Variabilidade de medidas de espessura da camada de fibras nervosas peripapilar utilizando spectral domain OCT

Orientador: Vital Paulino CostaTese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciências MédicasResumo: Esta pesquisa teve por finalidade avaliar a variabilidade intrasessão, intersessão e interexaminador das medidas de espessura da camada de fibras nervosas da retina peripapilar (CFNRP) com a Tomografia de Coerência Óptica de Domínio Espectral (TCO-DE). Foi incluído no estudo apenas um olho de 32 indivíduos saudáveis e de 34 pacientes com glaucoma. As medidas da CFNRP foram obtidas com o Cirrus HD-OCT 4000 (Carl Zeiss Meditec, Dublin, Califórnia, EUA) cinco vezes no mesmo dia, por um único examinador, para avaliação da variabilidade intrasessão. O mesmo examinador realizou medidas de espessura da CFNRP nos mesmos sujeitos em cinco dias diferentes, para avaliação da variabilidade intersessão. Um segundo examinador realizou medidas da espessura da CFNRP nos mesmos pacientes para avaliação da variabilidade interexaminador. O coeficiente de variação (CDV) e o coeficiente de correlação intraclasse (CCI) foram obtidos para os seguintes parâmetros: espessura média, espessura nos quadrantes e espessuras setoriais. Em relação à variabilidade intrasessão, em pacientes com glaucoma, os CDVs variaram de 4,51% a 11,84% e os CCIs variaram de 0,74 a 0,99; em indivíduos saudáveis, os CDVs variaram de 2,92% a 6,99% e os CCIs variaram de 0,89 a 0,98. Na análise da variabilidade intersessão observou-se que, em pacientes com glaucoma, os CDVs variaram de 3,68% a 10,50% e os CCIs variaram de 0,82 a 0,99; em indivíduos saudáveis, os CDVs variaram de 3,13% a 6,92% e os CCIs variaram de 0,87 a 0,99. Em relação à variabilidade interexaminador, em pacientes com glaucoma, os CDVs variaram de 2,62% a 14,94% e os CCIs variaram de 0,55 a 0,98; em indivíduos saudáveis, os CDVs variaram de 2,04% a 7,31% e os CCIs variaram de 0,86 a 0,98. Estes resultados indicam que as medidas de espessura da CFNRP com a TCO-DE apresentam reprodutibilidade excelente, com baixa variabilidade intrasessão, intersessão e interexaminadorAbstract: The purpose of this study was to evaluate the intrasession, intersession and interexaminer variabilities of peripapillary retinal nerve fiber layer (PRNFL) thickness measurements with Spectral Domain Optical Coherence Tomography. One eye of 32 healthy individuals and 34 patients with glaucoma were included in the study. The PRNFL measurements were obtained with the Cirrus HD-OCT Model 4000 (Carl Zeiss Meditec, Dublin, Califórnia, USA) five times during the same sitting by one examiner to assess intrasession variability. The same examiner performed PRNFL measurements in the same patients in five different days to assess intersession variability. A second examiner performed PRNFL measurements in the same patients to assess interexaminer variability. The coefficient of variation (COV) and the intraclass correlation coefficient (ICC) were obtained for the following parameters: average thickness, quadrant thickness and clock-hour thickness measurements. The analysis of the intrasession variability, in glaucoma patients, showed that COVs ranged from 4.51% to 11.84% and ICCs varied from 0.74 to 0.99, whereas in healthy individuals, COVs ranged from 2.92% to 6.99% and ICCs varied from 0.89 to 0.98. Regarding the intersession variability, in glaucoma patients COVs ranged from 3.68% to 10.50% and ICCs varied from 0.82 to 0.99; whereas in healthy individuals, COVs ranged from 3.13% to 6.92% and ICCs varied from 0.87 to 0.99. In interexaminer variability, between glaucoma patients, COVs ranged from 2.62% to 14.94% and ICCs varied from 0.55 to 0.98, whereas in healthy individuals, COVs ranged from 2.04% to 7.31% and ICCs varied from 0.86 to 0.98. These findings indicate that PRNFL measurements with Spectral Domain Optical Coherence Tomography display excellent reproducibility, with low intrasession, intersession and interexaminer variabilitiesDoutoradoOftalmologiaDoutor em Ciências Médica

Sensitivity And Specificity Of Machine Learning Classifiers For Glaucoma Diagnosis Using Spectral Domain Oct And Standard Automated Perimetry.

To evaluate the sensitivity and specificity of machine learning classifiers (MLCs) for glaucoma diagnosis using Spectral Domain OCT (SD-OCT) and standard automated perimetry (SAP). Observational cross-sectional study. Sixty two glaucoma patients and 48 healthy individuals were included. All patients underwent a complete ophthalmologic examination, achromatic standard automated perimetry (SAP) and retinal nerve fiber layer (RNFL) imaging with SD-OCT (Cirrus HD-OCT; Carl Zeiss Meditec Inc., Dublin, California). Receiver operating characteristic (ROC) curves were obtained for all SD-OCT parameters and global indices of SAP. Subsequently, the following MLCs were tested using parameters from the SD-OCT and SAP: Bagging (BAG), Naive-Bayes (NB), Multilayer Perceptron (MLP), Radial Basis Function (RBF), Random Forest (RAN), Ensemble Selection (ENS), Classification Tree (CTREE), Ada Boost M1(ADA),Support Vector Machine Linear (SVML) and Support Vector Machine Gaussian (SVMG). Areas under the receiver operating characteristic curves (aROC) obtained for isolated SAP and OCT parameters were compared with MLCs using OCT+SAP data. Combining OCT and SAP data, MLCs' aROCs varied from 0.777(CTREE) to 0.946 (RAN).The best OCT+SAP aROC obtained with RAN (0.946) was significantly larger the best single OCT parameter (p<0.05), but was not significantly different from the aROC obtained with the best single SAP parameter (p=0.19). Machine learning classifiers trained on OCT and SAP data can successfully discriminate between healthy and glaucomatous eyes. The combination of OCT and SAP measurements improved the diagnostic accuracy compared with OCT data alone.76170-

Sensibilidade e especificidade dos classificadores de aprendizagem de máquina para o diagnóstico de glaucoma usando Spectral Domain OCT e perimetria automatizada acromática

PURPOSE: To evaluate the sensitivity and specificity of machine learning classifiers (MLCs) for glaucoma diagnosis using Spectral Domain OCT (SD-OCT) and standard automated perimetry (SAP). METHODS: Observational cross-sectional study. Sixty two glaucoma patients and 48 healthy individuals were included. All patients underwent a complete ophthalmologic examination, achromatic standard automated perimetry (SAP) and retinal nerve fiber layer (RNFL) imaging with SD-OCT (Cirrus HD-OCT; Carl Zeiss Meditec Inc., Dublin, California). Receiver operating characteristic (ROC) curves were obtained for all SD-OCT parameters and global indices of SAP. Subsequently, the following MLCs were tested using parameters from the SD-OCT and SAP: Bagging (BAG), Naive-Bayes (NB), Multilayer Perceptron (MLP), Radial Basis Function (RBF), Random Forest (RAN), Ensemble Selection (ENS), Classification Tree (CTREE), Ada Boost M1(ADA),Support Vector Machine Linear (SVML) and Support Vector Machine Gaussian (SVMG). Areas under the receiver operating characteristic curves (aROC) obtained for isolated SAP and OCT parameters were compared with MLCs using OCT+SAP data. RESULTS: Combining OCT and SAP data, MLCs' aROCs varied from 0.777(CTREE) to 0.946 (RAN).The best OCT+SAP aROC obtained with RAN (0.946) was significantly larger the best single OCT parameter (p<0.05), but was not significantly different from the aROC obtained with the best single SAP parameter (p=0.19). CONCLUSION: Machine learning classifiers trained on OCT and SAP data can successfully discriminate between healthy and glaucomatous eyes. The combination of OCT and SAP measurements improved the diagnostic accuracy compared with OCT data alone.OBJETIVO: Avaliar a sensibilidade e especificidade dos classificadores de aprendizagem de máquina no diagnóstico de glaucoma usando Spectral Domain OCT (SD-OCT) e perimetria automatizada acromática (PAA). MÉTODOS: Estudo transversal observacional. Sessenta e dois pacientes com glaucoma e 48 indivíduos normais foram incluídos. Todos os pacientes foram submetidos a exame oftalmológico completo, e perimetria automatizada acromática (24-2 SITA; Humphrey Field Analyzer II, Carl Zeiss Meditec, Inc., Dublin, CA) e exame de imagem da camada de fibras nervosas utilizando SD-OCT (Cirrus HD-OCT; Carl Zeiss Meditec Inc., Dublin, California). Curvas ROC (Receiver operator characteristic) foram obtidas para todos os parâmetros do SD-OCT e índices globais do campo visual (MD, PSD, GHT). Subsequentemente, os seguintes classificadores de aprendizagem de máquina (CAMs) foram testados usando parâmetros do OCT e CV: Bagging (BAG), Naive-Bayes (NB), Multilayer Perceptron (MLP), Radial Basis Function (RBF), Random Forest (RAN), Ensemble Selection (ENS), Classification Tree (CTREE), Ada Boost M1(ADA), Support Vector Machine Linear (SVML) e Support Vector Machine Gaussian (SVMG). Áreas abaixo da curva ROC (aROC) obtidas com os parâmetros isolados do campo visual (CV) e OCT foram comparados com os CAMs usando dados associados do OCT e CV. RESULTADOS: Combinando os dados do OCT e do CV, aROCs dos CAMs variaram entre 0,777(CTREE) e 0,946 (RAN). A maior aROC dos CAMs OCT+CV obtida com RAN (0,946) foi significativamente maior que o melhor parâmetro do OCT (p<0,05), mas não houve diferença estatística significativa com o melhor parâmetro do CV (p=0,19). CONCLUSÃO: Os classificadores de aprendizagem de máquina treinados com dados do OCT e CV podem discriminar entre olhos normais e glaucomatosos com sucesso. A combinação das medidas do OCT e CV melhoraram a acurácia diagnóstica comparados aos parâmetros do OCT.17017

Effects of Misalignments in the Retinal Nerve Fiber Layer Thickness Measurements with Spectral Domain Optical Coherence Tomography

Purpose. To investigate misalignments (MAs) on retinal nerve fiber layer thickness (RNFLT) measurements obtained with Cirrus© SD-OCT. Methods. This was a retrospective, observational, cross-sectional study. Twenty-seven healthy and 29 glaucomatous eyes of 56 individuals with one normal exam and another showing MA were included. MAs were defined as an improper alignment of vertical vessels in the en face image. MAs were classified in complete MA (CMA) and partial MA (PMA), according to their site: 1 (superior, outside the measurement ring (MR)), 2 (superior, within MR), 3 (inferior, within MR), and 4 (inferior, outside MR). We compared RNFLT measurements of aligned versus misaligned exams in all 4 sectors, in the superior area (sectors 1 + 2), inferior area (sectors 3 + 4), and within the measurement ring (sectors 2 + 3). Results. RNFLT measurements at 12 clock-hour of eyes with MAs in the superior area (sectors 1 + 2) were significantly lower than those obtained in the same eyes without MAs P=0.043. No significant difference was found in other areas (sectors 1 + 2 + 3 + 4, sectors 3 + 4, and sectors 2 + 3). Conclusion. SD-OCT scans with superior MAs may present lower superior RNFLT measurements compared to aligned exams

Seed germination and vigor of passion fruit hybrids

Most commercial plantations of passion fruit is propagate plants by seed, but germination is irregular, which hinders the growth of seedlings and uniformity, and is connected with the plant genotype. The objective of this study was to evaluate the germination and early growth of passion fruit hybrid seedlings, obtained from different genetic combinations. The hybrids were obtained from the cross between progenies from the breeding program of the Universidade Federal de Viçosa with hybrids of the Empresa Brasileira de Pesquisa Agropecuária and of the Viveiros Flora Brasil. The experimental design was completely randomized with six hybrids, five replicates and fifty seeds per experimental unit. Germination was assessed daily until the 28 days, and at the end of the period it was obtained the mean time germination, emergence speed index, seedling height, the length of shoots and roots, and the individual seedling dry matter (root + shoot)was assessed. Among the passion fruit hybrids evaluated, hybrid HB2 (UFVM0212 × BRS Sol do Cerrado) showed the highest germination and seedling biometric values and might be a genotype with potential for breeding programs for seed quality. The specific combining ability of parents can influence the quality of seeds and the vigor of passion fruit seedlings. A factor must be considered is the correct choice of maternal and paternal parents, since they influence the quality of seeds. Most commercial plantations of passion fruit is propagate plants by seed, but germination is irregular, which hinders the growth of seedlings and uniformity, and is connected with the plant genotype. The objective of this study was to evaluate the germination and early growth of passion fruit hybrid seedlings, obtained from different genetic combinations. The hybrids were obtained from the cross between progenies from the breeding program of the Universidade Federal de Viçosa with hybrids of the Empresa Brasileira de Pesquisa Agropecuária and of the Viveiros Flora Brasil. The experimental design was completely randomized with six hybrids, five replicates and fifty seeds per experimental unit. Germination was assessed daily until the 28 days, and at the end of the period it was obtained the mean time germination, emergence speed index, seedling height, the length of shoots and roots, and the individual seedling dry matter (root + shoot)was assessed. Among the passion fruit hybrids evaluated, hybrid HB2 (UFVM0212 × BRS Sol do Cerrado) showed the highest germination and seedling biometric values and might be a genotype with potential for breeding programs for seed quality. The specific combining ability of parents can influence the quality of seeds and the vigor of passion fruit seedlings. A factor must be considered is the correct choice of maternal and paternal parents, since they influence the quality of seeds

Equilíbrio e risco de quedas em crianças com deficiência visual

Introdução: O comprometimento do sistema visual pode reduzir a estabilidade, resultando em aumento da oscilação corporal e/ou alteração da estratégia de movimento. Objetivo: Avaliar o equilíbrio em crianças com deficiência visual (DV),em fase escolar. Métodos: Foram avaliados cinco participantes, com diagnóstico de baixa visão (P1 e P5) e cegueira total (P2, P3 e P4). A avaliação foi realizada por meio de questionário, aplicação de teste clínico e avaliação do equilíbrio (EEP e PF BIOMEC 400). Resultados: O escore total da EEP de P1, P2 e P4 foi 56 pontos; de P3, 53; e de P5, 55 pontos. Na PF, P1 e P5 obtiveram melhor manutenção do equilíbrio. Todos os participantes apresentaram dificuldade em ficar em apoio unipodal. Conclusão: As crianças com DV são capazes de realizar as AVDs, mas podem apresentar maior risco de quedas, principalmente nas que exigem a posição unipodal. Introduction: The involvement of the visual system can reduce the stability, re-sulting in increased body sway and/or change in movement strategy. Objective: To evaluate the balance in children with visual impairment (DV) on the school stage. Methods: A total of five participants diagnosed with low vision (P1 and P5) and total blindness (P2, P3 and P4) were analysed. The evaluation was con-ducted through a questionnaire, clinical trial implementationand evaluation of the balance (EEP and PF 400 biomec). Results: The total score of EEP P1, P2 and P4 was 56 points, P3 was 53, and P5 was 55 points. In PF, P1 and P5 had better main-tain balance. All participants had trouble staying on leg support. Conclusion: Children with DV are able to perform ADLs, but may be at greater risk of falls, especially those that require a single leg stance

Os livros escolares como fontes de história da educação : um estado da arte

O trabalho insere-se na linha de investigações sobre a história dos manuais escolares, articulando-se em torno do objetivo de compreender as dimensões ligadas ao uso e ao tratamento desses objetos culturais como fontes para a pesquisa em História da Educação, por meio do exame da produção sobre a temática, publicada em periódicos nacio nais. Nos últimos 30 anos, a pesquisa histórica sobre os livros escolares teve um significativo desenvolvimento, isso se deu, principalmente, pelas várias possibilidades de informações sobre diferentes culturas, conhecimentos, intenções de usos e contextos que esse complexo objeto carrega. A partir de toda a complexidade e possibilidade de estudo dos livros escolares, a pesquisa voltou-se para o levantamento, sistematização e análise dos 100 artigos encontrados nas nove revistas acadêmicas selecionadas para o trabalho. Tal análise teve como objetivo entender como os livros escolares estão sendo estudados e pesquisados no Brasil, como objeto e fonte para a compreensão da História da Educação, a fim de compreender e visualizar os limites e avanços das investigações nacionais sobre o tema em questão, possibilitando a outros estudiosos explorar novos aspectos e reflexões ainda abertos para anális

Pressure ulcers in the intensive care unit: the relationship between nursing workload, illness severity and pressure ulcer risk

Aims and objective. To verify association between PU development with nursing workload and illness severity and to verify whether nursing workload and illness severity are related with Braden Scale scores. Background. Critically ill patients are more susceptible to treatment complications because of the severity of their clinical condition. Design. Prospective descriptive study. Methods. Patients consecutively admitted to three intensive care units (ICUs) of a public university hospital located in São Paulo, Brazil and without pressure ulcer (PU) at admission and a minimum stay of 24hours were included in the sample. Prospective data collection included demographic, clinical and hospitalisation data, Nursing Activities Score (NAS), Simplified Acute Physiology Score (SAPSII) and Braden Scale. Multivariate linear regression analysis was applied to verify whether nursing workload and illness severity are related with Braden Scale scores. Multivariate logistic regression analysis was used to verify whether nursing workload and illness severity were risk factors associated with PU development. Results. the study sample included 160 patients. the mean Braden score was 120 and PU incidence was 344%. Multivariate linear regression analysis identified as factors related to variation of Braden scores: illness severity (SAPSII), nursing workload (NAS) and age. Multivariate logistic regression showed a model with risk factors associated with PU development: sex, length of ICU stay, illness severity and nursing workload. Conclusion. Nursing workload, severity of illness, sex and length of ICU stay were identified as risk factors associated with PU development. However, nursing workload acted as a protective factor. Illness severity, nursing workload and age were related to Braden scores. Relevance to clinical practice. Accurate identification of risk factors and the use of clinical judgment in skin assessment are prerequisites for determining appropriate strategies to prevent pressure ulcers, to improve quality of care for patient safety and to reduce length of ICU and hospital stay and costs.Universidade Federal de São Paulo, São Paulo Hosp, São Paulo, BrazilMunicipal Hosp Dr Mario M Altenfelder Silva, São Paulo, BrazilUniversidade Federal de São Paulo, UNIFESP, Paulista Nursing Sch, São Paulo, BrazilUniversidade Federal de São Paulo, São Paulo Hosp, São Paulo, BrazilUniversidade Federal de São Paulo, UNIFESP, Paulista Nursing Sch, São Paulo, BrazilWeb of Scienc