Performance of a MALDI-TOF mass spectrometry-based method for rapid detection of third-generation oxymino-cephalosporin-resistant Escherichia coli and Klebsiella spp. from blood cultures.

We optimized and prospectively evaluated a simple MALDI-TOF MS-based method for direct detection of third-generation oxymino-cephalosporin resistance (3rd CephR) in Escherichia coli and Klebsiella spp. from blood cultures (BC). In addition, we assessed the performance of a lateral flow immunochromatographic assay (LFIC) for detecting extended-spectrum ß-lactamases (ESBL) (NG-Test CTX-M MULTI assay) using bacterial pellets from BC. A total of 168 BCs from unique patients were included. A pre-established volume of BC flagged as positive was transferred in brain heart infusion with or without ceftriaxone (2 mg/ml). After 2-h incubation, intact bacterial pellets were used for MALDI-TOF MS testing. Identification of bacterial species (index score > 2) in the presence of CRO was considered marker of 3rd CephR. The LFIC assay was evaluated in 141 BC. Bacteremia episodes were caused by E. coli (n = 115) or Klebsiella spp. (n = 53). A total of 49 strains were 3rd CephR by broth microdilution, of which 41 were ESBL producers, seven expressed ESBL and OXA-48 type D carbapenemase, and one harbored a plasmid-mediated AmpC. The MALDI-TOF MS method yielded four very major errors (false susceptibility) and two major errors (false resistance). The overall sensitivity of the assay was 91.8% and the specificity 98.3%. Concordance between the LFIC assay and the MALDI-TOF MS method for detection of ESBL-mediated 3rd CephR was 100%. Both evaluated methods may prove useful for early adjustment of empirical therapy in patients with E. coli and Klebsiella spp. bloodstream infections. Whether their use has a beneficial impact on patient outcomes is currently under investigation.

Multi-part quality evaluation of a customized mobile application for monitoring elderly patients with functional loss and helping caregivers.

BACKGROUND: The challenges faced by caregivers of the elderly with chronic diseases are always complex. In this context, mobile technologies have been used with promising results, but often have restricted functionality, or are either difficult to use or do not provide the necessary support to the caregiver - which leads to declining usage over time. Therefore, we developed the Mobile System for Elderly Monitoring, SMAI. The purpose of SMAI is to monitor patients with functional loss and to improve the support to caregivers' communication with the health team professionals, informing them the data related to the patients' daily lives, while providing the health team better tools. METHOD: SMAI is composed of mobile applications developed for the caregivers and health team, and a web portal that supports management activities. Caregivers use an Android application to send information and receive care advice and feedback from the health team. The system was constructed using a refinement stage approach. Each stage involved caregivers and the health team in prototype release-test-assessment-refinement cycles. SMAI was evaluated during 18 months. We studied which features were being used the most, and their use pattern throughout the week. We also studied the users' qualitative perceptions. Finally, the caregiver application was also evaluated for usability. RESULTS: SMAI functionalities showed to be very useful or useful to caregivers and health professionals. The Focus Group interviews reveled that among caregivers the use of the application gave them the sensation of being connected to the health team. The usability evaluation identified that the interface design and associated tasks were easy to use and the System Usability Scale, SUS, presented very good results. CONCLUSIONS: In general, the use of SMAI represented a positive change for the family caregivers and for the NAI health team. The overall qualitative results indicate that the approach used to construct the system was appropriate to achieve the objectives.

A rapid MALDI-TOF mass spectrometry-based method for categorization of Pseudomonas aeruginosa from blood cultures as susceptible or resistant to meropenem.

We developed and evaluated a simple, low-cost matrix-assisted laser desorption/ionization mass spectrometry (MALDI-TOF MS)-based method for the detection of meropenem (MER) resistance in Pseudomonas aeruginosa directly from blood. A volume of 50 µL of positive-flagged blood culture (BC) was transferred in 450 µL brain heart infusion (BHI) broth to microtubes either containing MER (test) or not (control) at 25 or 50 mg/L. P. aeruginosa was categorized as resistant or susceptible on the basis of whether or not the isolates could be identified, respectively, in the presence of the antibiotic (3 h of incubation). When using BCs spiked with 99 P. aeruginosa isolates (64 MER-resistant and 35 MER-susceptible) the method correctly classified 88/99 isolates (88.9%). Correct categorization was achieved in 23/23 (100%) of P. aeruginosa isolates (17 MER-susceptible and 6 MER-resistant) from prospectively collected BCs. Our method may prove useful for early targeted or adjustment of empirical therapy in patients with P. aeruginosa bloodstream infections.

[Frequency of attending primary care clinics by the immigrant versus autochthonous population]. / Frecuentación de la población inmigrante versus autóctona en atención primaria: ¿quién consume más servicios?

OBJECTIVES: To study the frequency of attendance in primary care of immigrant population compared to autochthonous one. To analyse differences in health services use according to geographical origin. METHODS: A retrospective descriptive study was carried out. All Family Medicine and Paediatrics consultations were analysed using the electronic medical record. DESIGN: Retrospective descriptive study. We analysed all the medicine and paediatrics appointments data from the electronic medical record. LOCATION: Urban Health Centre, Zaragoza. PARTICIPANTS: All patients with an appointment at the Health Centre during a one year period. INTERVENTION: Is in line with the reference population with health cards by sex and age. Direct standardisation was performed to avoid differences due to different population distribution. MAIN MEASURES: Number of visits annually to the doctor, on the basis of national origin, sex and age. RESULTS: We analysed 110,046 adult consultations (based on a population of 20,675 inhabitants, 20% of immigrants) and 17,647 paediatric consultations (based on 2,452 children, 29% of immigrants). Adjusted annual consultation ratio of Spanish patients was higher than that of the immigrant population (7.1 consultations vs 4.8 in children, and 4.7 vs 2.8 in adults) (P<.001). Adults from Eastern Europe showed the lowest number of consultations (1.6). In emergency consultations in Primary Care, Spanish children consulted more frequently than immigrants, but immigrant adults consulted more frequently than Spanish adults. CONCLUSIONS: Immigrant population consulted primary care services less often compared with the Spanish population. There are notable differences according to geographical origin. This can be explained by better health, better use of healthcare system, and other difficulties in accessibility to health systems.

The acceptance of virtual reality devices for cognitive rehabilitation: a report of positive results with schizophrenia.

This study presents a process of virtual environment development supported by a cognitive model that is specific to cognitive deficits of diverse disorders or traumatic brain injury, and evaluates the acceptance of computer devices by a group of schizophrenic patients. The subjects that participated in this experiment accepted to work with computers and immersive glasses and demonstrated a high level of interest in the proposed tasks. No problems of illness have been observed. This experiment indicated that further research projects must be carried out to verify the value of virtual reality technology for cognitive rehabilitation of psychiatric patients. The results of the current study represent a small but necessary step in the realization of that potential.

The UFRJ-UERJ group: interdisciplinary virtual reality experiments in neuropsychiatry.

This paper describes the research lines of an interdisciplinary group composed by two government universities in Rio de Janeiro. The first research line, a Virtual Environment for testing the acceptance of Virtual Reality equipment by schizophrenia patients, has stimulated a growing interest in this area in the country and abroad. The second research line, in progress now, develops a virtual environment to improve the learning abilities of children with Attention-Deficit and Hyperactivity Disorder (ADHD). Another study is related to the use of Virtual Reality in the cognitive treatment of common city phobias, beginning with the reproduction of some tunnels of our city to treatment of claustrophobic patients. The last of the research lines in progress in this group develops a virtual square for stimulating autistic patients.

Non-therapeutic male circumcision performed on immigrant children from Africa in Spain.

OBJECTIVES: To study the frequency, characteristics, and complications of non-therapeutic male circumcision on immigrant children from Africa in Spain. METHODS: This descriptive study focused on primary care consultations conducted at 21 Aragon health centres during 2010 and 2011. The data were gathered through interviewer-administered questionnaires to the parents of African children. Sociodemographic variables were studied, along with others related to the practice of circumcision. RESULTS: 283 questionnaires were obtained. 98.93 % of the children had undergone or were planning to undergo circumcision. 68.2 % were circumcised. Circumcisions were most frequently performed during a vacation to the country of origin (67.04 %), especially so for the Maghreb population. The remaining circumcisions had been performed in Spain. Half of the circumcisions practiced in Spain were performed at home, and 84 % of these were performed on Gambian children. CONCLUSIONS: The current study demonstrates that, in Aragon, Spain, almost all immigrant children from Africa have been or will be circumcised and that a considerable proportion has been circumcised at home by unqualified individuals. Gambians are particularly at risk of performing unsafe circumcision.

Plasticity in the shape and growth pattern of asteriscus otolith of black prochilodus Prochilodus nigricans (Teleostei: Characiformes: Prochilodontidae) freshwater Neotropical migratory fish

Using morphometric measurements and wavelets functions, the asterisci otoliths of curimatã, Prochilodus nigricans were analysed to identify the variation in shape and growth increment of individuals from Solimões, Japurá and Negro rivers of the Amazon basin, Brazil. The morphometric and morphological analyses did not reveal evidences of population segregation among rivers, but variations were found in the estimation of otolith growth increment. Also, the otolith shape showed a high variability between individuals, identifying four morphotypes. Morphotype 1 shows a more oval shape with a posterior zone clearly rounded; Morphotype 2 shows the posterior zone rounded, but the anterior end is more elongated; Morphotype 3 shows a completely different shape, elliptic-pentagonal and Morphotype 4 shows the posterior zone rounded, but the anterior end is more elongated and it is the pattern with antirostrum and rostrum more pointed and a deep notch. Therefore, the otolith shape exhibited a phenotypic plasticity that it was not associated with the metabolism of otolith growth. Whereas the otolith shape indicated a homogeneity in the sound perception through Amazon basin, the growth rates revealed an adaptive mechanism to environmental conditions or migratory process of this species.(AU)

Medidas e funções wavelets dos otólitos asteriscus de curimatã, Prochilodus nigricans foram analisados para identificar a variação da forma e do incremento de crescimento dos indivíduos dos rios Solimões, Japurá e Negro da bacia Amazônica, Brasil. As análises morfométricas e morfológicas não revelaram evidências de segregação populacional entre os rios, mas foram encontradas variações na estimativa do incremento do crescimento dos otólitos. Além disso, a forma do otólito mostrou uma alta variabilidade entre os indivíduos, identificando quatro morfotipos. O Morfotipo 1 mostra uma forma mais oval, com zona posterior levemente arredondada; Morfotipo 2 mostra a zona posterior arredondada, mas a extremidade anterior é mais alongada; Morfotipo 3 mostra uma forma completamente diferente, elíptico-pentagonal e Morfotipo 4 mostra a zona posterior arredondada, mas a extremidade anterior mais alongada e ele tem padrão com antirostrum e rostrum mais pontiagudos e abertura profunda. Portanto, a forma do otólito exibiu uma plasticidade fenotípica que não foi associada ao metabolismo do crescimento do otólito. No entanto a forma do otólito indicou uma homogeneidade através da percepção do som na bacia Amazônica, e as taxas de crescimento revelaram um mecanismo adaptativo às condições ambientais ou ao processo migratório da espécie.(AU)

Individual, spatial and inter-sex variation in somatic growth: a study of Piaractus mesopotamicus (Characiformes: Serrasalmidae), a long-distance freshwater Neotropical migratory fish

Growth is a fundamental biological process, driven by multiple endogenous (intra-individual) and exogenous (environmental) factors that maintain individual fitness and population stability. The current study aims to assess whether individual, spatial (headwaters and floodplains) and inter-sex variation occurs in the growth of Piaractus mesopotamicus in the Cuiabá River basin. Samples were collected monthly from July 2006 to July 2007, at two areas in the Cuiabá River basin (headwaters and floodplain). Three growth models (individuals; individuals and sex factors; individuals and areas factors) were developed and compared the fish growth parameters using Akaike information criterion (AIC). The best fit to the length-at-age data was obtained by a model that considered individual variation and sex. The theoretical maximum average length ( L∞ ) was 64.99 cm for females, and 63.23 cm for males. Females showed a growth rate (k) of 0.230 yr-1and males of 0.196 yr-1. Thus, could be concluded that individual variability and sex were the main sources of variation in P. mesopotamicus somatic growth parameters.(AU)

O crescimento é um processo biológico fundamental, impulsionado por múltiplos fatores endógenos (intra-individual) e exógenos (ambientais) que mantém o fitness individual e a estabilidade populacional. Este trabalho tem como objetivo avaliar se ocorre variação individual, espacial (região de cabeceira e planície de inundação) e entre sexo no crescimento de Piaractus mesopotamicus na bacia do rio Cuiabá. Amostragens foram realizadas mensalmente entre julho de 2006 a julho de 2007, em duas áreas da bacia do rio Cuiabá (região de cabeceira e planície de inundação). Três modelos de crescimento (indivíduos, indivíduos e sexo como fator, indivíduos e área como fator) foram elaborados e comparados os parâmetros de crescimentos dos peixes com base no critério de Informação de Akaike (AIC). O melhor ajuste aos dados de comprimento na idade data foi obtido pelo modelo que considerou a variação individual e o sexo. O comprimento médio máximo teórico ( L∞ ) das fêmeas foi 64,99 cm e para os machos 63,23 cm. O coeficiente de crescimento (k) médio foi de 0,230 yr-1 e 0,196 yr-1, respectivamente para fêmeas e machos. Portanto, pode-se concluir que variabilidade individual e sexo foram as principais origem de variação dos parâmetros de crescimento somático de P. mesopotamicus.(AU)

Serious games baseados em realidade virtual para educação médica / Serious games based on virtual reality in medical education

A evolução tecnológica tem permitido utilizar novas abordagens no processo de ensino-aprendizagem. Os serious games se relacionam com uma categoria especial de jogos, voltados a conteúdos e finalidades específicos, nos quais o jogador utiliza seus conhecimentos para resolver problemas, conhecer novas problemáticas e treinar tarefas. Uma das tecnologias propícias à construção de serious games é a Realidade Virtual, que oferece ambientes computacionais tridimensionais com formas avançadas de interação capazes de prover maior motivação ao processo de aprendizagem. No contexto da educação médica, tais aplicações apresentam um nicho ainda pouco explorado, se observados sua relevância e impactos na sociedade. Este artigo apresenta os serious games baseados em Realidade Virtual como uma proposta para o ensino de conteúdos específicos da área médica. Para isso, categoriza-os e apresenta o que tem sido desenvolvido nos últimos anos, seus componentes, características de desenvolvimento e suas potencialidades como oportunidades de pesquisa, desenvolvimento e negócios.

Technological innovations have allowed new approaches in educational processes. "Serious games" are a particular category of games and content devoted to specific purposes, in which players use their knowledge to solve problems, learn new issues, and train tasks. One of the technologies for developing serious games is virtual reality, which offers 3D computer environments with advanced interaction capable of providing high levels of motivation in the learning process. In the context of medical education, such applications present a niche that has received relatively little attention, considering their relevance and potential impact on society. This article presents serious games based on virtual reality as a proposal for teaching specific contents in the medical field. The article categorizes such games and discusses how they have been developed in recent years, their components, characteristics of development, and potential and opportunities for research, development, and business.

Reproductive biology of pacu Piaractus mesopotamicus (Holmberg, 1887) (Teleostei: Characidae) in the Cuiabá River Basin, Mato Grosso, Brazil

The purpose of this study was to analyze the reproductive strategy and life-history traits involved in the reproductive processes of P. mesopotamicus in two regions of the Cuiabá River basin, the first of these encompassing its headwaters (Cuiabazinho River - Rosário Oeste) and the other the flood area of the Cuiabá River (Porto Cercado - Poconé). A total of 391 individuals were sampled monthly from August 2006 to July 2007, 159 from the headwaters and 232 from the flood area. The size structure indicated that the females in the headwaters attain longer lengths than the males, while no differences in length were found in the flood area. Females predominated in the headwaters, while males outnumbered females in the flood area. The reproductive period in the headwaters extended from October to March, but was restricted to October and November in the flood area. Feeding activity showed significant differences in both sexes between the stages of gonadal maturation, with the highest values recorded in stages of gonadal inactivity. The length at first maturity was 34.89 cm and the length at which all specimens were ready for reproduction was 44 cm at both sampling sites. The spawning type was total and fecundity was positively correlated to the size of the female.(AU)

O presente estudo teve como objetivo analisar a estratégia reprodutiva e os traços de história de vida relacionados aos processos reprodutivos de P. mesopotamicus em duas regiões da bacia do rio Cuiabá: uma que representa a região das cabeceiras (rio Cuiabazinho - Rosário Oeste) e outra que abrange a área de inundação do rio Cuiabá (Porto Cercado - Poconé). Indivíduos foram amostrados, mensalmente, no período de agosto de 2006 a julho de 2007. Foram amostrados 391 indivíduos, sendo 159 de ambiente de cabeceira e 232 de área alagada. A estrutura de tamanho mostrou que em ambiente de cabeceira as fêmeas atingem comprimentos maiores que os machos, enquanto que em área alagada não houve diferença nos comprimentos. Ocorreu predomínio de fêmeas em ambiente de cabeceira, e de machos em área alagada. O período reprodutivo para o ambiente de cabeceira estendeu-se de outubro a março e para a área alagada foi restrito a outubro e novembro. A atividade alimentar apresentou diferenças significativas para ambos os sexos entre os estádios de maturação gonadal com os maiores valores encontrados em estádios de inatividade gonadal. O comprimento de primeira maturação foi de 34,89 cm e o comprimento em que todos estão aptos a reproduzirem foi de 44 cm para ambos os locais. O tipo de desova é total e a fecundidade foi positivamente relacionada ao tamanho da fêmea.(AU)

Realidade virtual para saúde no Brasil: conceitos, desafios e oportunidades / Virtual reality for health care in Brazil: concepts, challenges and opportunities

A Realidade Virtual é uma área tipicamente multidisciplinar que envolve conceitos provenientes das Engenharias, Computação, Física, Artes e também da área específica da aplicação à qual ela se destina. Por permitir uma interação humano-computador mais natural em ambiente tridimensional (3D) e possibilitar a reprodução de situações reais, torna-se um recurso de amplo potencial para a área da saúde. Este artigo aborda conceitos, desafios e oportunidades de aplicações de Realidade Virtual na área de saúde no Brasil, apresentando um estudo sobre as pesquisas na área e aplicações desenvolvidas. A análise da situação atual mostra que há vários grupos brasileiros de pesquisa desenvolvendo aplicações com grande diversidade de assuntos, contemplando principalmente as áreas de treinamento e educação. A partir da análise conduzida, verifica-se que ainda há vários desafios a serem superados a fim de que as aplicações de Realidade Virtual sejam incluídas na rotina dos profissionais da área de saúde. Se por um lado tais desafios retardam o uso efetivo desta tecnologia na prática, por outro constituem oportunidades ímpares de pesquisa e desenvolvimento, conforme é destacado na conclusão deste artigo.

Virtual Reality (VR) is a typically multidisciplinary field which involves concepts from Engineering, Computer Science, Physics, Arts as well as concepts from the specific application field. Because VR allows a more natural human-computer interaction in three-dimensional environments and enables the reproduction of real situations, it becomes a resource of wide potential for healthcare field. This paper discusses concepts, challenges and opportunities of Virtual Reality applications for healthcare in Brazil, by presenting a study about researches in the area and developed applications. The analysis of the current situation shows that there are various Brazilian research groups developing applications considering great diversity of subjects, covering mainly training and education area. This analysis shows that there are still many challenges to be overcome so that applications using Virtual Reality can be included in the routine of healthcare professionals. On one hand these challenges hinder the effective use of technology in  practice, on the other they open new opportunities for research and development,   as is highlighted in the conclusion of this paper.

La etica en el uso de la realidad virtual en la rehabilitacion cognitiva / Ethics in using virtual reality in cognitive rehabilitation

This work discusses the increasing computer use in the Cognitive Rehabilitation area, points to Virtual Reality as a new tendency in this field, relates associated ethical values and presents an integrated Virtual Environment for Cognitive Rehabilitation of persons with acquired brain injury of brain disorders