Objective: Childhood maltreatment (CM) is a significant risk factor for the development and severity of bipolar disorder (BD) with increased risk of suicide attempts (SA). This study evaluated whether a machine learning algorithm could be trained to predict if a patient with BD has a history of CM or previous SA based on brain metabolism measured by positron emission tomography. Methods: Thirty-six euthymic patients diagnosed with BD type I, with and without a history of CM were assessed using the Childhood Trauma Questionnaire. Suicide attempts were assessed through the Mini International Neuropsychiatric Interview (MINI-Plus) and a semi-structured interview. Resting-state positron emission tomography with 18F-fluorodeoxyglucose was conducted, electing only grey matter voxels through the Statistical Parametric Mapping toolbox. Imaging analysis was performed using a supervised machine learning approach following Gaussian Process Classification. Results: Patients were divided into 18 participants with a history of CM and 18 participants without it, along with 18 individuals with previous SA and 18 individuals without such history. The predictions for CM and SA were not significant (accuracy = 41.67%; p = 0.879). Conclusion: Further investigation is needed to improve the accuracy of machine learning, as its predictive qualities could potentially be highly useful in determining histories and possible outcomes of high-risk psychiatric patients.

Abstract Background Cognitive dysfunction (CD) is a widespread manifestation in adult systemic lupus erythematosus (SLE) patients, but this subject is rarely examined in patients with childhood-onset SLE (cSLE). This study aimed to assess the frequency of CD, its associations with lupus clinical manifestations and its impact on the health-related quality of life (HRQL) in young adult cSLE patients. Methods We evaluated 39 cSLE patients older than 18 years. They underwent a rheumatologic evaluation and extensive neuropsychological assessment, encompassing all cognitive domains described by the American College of Rheumatology. HRQL was assessed with the WHOOQOL-BREEF, General Activities of Daily Living Scale (GADL) and Systemic Lupus Erythematosus-specific quality-of-life instrument (SLEQOL). The activity of SLE was evaluated with the modified sle disease activity index (sledai-2k). Results Impairment in at least one cognitive domain was found in 35 (87.2%) patients. The most compromised domains were attention (64.1%), memory (46.2%), and executive functions (38.5%). Patients with cognitive impairment were older, had more accumulated damage and had worse socioeconomic status. Regarding the association between cognitive dysfunction and HRQL, memory impairment was correlated with worse environmental perception and a worse relationship with the treatment. Conclusion In this study, the frequency of CD in cSLE patients was as high as that in the adult SLE population. CD can significantly impact the response of cSLE patients to treatment, justifying preventive measures in the care of this population.

This article continues our presentation of the Brazilian Psychiatric Association guidelines for the management of patients with suicidal behavior, with a focus on screening, intervention, postvention, prevention, and promotion. For the development of these guidelines, we conducted a systematic review of the MEDLINE (via PubMed), Cochrane Database of Systematic Reviews, Web of Science, and SciELO databases for research published from 1997 to 2020. Systematic reviews, clinical trials, and cohort/observational studies on screening, intervention, and prevention in suicidal behavior were included. This project involved 14 Brazilian psychiatry professionals and 1 psychologist selected by the Psychiatric Emergencies Committee of the Brazilian Psychiatric Association for their experience and knowledge in psychiatry and psychiatric emergencies. Publications were evaluated according to the 2011 Oxford Center for Evidence-Based Medicine (OCEBM) Levels of Evidence Classification. Eighty-five articles were reviewed (of 5,362 initially collected and 755 abstracts on the drug approach). Forms of screening, intervention, and prevention are presented. The intervention section presents evidence for psychotherapeutic and drug interventions. For the latter, it is important to remember that each medication is effective only for specific groups and should not replace treatment protocols. We maintain our recommendation for the use of universal screening plus intervention. Although the various studies differ in terms of the populations evaluated and several proposals are presented, there is already significant evidence for certain interventions. Suicidal behavior can be analyzed by evidence-based medicine protocols. Currently, the best strategy is to combine several techniques through the Safety Plan. Nevertheless, further research on the topic is needed to elucidate some approaches with particular potential for intervention and prevention. Systematic review registry number: CRD42020206517

Suicide is a global public health problem that causes the loss of more than 800,000 lives each year, principally among young people. In Brazil, the average mortality rate attributable to suicide is approximately 5.23 per 100,000 population. Although many guidelines have been published for the management of suicidal behavior, to date, there are no recent guidelines based on the principles of evidence-based medicine that apply to the reality of suicide in Brazil. The objective of this work is to provide key guidelines for managing patients with suicidal behavior in Brazil. This project involved 11 Brazilian psychiatry professionals selected by the Psychiatric Emergencies Committee (Comissão de Emergências Psiquiátricas) of the Brazilian Psychiatric Association for their experience and knowledge in psychiatry and psychiatric emergencies. For the development of these guidelines, 79 articles were reviewed (from 5,362 initially collected and 755 abstracts). In this review, we present definitions, risk and protective factors, assessments, and an introduction to the Safety Plan. Systematic review registry number: CRD42020206517

Resumen En el caso de personas con limitación motriz de miembros superiores, los gestos faciales son la principal forma de comunicarse con el mundo. Sin embargo, las interfaces actuales basadas en gestos no tienen en cuenta la reducción de movilidad que la mayoría de las personas con limitación motriz experimentan durante sus periodos de recuperación. Como alternativa para superar esta limitación, se presenta una interfaz humana-computador basada en técnicas de visión por computador sobre dos tipos de imagen: la imagen del rostro capturada mediante webcam y la captura de pantalla de una aplicación de escritorio en primer plano. La primera imagen es utilizada para detectar, seguir y estimar la pose del rostro con el fin de desplazar y ejecutar comandos con el cursor; la segunda imagen es utilizada para lograr que los desplazamientos del cursor sean realizados a zonas específicas de interacción de la aplicación de escritorio. La interfaz es programada totalmente en Python 3.6 utilizando bibliotecas de código abierto y se ejecuta en segundo plano dentro del sistema operativo Windows. El desempeño de la interfaz se evalúa con videos de personas utilizando cuatro comandos de interacción con la aplicación WhatsApp versión de escritorio. Se encontró que la interfaz puede operar con varios tipos de iluminación, fondos, distancias a la cámara, posturas y velocidades de movimiento; la ubicación y el tamaño de la ventana de WhatsApp no afecta la efectividad de la interfaz. La interfaz opera a una velocidad de 1 Hz y utiliza el 35 % de la capacidad de un procesador Intel Core i5 y 1,5 GB de RAM para su ejecución lo que permite concebir esta solución en equipos de cómputo personales.

Abstract People with reduced upper-limb mobility depend mainly on facial gestures to communicate with the world; nonetheless, current facial gesture-based interfaces do not take into account the reduction in mobility that most people with motor limitations experience during recovery periods. This study presents an alternative to overcome this limitation, a human-computer interface based on computer vision techniques over two types of images: images of the user’s face captured by a webcam and screenshots of a desktop application running on the foreground. The first type is used to detect, track, and estimate gestures, facial patterns in order to move and execute commands with the cursor, while the second one is used to ensure that the cursor moves to specific interaction areas of the desktop application. The interface was fully programmed in Python 3.6 using open source libraries and runs in the background in Windows operating systems. The performance of the interface was evaluated with videos of people using four interaction commands in WhatsApp Desktop. We conclude that the interface can operate with various types of lighting, backgrounds, camera distances, body postures, and movement speeds; and the location and size of the WhatsApp window does not affect its effectiveness. The interface operates at a speed of 1 Hz and uses 35 % of the capacity a desktop computer with an Intel Core i5 processor and 1.5 GB of RAM for its execution; therefore, this solution can be implemented in ordinary, low-end personal computers.

Resumen: Introducción: la pandemia provocada por el SARS-CoV-2 genera un importante desafío para el sistema sanitario y especialmente para la Medicina Intensiva. Es necesario prepararse en múltiples aspectos. Además, considerar plausible una demanda extraordinaria de camas críticas que puede llevar a un desbalance entre las necesidades clínicas y la disponibilidad efectiva de los recursos sanitarios. Objetivos: realizar un análisis bioético para brindar una orientación en la atención a los pacientes críticos. Objetivos específicos: 1) Analizar los principios bioéticos fundamentales en este contexto. 2) Apoyar a los clínicos en la toma de decisiones difíciles. 3) Hacer explícitos los criterios de asignación de recursos. 4) Definir líneas de acción ante un posible escenario de “desastre sanitario”. Método: la SUMI ha generado un ámbito de trabajo colectivo cuyo método de trabajo fue la deliberación. En la documentación se utiliza la revisión bibliográfica y los protocolos ya existentes. Resultados: el trabajo plantea un análisis teórico documentado sobre los principios bioéticos involucrados en el contexto de pandemia, sobre los escenarios de demanda asistencial y sobre la fundamentación para un cambio en los criterios éticos ante un escenario de saturación del sistema. Conclusión: se plantean recomendaciones prácticas para: 1) Toma de decisiones de ingreso y egreso en demanda controlada. 2) Criterios de acción ante el aumento de la demanda estableciendo definiciones de los diferentes escenarios. 3) Recomendaciones para aplicar en un escenario de saturación del sistema.

Summary: Introduction: the pandemic caused by SARS-CoV2 constitutes a significant challenge for the health system, and especially for Critical Care Units, so we need to prepare in many aspects. Likewise, we need to consider there could be an extraordinary demand for beds in critical care units, what would lead to an imbalance between clinical needs and the effective availability of health resources. Objectives: the study aims to perform a bioethical analysis that could provide guidelines for the assistance of patients in critical care. Specific objectives: 1) to analyse the main bioethical principles in this context, 2) to support clinicians in the making of difficult decisions, 3) to make the resource allocation criteria specific, 4) to define action lines upon a potential “health’s disastrous” scenario Method: the Uruguayan Society of Intensive Care has generated a space for collective work based on discussion processes. Documents include a bibliographic review and the existing protocols. Results: the study presents a theoretical analysis that is backed up by the bioethical principles involved in the pandemic context on the scenarios of demand for assistance and, by the arguments calling for a change in the ethical criteria upon the saturation of the health system. Conclusion: practical recommendations are made: 1) for the making of decisions about admission and discharge in a controlled demand. 2) to define action criteria upon an increase in demand, clearly defining the different scenarios, 3) to apply upon the saturation of the health system.

Resumo: Introdução: a pandemia causada pelo SARS-CoV2 gera um importante desafio para o sistema de saúde e principalmente para a Medicina Intensiva. É preciso se preparar em vários aspectos. Além disso, considera plausível uma demanda extraordinária por leitos críticos, que pode levar a um desequilíbrio entre as necessidades clínicas e a disponibilidade efetiva de recursos de saúde. Objetivos: realizar uma análise bioética para orientar o cuidado ao paciente crítico. Objetivos específicos: 1) Analisar os princípios bioéticos fundamentais neste contexto, 2) Apoiar os médicos na tomada de decisões difíceis, 3) Tornar explícitos os critérios de alocação de recursos, 4) Definir linhas de ação perante um possível cenário de " desastre de saúde ". Métodos: a SUMI gerou um ambiente de trabalho coletivo cujo método de trabalho era deliberativo. A documentação usa a revisão da literatura e os protocolos existentes. Resultados: o trabalho propõe uma análise teórica documentada sobre os princípios bioéticos envolvidos no contexto da Pandemia, sobre os cenários da demanda de saúde e sobre os fundamentos para uma mudança de critérios éticos em um cenário de saturação do sistema. Conclusão: são propostas recomendações práticas para: 1) tomada de decisão para admissão e alta sob demanda controlada. 2) critérios de atuação frente ao aumento da demanda, estabelecendo definições dos diferentes cenários. 3) recomendações a serem aplicadas em um cenário de saturação do sistema.

Abstract This paper presents a non-perceptual color space based on spherical coordinates that is called RTP after Rho, Theta and Phi. Like HSV space color, RTP decouples the information associated to chrominance (θ,φ) and intensity (ρ), however RTP keeps together the reddish colors. To show the potentials of our color space, we approach the problem of identifying either an image is a computer graphic or a photorealistic image. We got an average accuracy of 84.55% detecting computer graphics and outperforming the ones from RGB, HSV and HSI color spaces with statistically significative differences on classification average accuracy. RTP color space can be used in other issues where chrominance decoupling improves the discriminant capability.

Resumen Este artículo presenta un espacio de color no perceptual basado en coordenadas esféricas llamado RTP por las siglas de Rho, Theta y Phi. De manera similar al conocido espacio HSV, RTP desacopla la información de cromaticidad (θ,φ) e intensidad (ρ), pero representa los tonos rojizos de manera continua. Para evaluar las potencialidades del espacio propuesto, se abordó el problema de discriminación entre imágenes reales y generadas por computador, donde se obtuvo una precisión promedio en la identificación de 84.55%. El desempeño alcanzado supera los obtenidos con los espacios RGB, HSI y HSV, mostrando diferencias estadísticamente significativas. El espacio RTP puede usarse en otras aplicaciones donde el desacople de los componentes cromáticos juegan un papel principal en la discriminación de los objetos contenidos en las imágenes.

Resumen Las interfaces cerebro-computadora no invasivas basadas en EEG de maginación motora (miBCI) prometen restaurar efectivamente el control motor a pacientes con discapacidades motoras, por ejemplo, aquellos con lesión de la médula espinal (LME). Sin embargo, todavía es necesario investigar las miBCI, con fines de rehabilitación, para este tipo de pacientes que utilizan dispositivos de adquisición de señales EEG de bajo costo, tales como Emotiv EPOC. En este trabajo, se describe en detalle y se comparan diez arquitecturas miBCI basadas en información de covarianza de señales EEG, adquiridas con Emotiv EPOC, para la decodificación de intención de mano abierta y cerrada en tres sujetos control y dos pacientes con LME cervical. Cuatro de estas diez miBCI usan información de covarianza para construir filtros espaciales y el resto usa la información covarianza como una representación directa de las señales EEG, permitiendo la manipulación directa mediante geometría de Riemann. Como resultado, se encontró que, a pesar de que todas las arquitecturas miBCI tienen una precisión general por encima del nivel de azar, las que utilizan la covarianza como representación directa de las señales EEG junto con clasificadores lineales, superan las miBCI que usan la covarianza para el filtrado espacial, tanto en sujetos de control como en pacientes con LME. Estos resultados sugieren un alto potencial de las miBCI basadas en la geometría de Riemann para la rehabilitación de pacientes con LME, utilizando dispositivos de adquisición de EEG de bajo costo.

Abstract Non-invasive EEG-based motor imagery brain-computer interfaces (miBCIs) promise to effectively restore the motor control of motor-impaired patients with conditions that include Spinal Cord Injury (SCI). Nonetheless, miBCIs should be further researched for this type of patients using low-cost EEG acquisition devices, such as the Emotiv EPOC, for home rehabilitation purposes. In this work, we describe in detail and compare ten miBCI architectures based on covariance information from EEG epochs. The latter were acquired with Emotiv EPOC from three control subjects and two SCI patients in order to decode the close and open hand intentions. Four out of the ten miBCIs use covariance information to create spatial filters; the rest employ covariance as a direct representation of the EEG signals, thus allowing the direct manipulation by Riemannian geometry. We found that, although all the interfaces present an overall accuracy above chance level, the miBCIs that use covariance as a direct representation of the EEG signals together with linear classifiers outperform miBCIs that use covariance for spatial filtering, both in control subjects and SCI. These results suggest the high potential of Riemannian geometry-based miBCIs for the rehabilitation of SCI patients with low-cost EEG acquisition devices.

Resumen El número de trabajos relacionados con Interfaces Cerebro-Computador (BCI, Brain-Computer Interface en inglés) directamente aplicados al proceso de rehabilitación de pacientes con lesiones de médula espinal está en aumento debido a la mejora en las técnicas de procesamiento digital de señales y reconocimiento de patrones que permiten relacionar las señales electroencefalográficas con acciones motoras. Los resultados preliminares de las pruebas de las BCI sobre sujetos reales permiten visualizar en un futuro relativamente cercano la inclusión de este tipo de herramientas en los protocolos de rehabilitación. Sin embargo, hay muchas barreras por resolver, principalmente las relacionadas con el aumento del desempeño y la generación de múltiples comandos naturales mediante interfaces cerebro-computador a partir de electroencefalografía superficial (EEG). En este trabajo se hace una revisión de los más importantes trabajos que muestran la evolución, el estado actual y las oportunidades de investigación alrededor de la temática de interfaces cerebro-computador en procesos de neurorrehabilitación de miembros superiores en pacientes con lesiones medulares.

Abstract The number of researches related to rehabilitation processes in spinal cord injury patients using Brain-Computer Interfaces is increasing due to the development of improved digital signal processing and pattern recognition techniques that allows decoding motor actions from electroencephalographic signals. Preliminary results on the application of BCI with real experimental subjects allow to envision a rehabilitation scenario using this kind of technology as part of the therapeutic protocols in a near future. Yet, some problems need to be solved: improve target detection performance and the generation of natural commands by non-invasive brain-computer interfaces based on surface electroencephalography are some of them. In this work, we make a review of the most important researches to exhibit the evolution, the current status, and the research opportunities on the use of brain-computer interfaces for upper limb neurorehabilitation in spinal cord injury patients.

Resumo O número de trabalhos relacionados com Interfaces Cérebro-Computador (BCI, Brain-Computer Interface en inglés) diretamente aplicado no processo de reabilitação de pacientes com lesões de medula espinal está no aumento e a melhoria nas técnicas de processamento digital de sinais e reconhecimento de patrones que permitam relacionar as seqüências de eletroencefalográficas com ações motoras. Os resultados preliminares das provas de BCI sobre sujeitos reais permitem visualizar em um futuro, mais perto da inclusão deste tipo de ferramentas em protocolos de reabilitação. Sin embargo, feno muitas barreras por resolver, principalmente as relacionadas com o aumento do desempenho e a geração de comandos comandos por meio de interfaces cerebro-computador a partir de electroencefalografía superficial (EEG). No presente trabalho, a empresa tem uma revisão dos mais importantes trabalhos e mostra as evoluções, o estado real e as oportunidades de pesquisa em torno da temática de interfaces cerebro-computador em processos de neurorrehabilitação de supostos superiores en pacientes com lesiones medulares.

ABSTRACT This paper presents the design and implementation of a novel technique for the recognition of four hand motions for real time response (flexion (FL), extension (EX), opening (OP) and closure (CL)) from electromyographic (EMG) signals generated from two forearm muscles: palmaris longus and extensor digitorum. The development of the work had two main stages: the low cost hardware for acquisition and conditioning of the EMG analog signals and the processing system for the identification and classification of the movement performed for real time response; the entire system was integrated in a hardware-software application using MATLAB and processing techniques for the discriminant analysis were performed. Three methods were evaluated for pattern recognition getting 98% recognition rates with the method proposed which had the best performance.

RESUMEN Este trabajo presenta el diseño e implementación de una nueva técnica para el reconocimiento de cuatro movimientos de la mano (flexión (FL), extensión (EX), apertura (OP) y cierre (CL)) para respuesta en tiempo real a partir de señales electromiográficas EMG generadas desde dos músculos del antebrazo: palmaris longus y extensor digitorum. El trabajo se desarrolló en dos principales etapas: el hardware de bajo costo para la adquisición y adecuación analógica de las señales EMG; el sistema de procesamiento para la identificación y clasificación de los movimientos capturados para respuesta en tiempo real. El sistema fue integrado mediante una aplicación hardware-software usando MATLAB y se usaron técnicas de procesamiento para el análisis discriminante. Tres métodos fueron evaluados para el reconocimiento de patrones obteniendo tasas de reconocimiento del 98% con el nuevo método propuesto.

Resumen Se presenta un sistema de visión artificial para la detección de mentiras por medio del análisis de secuencias de imágenes térmicas del rostro, como mecanismo alternativo al polígrafo, al presentar características de no-contacto, no-intrusión, la posibilidad futura de utilización reservada, así como de análisis a múltiples personas simultáneamente. El sistema se basa en la detección de los cambios fisiológicos de temperatura en la zona de los lagrimales causados por el incremento sutil del flujo sanguíneo a través de la red vascular cercana. Los resultados obtenidos alcanzan el 79.2 % de acierto en la detección de mentiras, utilizando segmentación de la zona periorbital, seguimiento entre tramas consecutivas mediante el algoritmo de Kanade-Lucas-Tomasi, y una clasificación sencilla basada en la comparación entre las temperaturas estimadas durante las preguntas de control y el resto del interrogatorio. El desempeño del sistema es comparable con resultados obtenidos en trabajos donde se emplean cámaras de mejores prestaciones que la utilizada en la experimentación.

Abstract An artificial vision system is presented for lie detection by analyzing face thermal image sequences. This system represents an alternative technique to the polygraph. Some of its features are: 1) it has no physical contact with the examinee, 2) it is non-intrusive, 3) it has a potential for private use, and 4) it can simultaneously analyze several persons. The proposed system is based on the detection of physiological changes in temperature in the lacrimal puncta area caused by the subtle increase in blood flow through the nearby vascular network. These changes take place when anxiety appears as a consequence of deception. Thus, the system segments the periorbital area, and tracks consecutive frames using the Kanade-Lucas-Tomasi algorithm. The results show a success rate of 79.2 % in detecting lies using a simple classification based on the comparison between the estimated temperatures in control questions, and the rest of the interrogation procedure. The performance of this system is comparable with previous works, where cameras with better specifications were used.

Resumo Apresenta-se um sistema de visão artificial para a detecção de mentiras por meio da análise de sequências de imagens térmicas do rosto, como mecanismo alternativo ao polígrafo, ao apresentar características de não-contato, não-intrusão, a possibilidade futura de utilização reservada, assim como de análise a múltiplas pessoas simultaneamente. O sistema baseia-se na detecção das mudanças fisiológicas de temperatura na zona dos lacrimais causados pelo incremento sutil do fluxo sanguíneo através da rede vascular próxima. Os resultados obtidos alcançam 79,2 % de acerto na detecção de mentiras, utilizando segmentação da zona periorbital, seguimento entre tramas consecutivas mediante o algoritmo de Kanade-Lucas-Tomasi, e uma classificação simples baseada na comparação entre as temperaturas estimadas durante as perguntas de controle e o resto do interrogatório. O desempenho do sistema é comparável com resultados obtidos em trabalhos onde são empregadas câmaras de melhor qualidade do que a utilizada na experimentação.