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Objectives: to understand the practice of the nurse in healthcare management of children with chronic condition in the hospital setting., Methods: analytical study of qualitative approach with theoretical and methodological reference of institutional ethnography. Developed in the pediatric unit of a university hospital, in a municipality in Northeastern Brazil. Data collections techniques were: participant observation, documentary analysis and semi-structured interview. Participants of the study totaled twenty professionals, including nurses, social workers, psychologists, pharmacists, nutritionists, physiotherapists, and doctors. For data analysis, it was used the Bardin's Content Analysis with interface of the Atlas.ti software., Results: categories of analysis were "Nurse as mediator of healthcare management"; "Nursing process as a mechanism of healthcare management"., Final: considerations: the nurse proved to be essential for healthcare management of the child with chronic condition, acting as mediator of the relationship between the doctor, the members of the health team, the user and their family.

Background: Outlining lesion contours in Ultra Sound (US) breast images is an important step in breast cancer diagnosis. Malignant lesions infiltrate the surrounding tissue, generating irregular contours, with spiculation and angulated margins, whereas benign lesions produce contours with a smooth outline and elliptical shape. In breast imaging, the majority of the existing publications in the literature focus on using Convolutional Neural Networks (CNNs) for segmentation and classification of lesions in mammographic images. In this study our main objective is to assess the ability of CNNs in detecting contour irregularities in breast lesions in US images., Methods: In this study we compare the performance of two CNNs with Direct Acyclic Graph (DAG) architecture and one CNN with a series architecture for breast lesion segmentation in US images. DAG and series architectures are both feedforward networks. The difference is that a DAG architecture could have more than one path between the first layer and end layer, whereas a series architecture has only one path from the beginning layer to the end layer. The CNN architectures were evaluated with two datasets., Results: With the more complex DAG architecture, the following mean values were obtained for the metrics used to evaluate the segmented contours: global accuracy: 0.956; IOU: 0.876; F measure: 68.77%; Dice coefficient: 0.892., Conclusion: The CNN DAG architecture shows the best metric values used for quantitatively evaluating the segmented contours compared with the gold-standard contours. The segmented contours obtained with this architecture also have more details and irregularities, like the gold-standard contours.

Background: Low-intensity physiotherapeutic ultrasound has been used in physical therapy clinics; however, there remain some scientific issues regarding the bone-healing process. The objective of this study was to investigate the influence of low-intensity physiotherapeutic ultrasound on the initial stage of bone healing in rats., Methods: Twenty-two male adult rats were assessed quantitatively and qualitatively using radiographic, biochemical, and histological analyses. Numerical simulations were also performed. Fractures in animals in the ultrasound group ( n  = 11) were treated with low-intensity ultrasound (pulsed mode, duty cycle 20 %) for 10 min daily at an intensity of 40 mW/cm 2 SATA (1.0 MHz) for 10 days. Fractures in animals in the control group ( n  = 11) were not treated., Results: Alkaline phosphatase levels were non-significantly higher in the ultrasound group than in the control group in the time intervals considered ( t (13) = 0.440; 95 % confidence interval (CI) -13.79 to 20.82; p  = 0.67). Between-group serum calcium levels were also not significantly different ( t (13) = -0.842; 95 % CI -0.48 to 0.21; p  = 0.42). Finally, there were no significant differences in radiological scores between the two groups ( U  = 118; 95 % CI -1.99 to 1.99; p  = 0.72). However, the diameter of the newly formed bone tissue was greater and more evident in the ultrasound group., Conclusions: Thirteen days after fracture, there was no significant between-group differences in bone-healing processes, although the increased alkaline phosphatase levels and diameter of new bone tissue need to be further investigated.

Introduction: Syphilis is one of the known transfusion-transmissible infections and causes 100,000 deaths yearly, with around 90% of these deaths occurring in the developing world. Little data is available regarding the prevalence of syphilis among Saudi blood and stem cell donors. We conducted a survey on the incidence of syphilis among all blood and stem cell donors., Methods: This study was conducted at the Prince Sultan Military Medical City in Riyadh, Saudi Arabia in the 10 years period data during 2006-2015. Data were analyzed about full history, physical examination, age, sex, weight, profession, marital status, number of the donations, data of last donation, having a relation who received blood transfusion, as well as the screening test results of the donated blood. We determined the seroprevalence of infection and compared by sex and other variable through frequency analysis, Chi square, Fisher, and prevalence ratios., Results: Approximately 240,000 blood donors were screened and studied in the period of study. Most of the blood donors were male (98.3%) and 89% of them were citizens of Saudi Arabia. According to our findings, we estimated that, in the last 10 years, approximately 0.044% of all the blood donors were syphilis positive cases. No cases were detected as positive for syphilis among stem cell donors. Only 60 blood donors tested positive for syphilis. In addition, we studied 202 stem cell transplant donors during the same period, of which 59% were male and none texted positive for syphilis., Conclusions: A concerted effort between the government, health care providers, regulatory bodies and accreditation agencies have all contributed in eliminating the risk of spreading syphilis among blood donors., Competing Interests: There is no conflict of interest to be declared.

Background: Bioheat models have been proposed to predict heat distribution in multilayered biological tissues after therapeutic ultrasound (TUS) stimulation. However, evidence on its therapeutic benefit is still controversial for many clinical conditions. The aim of this study was to evaluate and to compare the TUS heating distribution on commercially available bone phantoms and in vitro femur and tibia human samples, at 1 MHz and several ultrasonic pulse regimens, by means of a thermographic image processing technique., Methods: An infrared camera was used to capture an image after each 5-min 1-MHz TUS stimulation on bone phantoms, as well as in vitro femur and tibia samples (N = 10). An intensity-based processing algorithm was applied to estimate temperature distribution. Sections of five femurs in the coronal plane were also used for the evaluation of heat distribution inside the medullar canal., Results: Temperature increased up to 8.2 and 9.8 °C for the femur and tibia, respectively. Moreover, the temperature increased up to 10.8 °C inside the medullar canal. Although temperature distributions inside the region of interest (ROI) were significantly different (p < 0.001), the average and standard deviation values for bone phantoms were more similar to the femur than to the tibia samples. Pulsed regimens caused lower increments in temperature than continuous sonication, as expected., Conclusions: Commercially available bone phantoms could be used in research focusing on thermal effects of ultrasound. Small differences in mean and standard deviation temperatures were observed between bone samples and phantoms. Temperature can reach more than 10 °C inside the medullar canal on a fixed probe position which may lead to severe cellular damage.

Purpose: To determine the effectiveness of low-intensity therapeutic ultrasound (LITUS) on wound healing in rats with third-degree burns., Methods: Twenty rats were divided into the Control Group that comprised four rats without third-degree burns that did not undergo LITUS, the Burned Group (BG), comprising eight rats with third-degree burns that did not undergo LITUS, and the Burned with Treatment Group (BTG), comprising eight rats with third-degree burns that were administered LITUS. LITUS began 24 h after injury and involved daily applications for 8 min at 0.1 W/cm2 for 14 days., Results: The BTG lost less weight than the BG (Q=2.75; p<0.05). No visible differences were apparent among the groups' lesions on day 4. By the end of treatment, wound healing was more evident in the BTG. No statistically significant differences were found between the BG and the BTG in relation to the parameters measured using the histological changes in burn wound healing scoring system., Conclusion: The LITUS protocol applied to the animals with third-degree burns accelerated the formation of fibrin-leukocyte crusts and significantly reduced weight loss. However, burn wound healing was not accelerated.

Background: Hematopoietic stem cell transplantation (HSCT) involves the infusion of hematopoietic stem cells from a suitable donor to a patient who has undergone chemotherapy. Stem Cell transplantation is used for the treatment for a wide variety of diseases, including leukemia and lymphoma., Purpose: This study highlights prevention strategies of infectious diseases among HSCT donors and recipients in our institute as guided by International guidelines. We aim to highlight the strategy for extensive screening of HIV, Hepatitis B and C, CMV infection and syphilis cases in all the stem cell units stored in our facility., Methods: We searched the institutional database to identify cases of infectious diseases among HSC transplants. Extensive donor evaluation was conducted through screening and laboratory infectious disease testing for HIV, Hepatitis B and C, CMV infection and syphilis., Results: Between 1996 and 2014, 263 consecutive adult HSCT were performed. An approximate equal number of autologous and allogeneic HSC collections were undertaken. The median age for autologous donors was 35 years, whereas that of allogeneic donors is 25 years. Of the 263 stem cell donors, we found 18 patients (autologous) and 2 donors (allogeneic) to be infected. We did not find any of the donors infected with HIV by the serology as well as the NAT testing protocol., Conclusion: Donor screening and testing is the most critical parameter in stem cell transplantation in order to ensure the safety of the product to be transplanted. Modifications in the regulations related to donor screening are aimed at providing safe transplantation and negate the risk of accidental infection of the donor.

A simple experimental protocol applying a quantitative ultrasound (QUS) pulse-echo technique was used to measure the acoustic parameters of healthy femoral diaphyses of Wistar rats in vivo. Five quantitative parameters [apparent integrated backscatter (AIB), frequency slope of apparent backscatter (FSAB), time slope of apparent backscatter (TSAB), integrated reflection coefficient (IRC), and frequency slope of integrated reflection (FSIR)] were calculated using the echoes from cortical and trabecular bone in the femurs of 14 Wistar rats. Signal acquisition was performed three times in each rat, with the ultrasound signal acquired along the femur's central region from three positions 1 mm apart from each other. The parameters estimated for the three positions were averaged to represent the femur diaphysis. The results showed that AIB, FSAB, TSAB, and IRC values were statistically similar, but the FSIR values from Experiments 1 and 3 were different. Furthermore, Pearson's correlation coefficient showed, in general, strong correlations among the parameters. The proposed protocol and calculated parameters demonstrated the potential to characterize the femur diaphysis of rats in vivo. The results are relevant because rats have a bone structure very similar to humans, and thus are an important step toward preclinical trials and subsequent application of QUS in humans.

In this paper, we investigated the behavior of 22 co-occurrence statistics combined to six gray-scale quantization levels to classify breast lesions on ultrasound (BUS) images. The database of 436 BUS images used in this investigation was formed by 217 carcinoma and 219 benign lesions images. The region delimited by a minimum bounding rectangle around the lesion was employed to calculate the gray-level co-occurrence matrix (GLCM). Next, 22 co-occurrence statistics were computed regarding six quantization levels (8, 16, 32, 64, 128, and 256), four orientations (0° , 45° , 90° , and 135°), and ten distances (1, 2,...,10 pixels). Also, to reduce feature space dimensionality, texture descriptors of the same distance were averaged over all orientations, which is a common practice in the literature. Thereafter, the feature space was ranked using mutual information technique with minimal-redundancy-maximal-relevance (mRMR) criterion. Fisher linear discriminant analysis (FLDA) was applied to assess the discrimination power of texture features, by adding the first m-ranked features to the classification procedure iteratively until all of them were considered. The area under ROC curve (AUC) was used as figure of merit to measure the performance of the classifier. It was observed that averaging texture descriptors of a same distance impacts negatively the classification performance, since the best AUC of 0.81 was achieved with 32 gray levels and 109 features. On the other hand, regarding the single texture features (i.e., without averaging procedure), the quantization level does not impact the discrimination power, since AUC = 0.87 was obtained for the six quantization levels. Moreover, the number of features was reduced (between 17 and 24 features). The texture descriptors that contributed notably to distinguish breast lesions were contrast and correlation computed from GLCMs with orientation of 90° and distance more than five pixels.

Purpose: To propose a novel model of pseudarthrosis in a small animal and to investigate the ability of backscatter parameters from ultrasound signals in differentiating normal bone from those ones with pseudarthrosis., Methods: Twelve Rattus norvegicus albinus free from pathogenic species (SPF) were randomly divided in two groups, with six animals each. In the Control group a surgical approach to the femur was made, followed by the synthesis of the muscle and skin layers. The Experimental group was submitted to an osteotomy of the femur and a vascularized flap of the fascia lata was interposed in the line of the fractured bone. Then the alignment and bone stabilization were accomplished, by using nylon stitch in U shape introduced in holes made in the proximal and distal fractured bone. Bone samples were scanned with ultrasound and signals were collected for each one to analyze the parameter Apparent Integrated Backscatter - AIB., Results: Radiological and anatomopathologic studies revealed the absence of bone consolidation with persistence of fiber-osteoid tissue. Values of the ultrasound parameter AIB from normal bones were statistically different from those with pseudarthrosis., Conclusion: The experimental model was suitable for pseudarthrosis development in rats and the ultrasound backscatter parameters were able to identify such a bone disease in vitro.

Objective: To develop a Charlson-like comorbidity index based on clinical conditions and weights of the original Charlson comorbidity index., Methods: Clinical conditions and weights were adapted from the International Classification of Diseases, 10th revision and applied to a single hospital admission diagnosis. The study included 3,733 patients over 18 years of age who were admitted to a public general hospital in the city of Rio de Janeiro, southeast Brazil, between Jan 2001 and Jan 2003. The index distribution was analyzed by gender, type of admission, blood transfusion, intensive care unit admission, age and length of hospital stay. Two logistic regression models were developed to predict in-hospital mortality including: a) the aforementioned variables and the risk-adjustment index (full model); and b) the risk-adjustment index and patient's age (reduced model)., Results: Of all patients analyzed, 22.3% had risk scores > or = 1, and their mortality rate was 4.5% (66.0% of them had scores > or = 1). Except for gender and type of admission, all variables were retained in the logistic regression. The models including the developed risk index had an area under the receiver operating characteristic curve of 0.86 (full model), and 0.76 (reduced model). Each unit increase in the risk score was associated with nearly 50% increase in the odds of in-hospital death., Conclusions: The risk index developed was able to effectively discriminate the odds of in-hospital death which can be useful when limited information is available from hospital databases.

Objectives: The existence of proper non-invasive temperature estimators is an essential aspect when thermal therapy applications are envisaged. These estimators must be good predictors to enable temperature estimation at different operational situations, providing better control of the therapeutic instrumentation. In this work, radial basis functions artificial neural networks were constructed to access temperature evolution on an ultrasound insonated medium., Methods: The employed models were radial basis functions neural networks with external dynamics induced by their inputs. Both the most suited set of model inputs and number of neurons in the network were found using the multi-objective genetic algorithm. The neural models were validated in two situations: the operating ones, as used in the construction of the network; and in 11 unseen situations. The new data addressed two new spatial locations and a new intensity level, assessing the intensity and space prediction capacity of the proposed model., Results: Good performance was obtained during the validation process both in terms of the spatial points considered and whenever the new intensity level was within the range of applied intensities. A maximum absolute error of 0.5 degrees C+/-10% (0.5 degrees C is the gold-standard threshold in hyperthermia/diathermia) was attained with low computationally complex models., Conclusion: The results confirm that the proposed neuro-genetic approach enables foreseeing temperature propagation, in connection to intensity and space parameters, thus enabling the assessment of different operating situations with proper temperature resolution.

The safe and effective application of thermal therapies is restricted due to lack of reliable noninvasive temperature estimators. In this paper, the temporal echo-shifts of backscattered ultrasound signals, collected from a gel-based phantom, were tracked and assigned with the past temperature values as radial basis functions neural networks input information. The phantom was heated using a piston-like therapeutic ultrasound transducer. The neural models were assigned to estimate the temperature at different intensities and points arranged across the therapeutic transducer radial line (60 mm apart from the transducer face). Model inputs, as well as the number of neurons were selected using the multiobjective genetic algorithm (MOGA). The best attained models present, in average, a maximum absolute error less than 0.5 degrees C, which is pointed as the borderline between a reliable and an unreliable estimator in hyperthermia/diathermia. In order to test the spatial generalization capacity, the best models were tested using spatial points not yet assessed, and some of them presented a maximum absolute error inferior to 0.5 degrees C, being "elected" as the best models. It should be also stressed that these best models present implementational low-complexity, as desired for real-time applications.

This work presents an ultrasonic method to characterize the layers of a stratified medium, using independent measurements of wave speed and thickness of each layer. The model, based on geometrical acoustics, includes refraction. Two transducers are used: one active (3.4 MHz) and a hydrophone as a receptor, which is moved laterally through 15 positions. The distance between the transducers and the delay between the echoes, from the interfaces separating the layers, received by them are used to estimate the speed and thickness. Three types of layered phantoms were used: Ph1 made with alcohol/acrylic, Ph2 made with polyvinyl chloride/water/acrylic, and Ph3 made with acrylic/water/polyvinyl chloride. The experimental results for speed of sound and layer thickness presented an experimental mean relative error, for thickness and wave speed, lower than 7.0% and 6.6%, respectively.

Mean scatterer spacing (MSS) holds particular promise for the detection of changes in quasiperiodic tissue microstructures such as may occur during development of disease in the liver, spleen, or bones. Many techniques that may be applied for MSS estimation (temporal and spectral autocorrelation, power spectrum and cepstrum, higher order statistics, and quadratic transformation) characterize signals that contain a mixture of periodic and nonperiodic contributions. In contrast, singular spectrum analysis (SSA), a method usually applied in nonlinear dynamics, first identifies components of signals corresponding to periodic structures and, second, identifies dominant periodicity. Thus, SSA may better separate periodic structures from nonperiodic structures and noise. Using an ultrasound echo simulation model, we previously demonstrated SSA's potential to identify MSS of structures in quasiperiodic scattering media. The current work aims to observe the behavior of MSS estimation by SSA using ultrasound measurements in phantom materials (two parallel, nylon-line phantoms and four foam phantoms of different densities). The SSA was able to estimate not only the nylon-line distances but also nylon-line thickness. The method also was sensitive to the average pore-size differences of the four sponges. The algorithms then were applied to characterize human cancellous bone microarchitectures. Using 1-MHz center-frequency, radio-frequency ultrasound signals, MSS was measured in 24 in vitro bone samples and ranged from 1.0 to 1.7 mm. The SSA MSS estimates correlate significantly to MSS measured independently from synchrotron microtomography, r2 = 0.68. Thus, application of SSA to backscattered ultrasound signals seems to be useful for providing information linked to tissue microarchitecture that is not evident from clinical images.

Immunization with a proper dose of an antigenic stimulus leads to cell proliferation and antibody response of circulating lymphocytes. We have previously observed that Secondary immunized spleenocytes resist ceramide-mediated apoptosisin vitro. Our present study is aimed at investigating thein vivo effect of immunization on apoptosis. Mice were subjected to either Primary or Secondary dose with Tetanus Toxoid. Unimmunized spleenocytes served as controls. Unimmunized, Primary and Secondary immunized mice were later exposed to chemotherapeutic drugs such as Etoposide/Methotrexate/Vincristine to induce apoptosis. Apoptosis was studied by using the Feulgen reaction on 5μ thin parafin sections of spleen. It was observed that Secondary immunized mice showed a lower percentage of apoptosis as compared to Primary or Unimmunized mice that was subjected to either of the chemotherapeutic drugs. It was thus concluded that Secondary immunization inhibits the process of chemotherapeutic drug induced apoptosis in vivo.

Conventional methods determine the ultrasonic wave speed measuring the medium path length propagated by a pulsed wave and the corresponding time-of-flight. In this work, the wave speed is determined without the need of the path length. A transmit transducer sends a pulsed wave into the medium (wave speed constant along the beam axis) and the backscattered signal is collected by a hydrophone placed at two distinct positions near the transmitted beam. The time-delay profile, between gated windows of the two rf-signals received by the hydrophone, is determined using a cross-correlation method. Also, a theoretical time-delay profile is determined considering the wave speed as a parameter. The estimated wave speed is obtained upon minimization of the rms error between theoretical and experimental time-delay profiles. A PZT conically focused transmitting transducer with center frequency of 3.3 MHz, focal depth of 30 mm, and beam full width (-3 dB) of 2 mm at the focus was used together with a PZT hydrophone (0.8 mm of aperture). The method was applied to three phantoms (wave speed of 1220, 1540, and 1720 m/s) and, in vitro, to fresh bovine liver sample, immersed in a temperature-controlled water bath. The results present a relative speed error less than 3% when compared with the sound speed obtained by a conventional method.

This paper presents a computerised information system for the characterisation and analysis of the hospital admission flow of patients. Based on administrative data made available by the Ministry of Health of Brazil (DATASUS-MS), the system allows the representation of patients' flow from residence to hospital, as well as information on performed medical procedures, diagnoses and other patient and hospital characteristics. Residences are represented in terms of their postal codes and admission diagnosis according to the ICD-10 classification. The system has a flexible and simple geographic coordinates input module, and can be used even when no standard coordinates system (e.g., Mercator) are available. It provides two types of graphical representation: 'static' (concerning characteristics of a hospital or geographical area) and 'dynamic' (residence to hospital flow). Its use is exemplified with a geographical representation of access to ultra-sound exams in selected hospitals in the city of Rio de Janeiro, Brazil, July 1998. In conclusion, the system seems a powerful instrument for health needs identification and planning, as well as for quality assessment and for the generation of information useful for epidemiological research.