91, same as for G [10-500 kHz] and 0.92 for G [5-1000 kHz]. Limits of agreement were 0.12 ± 4.46 l for the device, 0.09 ± 4.45 for G [10-500 kHz] and 0.04 ± 4.58 for G [5-1000 kHz]. Such close results between the EBIS methods validate the proposed approach of using G spectrum for initial Cole characterization and posterior clinical estimation of body fluids status.


Assuntos
Composição Corporal , Espectroscopia Dielétrica/métodos , Algoritmos , Composição Corporal/efeitos dos fármacos , Líquidos Corporais/efeitos dos fármacos , Líquidos Corporais/fisiologia , Simulação por Computador , Bases de Dados Factuais , Capacitância Elétrica , Impedância Elétrica , Líquido Extracelular/fisiologia , Estudos de Viabilidade , Feminino , Hormônio do Crescimento/uso terapêutico , Terapia de Reposição Hormonal , Humanos , Líquido Intracelular/fisiologia , Masculino , Pessoa de Meia-Idade , Modelos Biológicos , Análise de Regressão
8.
Artigo em Inglês | MEDLINE | ID: mdl-25570716

RESUMO

The reduced Heart Rate Variability (HRV) is believed to be associated with several diseases such as congestive heart failure, diabetes and chronic kidney diseases (CKD). In these cases, HRV biofeedback may be a potential intervention method to increase HRV which in turn is beneficial to these patients. In this work, a real-time Android biofeedback application based on a Bluetooth enabled ECG and thoracic electrical bioimpedance (respiration) measurement device has been developed. The system performance and usability have been evaluated in a brief study with eight healthy volunteers. The result demonstrates real-time performance of system and positive effects of biofeedback training session by increased HRV and reduced heart rate. Further development of the application and training protocol is ongoing to investigate duration of training session to find an optimum length and interval of biofeedback sessions to use in potential interventions.


Assuntos
Biorretroalimentação Psicológica/instrumentação , Eletrônica/instrumentação , Frequência Cardíaca/fisiologia , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem
9.
Artigo em Inglês | MEDLINE | ID: mdl-24109748

RESUMO

Personalised Health Systems (PHS) that could benefit the life quality of the patients as well as decreasing the health care costs for society among other factors are arisen. The purpose of this paper is to study the capabilities of the System-on-Chip Impedance Network Analyser AD5933 performing high speed single frequency continuous bioimpedance measurements. From a theoretical analysis, the minimum continuous impedance estimation time was determined, and the AD5933 with a custom 4-Electrode Analog Front-End (AFE) was used to experimentally determine the maximum continuous impedance estimation frequency as well as the system impedance estimation error when measuring a 2R1C electrical circuit model. Transthoracic Electrical Bioimpedance (TEB) measurements in a healthy subject were obtained using 3M gel electrodes in a tetrapolar lateral spot electrode configuration. The obtained TEB raw signal was filtered in MATLAB to obtain the respiration and cardiogenic signals, and from the cardiogenic signal the impedance derivative signal (dZ/dt) was also calculated. The results have shown that the maximum continuous impedance estimation rate was approximately 550 measurements per second with a magnitude estimation error below 1% on 2R1C-parallel bridge measurements. The displayed respiration and cardiac signals exhibited good performance, and they could be used to obtain valuable information in some plethysmography monitoring applications. The obtained results suggest that the AD5933-based monitor could be used for the implementation of a portable and wearable Bioimpedance plethysmograph that could be used in applications such as Impedance Cardiography. These results combined with the research done in functional garments and textile electrodes might enable the implementation of PHS applications in a relatively short time from now.


Assuntos
Pletismografia/métodos , Cardiografia de Impedância/instrumentação , Impedância Elétrica , Eletrodos , Humanos , Monitorização Fisiológica , Pletismografia/instrumentação
10.
Magn Reson Chem ; 51(10): 649-54, 2013 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-24038382

RESUMO

A novel data-evaluation procedure for the automatic atom to peak or multiplet assignment of 1H-NMR spectra of small molecules has been developed using a fast and robust expert system. The applicability and reliability of the method are demonstrated by comparison of a manually assigned database of 1H-NMR spectra with the assignments produced by the automatic procedure. The results of this analysis show an excellent success ratio, indicating that this new algorithm can have a major impact as a time saving tool for the organic chemist. A new graphical feature used to illustrate both the stability and quality of the elementary assignments is also introduced.

11.
Eur J Clin Nutr ; 67 Suppl 1: S22-7, 2013 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-23299868

RESUMO

BACKGROUND/OBJECTIVES: Functional garments for physiological sensing purposes have been used in several disciplines, that is, sports, firefighting, military and medicine. In most of the cases, textile electrodes (textrodes) embedded in the garment are used to monitor vital signs and other physiological measurements. Electrical bioimpedance (EBI) is a non-invasive and effective technology that can be used for the detection and supervision of different health conditions.EBI technology could make use of the advantages of garment integration; however, a successful implementation of EBI technology depends on the good performance of textrodes. The main drawback of textrodes is a deficient skin-electrode interface that produces a high degree of sensitivity to signal disturbances. This sensitivity can be reduced with a suitable selection of the electrode material and an intelligent and ergonomic garment design that ensures an effective skin-electrode contact area. SUBJECTS/METHODS: In this work, textrode functional straps for total right side EBI measurements for body composition are presented, and its measurement performance is compared against the use of Ag/AgCl electrodes. Shieldex sensor fabric and a tetra-polar electrode configuration using the ImpediMed spectrometer SFB7 in the frequency range of 3-500 kHz were used to obtain and analyse the impedance spectra and Cole and body composition parameters. RESULTS: The results obtained show stable and reliable measurements; the slight differences obtained with the functional garment do not significantly affect the computation of Cole and body composition parameters. CONCLUSIONS: The use of a larger sensor area, a high conductive material and an appropriate design can compensate, to some degree, for the charge transfer deficiency of the skin-electrode interface.


Assuntos
Antropometria/métodos , Composição Corporal , Vestuário , Espectroscopia Dielétrica/métodos , Impedância Elétrica , Eletrodos , Têxteis , Humanos , Masculino , Mercúrio , Monitorização Fisiológica/métodos , Reprodutibilidade dos Testes , Pele
12.
Physiol Meas ; 33(8): 1363-77, 2012 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-22828035

RESUMO

Hypothermia has been proven as an effective rescue therapy for infants with moderate or severe neonatal hypoxic ischemic encephalopathy. Hypoxia-ischemia alters the electrical impedance characteristics of the brain in neonates; therefore, spectroscopic analysis of the cerebral bioimpedance of the neonate may be useful for the detection of candidate neonates eligible for hypothermia treatment. Currently, in addition to the lack of reference bioimpedance data obtained from healthy neonates, there is no standardized approach established for bioimpedance spectroscopy data analysis. In this work, cerebral bioimpedance measurements (12 h postpartum) in a cross-section of 84 term and near-term healthy neonates were performed at the bedside in the post-natal ward. To characterize the impedance spectra, Cole parameters (R(0), R(∞), f(C) and α) were extracted from the obtained measurements using an analysis process based on a best measurement and highest likelihood selection process. The results obtained in this study complement previously reported work and provide a standardized criterion-based method for data analysis. The availability of electrical bioimpedance spectroscopy reference data and the automatic criterion-based analysis method might support the development of a non-invasive method for prompt selection of neonates eligible for cerebral hypothermic rescue therapy.


Assuntos
Automação , Cérebro/fisiologia , Espectroscopia Dielétrica/métodos , Eletrodos , Feminino , Humanos , Recém-Nascido , Masculino , Padrões de Referência , Software
14.
Artigo em Inglês | MEDLINE | ID: mdl-23365848

RESUMO

Electrical Bioimpedance Spectroscopy (EBIS) is currently used in different tissue characterization applications. In this work we aim to use EBIS to study changes in electrical properties of the cerebral tissues after an incident of hemorrhage/ischemic stroke. To do so a case-control study was conducted using six controls and three stroke cases. The preliminary results of this study show that by using Cole-based analysis on EBIS measurements and analyzing the Cole parameters R(0) and R(∞), it is possible to detect changes on electrical properties of cerebral tissue after stroke.


Assuntos
Isquemia Encefálica/fisiopatologia , Hemorragias Intracranianas/fisiopatologia , Monitorização Fisiológica/instrumentação , Monitorização Fisiológica/métodos , Acidente Vascular Cerebral/fisiopatologia , Adulto , Impedância Elétrica , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
15.
Artigo em Inglês | MEDLINE | ID: mdl-23365954

RESUMO

This paper presents a novel frequency distribution scheme intended to provide more accurate estimations of Cole parameters. Nowadays a logarithmic frequency distribution is mostly used in Electrical Bioimpedance Spectroscopy (EBIS) applications. However it is not optimized following any criterion. Our hypothesis is that an EBIS signal contains more information where the variation of the measurement regarding the frequency is larger; and that there ought to be more measuring frequencies where there is more information. Results show that for EBIS data with characteristic frequencies up to 200 kHz the error obtained with both frequency distribution schemes is similar. However, for EBIS data with higher values of characteristic frequency the error produced when estimating the values from EBIS measurements using an adaptive frequency distribution is smaller. Thus it may useful for EBIS applications with high values of characteristic frequency, e.g. cerebral bioimpedance.


Assuntos
Espectroscopia Dielétrica/métodos , Encéfalo/metabolismo , Espectroscopia Dielétrica/estatística & dados numéricos , Impedância Elétrica , Humanos , Análise dos Mínimos Quadrados , Dinâmica não Linear
16.
Artigo em Inglês | MEDLINE | ID: mdl-23366648

RESUMO

One of the most common measurement artifacts present in Electrical Bioimpedance Spectroscopy measurements (EBIS) comes from the capacitive leakage effect resulting from parasitic stray capacitances. This artifact produces a deviation in the measured impedance spectrum that is most noticeable at higher frequencies. The artifact taints the spectroscopy measurement increasing the difficulty of producing reliable EBIS measurements at high frequencies. In this work, an approach for removing such capacitive influence from the spectral measurement is presented making use of a novel method to estimate the value of the parasitic capacitance equivalent that causes the measurement artifact. The proposed method has been tested and validated theoretically and experimentally and it gives a more accurate estimation of the value of the parasitic capacitance than the previous methods. Once a reliable value of parasitic capacitance has been estimated the capacitive influence can be easily compensated in the EBIS measured data. Thus enabling analysis of EBIS data at higher frequencies, i.e. in the range of 300-500 kHz like measurements intended for cerebral monitoring, where the characteristic frequency is remarkably higher than EBIS measurements i.e. within the range 30 to 50 kHz, intended for body composition assessment.


Assuntos
Encéfalo/fisiologia , Impedância Elétrica , Artefatos , Humanos
17.
Artigo em Inglês | MEDLINE | ID: mdl-22254694

RESUMO

Electrical Bioimpedance Spectroscopy (EBIS) has been widely used for assessment of total body composition and fluid distribution. (EBIS) measurements are commonly performed with electrolytic electrodes placed on the wrist and the ankle with a rather small skin-electrode contact area. The use of textile garments for EBI requires the integration of textrodes with a larger contact area surrounding the limbs in order to compensate the absence of electrolytic medium commonly present in traditional Ag/AgCl gel electrodes. Recently it has been shown that mismatch between the measurements electrodes might cause alterations on the EBIS measurements. When performing EBIS measurements with textrodes certain differences have been observed, especially at high frequencies, respect the same EBIS measurements using Ag/AgCl electrodes. In this work the influence of increasing the skin-electrode area on the estimation of body composition parameters has been studied performing experimental EBIS measurement. The results indicate that an increment on the area of the skin-electrode interface produced noticeable changes in the bioimpedance spectra as well as in the body composition parameters. Moreover, the area increment showed also an apparent reduction of electrode impedance mismatch effects. This influence must be taken into consideration when designing and testing textile-enable EBIS measurement systems.


Assuntos
Composição Corporal/fisiologia , Espectroscopia Dielétrica/instrumentação , Eletrodos , Pletismografia de Impedância/métodos , Fenômenos Fisiológicos da Pele , Desenho Assistido por Computador , Desenho de Equipamento , Análise de Falha de Equipamento , Humanos , Reprodutibilidade dos Testes , Sensibilidade e Especificidade , Propriedades de Superfície
18.
Artigo em Inglês | MEDLINE | ID: mdl-22255040

RESUMO

Advances on System-On-Chip and Textile technology allows the development of Textile-enabled measurement instrumentation. Textile Electrodes (Textrodes) have been proven reliable for performing Electrical Bioimpedance Spectroscopy (EBIS) measurements, and the availability of a integrated circuit impedance spectrometer, the AD5933, has allowed the implementation of small size EBIS spectrometers. In this work an AD5933-based spectrometer has been implemented, and its performance on 2R1C circuits and for tetrapolar total right side EBIS measurements has been compared against the commercially available spectrometer SFB7. The study has been focused on the working upper frequency range and the estimation of the Cole parameters required for assessment of body fluid distribution: R(0) and R(∞). The results indicate that AD5933-based spectrometer implemented in this work can perform accurate impedance measurements well above the upper limits recommended in the datasheet. The AD5933-EBIS presents a good performance compared with the SFB7 on the 2R1C circuit and the total right side measurements, showing a smaller error in the resistance spectrum and small deviation error in the reactance when measuring over 270 kHz. The comparison on the Cole parameters estimation obtained with the SFB7 and the AD5933-based spectrometer exhibit a difference below 1% for the estimation of R(0) and R(∞). Consequently the overall measurement performance shown by the implemented AD5933-based spectrometer suggests its feasible use for EBIS measurements using dry Textrodes. This is of special relevance for the proliferation of EBI-based personalized health monitoring systems for patients that require to monitor the distribution of body fluids, like in dialysis.


Assuntos
Espectroscopia Dielétrica/instrumentação , Têxteis , Eletrodos
19.
Artigo em Inglês | MEDLINE | ID: mdl-21096699

RESUMO

Electrical Bioimpedance (EBI) is one of the non-invasive monitoring technologies that could benefit from the emerging textile based measurement systems. If reliable and reproducible EBI measurements could be done with textile electrodes, that would facilitate the utilization of EBI-based personalized healthcare monitoring applications. In this work the performance of a custom-made dry-textile electrode prototype is tested. Four-electrodes ankle-to-wrist EBI measurements have been taken on healthy subjects with the Impedimed spectrometer SFB7 in the frequency range 5 kHz to 1 MHz. The EBI spectroscopy measurements taken with dry electrodes were analyzed via the Cole and Body Composition Analysis (BCA) parameters, which were compared with EBI measurements obtained with standard electrolytic electrodes. The analysis of the obtained results indicate that even when dry textile electrodes may be used for EBI spectroscopy measurements, the measurements present remarkable differences that influence in the Cole parameter estimation process and in the final production of the BCA parameters. These initial results indicate that more research work must be done to in order to obtain a textile-based electrode that ensures reliable and reproducible EBI spectroscopy measurements.


Assuntos
Tornozelo , Composição Corporal/fisiologia , Impedância Elétrica , Monitorização Ambulatorial/métodos , Têxteis , Punho , Humanos
20.
Artigo em Inglês | MEDLINE | ID: mdl-19964893

RESUMO

Home e-health systems and services are revealed as one of the most important challenges to promote Quality of Life related to Health in the Information Society. Leading companies have worked on e-health systems although the majority of them are addressed to hospital or primary care settings. The solution detailed in this paper offers a personal health system to be integrated with Smart Home services platform to support home based e-care. Thus, the home e-health system and architecture detailed in this research work is ready to supply a seamless personal care solution both from the biomedical data analysis, service provision, security guarantee and information management s point of view. The solution is ready to be integrated within the Accessible Digital Home, a living lab managed by Universidad Politécnica de Madrid for R&D activities.


Assuntos
Diagnóstico por Computador/instrumentação , Internet/instrumentação , Monitorização Ambulatorial/instrumentação , Telemedicina/instrumentação , Terapia Assistida por Computador/instrumentação , Interface Usuário-Computador , Diagnóstico por Computador/métodos , Desenho de Equipamento , Análise de Falha de Equipamento , Humanos , Monitorização Ambulatorial/métodos , Reprodutibilidade dos Testes , Sensibilidade e Especificidade , Integração de Sistemas , Telemedicina/métodos , Terapia Assistida por Computador/métodos
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