Cognitive Load measurement by using a concurrent multitasking simulation game

[Resumen] La Teoría de la Carga Cognitiva establece que el proceso de aprendizaje o el desempeño de una tarea se ven afectados cuando hay una sobrecarga en la memoria de trabajo. Además, realizar múltiples tareas de manera simultánea también tienen un impacto en est sobrecarga. Este trabajo presenta una herramienta, un juego de multitareas, que permite inferir carga cognitiva. Se ha llevado a cabo una prueba experimental utilizando el juego y recogiendo información tanto subjetiva como objetiva de todos los participantes. Adicionalmente se analizó el impacto de aumentar la complejidad de la tarea primaria. Todas las variables fisiológicas se vieron afectadas por este cambio en la tarea primaria, especialmente la temperatura corporal y los movimientos de los ojos. Además, la información subjetiva proporcionada con el cuestionario NASA-TLX y la escala Paas también aumentaron con la complejidad de la tarea primaria. Finalmente, se obtuvo una importante correlación entre las dos medidas subjetivas.[Abstract] The Cognitive Load Theory states that the learning process or the performance of a task is affected when there is an overload on the working memory. Additionally, concurrent multitasking has also an impact on this overload. This work presents a tool, a multitasking game that allows to infer cognitive load. An experimental test has been performed using the game and gathering subjective and objective information. Within this test, an analysis of the impact of increasing the complexity of the primary task has been performed. All the physiological variables were affected, especially the body temperature and the eye movements. Moreover, the subjective information provided with the NASA-TLX questionnaire and the Paas scale also increased with the complexity of the primary task. Additionally, a strong correlation between the two subjective measures was obtained

Simulador de reanimación cardiopulmonar con realimentación en tiempo real

El paro cardiaco es un problema que causa anualmente un gran número de muertes en todo el mundo. Sin embargo, una parada cardiaca es un estado potencialmente reversible si se inicia inmediatamente una reanimación cardiaca de calidad y se utiliza un desfibrilador externo automático. En general, los simuladores utilizados en los cursos de formación no permiten evaluar objetivamente la maniobra de reanimación cardiopulmonar (RCP). Normalmente, estos simuladores solo cuentan con realimentación sonora sobre la profundidad de las compresiones. Así, tanto los alumnos mientras practican como los instructores mientras valoran la maniobra, deben evaluar y corregir la reanimación guiados por lo que perciben a simple vista y no en base a información objetiva. En este trabajo, se ha desarrollado un simulador clínico con realimentación a tiempo real, con el que se pretende facilitar el aprendizaje y la evaluación objetiva de la maniobra de RCP impartida en cursos de formación

The Helicobacter pylori Genome Project : insights into H. pylori population structure from analysis of a worldwide collection of complete genomes

Helicobacter pylori, a dominant member of the gastric microbiota, shares co-evolutionary history with humans. This has led to the development of genetically distinct H. pylori subpopulations associated with the geographic origin of the host and with differential gastric disease risk. Here, we provide insights into H. pylori population structure as a part of the Helicobacter pylori Genome Project (HpGP), a multi-disciplinary initiative aimed at elucidating H. pylori pathogenesis and identifying new therapeutic targets. We collected 1011 well-characterized clinical strains from 50 countries and generated high-quality genome sequences. We analysed core genome diversity and population structure of the HpGP dataset and 255 worldwide reference genomes to outline the ancestral contribution to Eurasian, African, and American populations. We found evidence of substantial contribution of population hpNorthAsia and subpopulation hspUral in Northern European H. pylori. The genomes of H. pylori isolated from northern and southern Indigenous Americans differed in that bacteria isolated in northern Indigenous communities were more similar to North Asian H. pylori while the southern had higher relatedness to hpEastAsia. Notably, we also found a highly clonal yet geographically dispersed North American subpopulation, which is negative for the cag pathogenicity island, and present in 7% of sequenced US genomes. We expect the HpGP dataset and the corresponding strains to become a major asset for H. pylori genomics

Automated Trauma Management Evaluation for Knowledge Acquisition Through Simulation

La lesión traumática es una de las principales causas de muerte en el mundo, siendo la principal causa de muerte para personas menores de 45 años; por lo tanto, aprender cómo manejar este tipo de lesiones es importante. En esta Tesis, se resaltan los aspectos principales a considerar antes de tratar a un paciente de trauma: entender la severidad de las lesiones; el país en el cual se aprende el manejo de estas lesiones, puesto que la exposición y los recursos disponibles pueden variar; y la respuesta fisiopatológica del cuerpo, en función del mecanismo y del tipo de lesión sufrida. La formación en trauma ha mejorado desde que se creó la primera formación específica en trauma en 1978, el Advanced Trauma Life Support (ATLS). Debido a la importancia de estas lesiones de trauma, se han llevado a cabo revisiones periódicas de esta formación y nuevas formaciones han surgido, centrándose en encontrar la mejor manera de formar a los clínicos. La simulación clínica ha apoyado el aprendizaje del manejo del trauma a lo largo del tiempo, ofreciendo experiencias prácticas, lo que supone un método de aprendizaje más rápido, incluyéndose como complemento a las clases tradicionales. En esta Tesis, se lleva a cabo un análisis exhaustivo sobre el estado actual de las formaciones en trauma basadas en simulación. En este análisis se presentan las principales áreas de mejora detectadas. Por lo tanto, se ha desarrollado una modalidad de simulación que pueda estar accesible para diferentes niveles de conocimiento y de experiencia. Esta modalidad, es un simulador de trauma web que permite incluir cualquier escenario de trauma así como cualquier acción que sea necesaria para estabilizar a un paciente con este tipo de lesión. Cuando una acción se lleva a cabo en el simulador, hay un impacto en las constantes vitales del paciente, dotando de realismo a la simulación. Además, todos los datos que se generan a lo largo de la simulación se guardan automáticamente en una base de datos y, nada más finalizar la simulación, un informe se genera también de forma automática. Finalmente, el simulador que se desarrolla en esta Tesis permite incorporar protocolos de manejo del trauma, lo que es clave para poder medir la adquisición de conocimiento. Definir protocolos de manejo del trauma es todavía un reto pero, es una necesidad clara para poder mejorar la atención a los pacientes de trauma. Por lo tanto, en esta Tesis se presentan protocolos de manejo del trauma. Para elaborarlos, guías generales del manejo del trauma tales como los manuales del ATLS y del Prehospital Trauma Life Support (PHTLS) se han tenido en cuenta, junto con la experiencia de clínicos especialistas en trauma. De esta manera, se han elaborado protocolos de actuación basados en acciones, en los cuales, todas las acciones a llevar a cabo se detallan, también cuándo se deben hacer y el orden en el que se deben llevar a cabo. Debido a que los protocolos de trauma precisan de flexibilidad por las circunstancias imprevisibles que pudieran darse, se proponen diferentes alternativas para cada protocolo de trauma. Finalmente, se presentan protocolos de actuación para cuatro escenarios diferentes de trauma. Incorporar los protocolos de trauma en el simulador web desarrollado es el paso siguiente en esta Tesis. Esto permite comparar cómo se ha realizado una simulación llevada a cabo por un alumno con respecto al protocolo de trauma correspondiente. Este es un aspecto importante para que sea posible construir un sistema de evaluación automático. Por otro lado, otro aspecto importante es, desarrollar unas métricas que permitan medir el nivel de cumplimiento con respecto al tratamiento que se debería dar a un paciente de trauma. Las métricas desarrolladas en esta Tesis tienen en cuenta todos los aspectos relevantes del manejo del trauma, lo que permite analizar cómo se ha llevado a cabo la simulación con respecto a las acciones que se deberían haber hecho en los primeros minutos del tratamiento, si las acciones mínimas que se deberían llevar a cabo se han hecho y cómo de bien se ha hecho todo el tratamiento completo con respecto al protocolo establecido. Por lo tanto, nuevas métricas se han desarrollado. Algunas de estas métricas provienen de la matriz de confusión; dos de ellas, las puntuaciones de subsecuencias y diagonales, se han desarrollado específicamente en esta Tesis y un alineamiento global se ha creado basado en el algoritmo de Needleman-Wunsch. Este algoritmo se ha modificado teniendo en cuenta las necesidades específicas del manejo del trauma. Estas necesidades son muy importantes puesto que, el tiempo para estabilizar a un paciente con una lesión de trauma es muy poco y se tiene que responder muy rápidamente. Por lo tanto, llevar a cabo acciones o tratamientos que no son exactamente los que se deberían llevar a cabo consume tiempo, lo que no deja mucho para poder corregirlos y actuar de nuevo. Es por esto que nuevos parámetros se incluyen en este algoritmo, para premiar las acciones que se hacen bien o que son similares a las que se deberían llevar a cabo, o para penalizar las acciones que no son adecuadas en un determinado momento, o que tienen un impacto negativo en las contantes vitales del paciente o que, simplemente, no se hacen. Finalmente, las métricas que se han desarrollado en esta Tesis se han usado en una prueba experimental con el simulador web desarrollado, obteniendo resultados satisfactorios. Estos resultados miden el nivel de aprendizaje adquirido usando el simulador web desarrollado, presentando una mejora en el manejo de casos de trauma tras dos semanas de entrenamiento. Los resultados que se han obtenido en esta Tesis confirman las hipótesis y los objetivos de investigación. ----------ABSTRACT---------- Trauma is one of the leading causes of death in the world, being the main cause of death in people under 45 years old; therefore, learning how to manage traumatic injuries is of great importance. Within this Thesis, the main aspects to consider prior to trauma treatment are highlighted: understanding the severity of the lesions; the country in which a training takes places, as the exposure and resources available may be different; and the pathophysiology response of the body, due to the mechanism of the injury and the types of lesions suffered. The current trauma management training landscape has improved since the first ATLS training was created in 1978. Due to the importance of trauma injuries, continuous improvements are developed on how to better train clinicians. Clinical simulation has supported trauma management learning along time, providing a hands-on experience which supports a faster knowledge acquisition method to incorporate in traditional lecture courses. Within this Thesis, a deep analysis on the current state of simulation-based trauma trainings is presented, in which the main gaps detected are addressed. Therefore, a simulation modality that can be available to different levels of knowledge and expertise has been developed. This is a Web-based Trauma Simulator (WBTS) which allows to include any trauma scenario as well as all the necessary actions to stabilize the trauma patient. Once an action is accomplished, there is an impact on the vital signs of the patient, providing realism to the simulation. Additionally, all the data generated along the simulation is automatically gathered into a database and a report is automatically generated after the simulation. Finally, the simulator developed within this Thesis supports to incorporate trauma management protocols which is key to measure knowledge acquisition. It is still a challenge to define trauma management protocols but, it is a clear need to provide a quality treatment to trauma patients. Therefore, trauma protocols are objectified in this Thesis. To develop them, general trauma management guidelines such as ATLS and PHTLS manuals are considered, together with the experience of trauma experts. This supports the translation from general guidelines to the local real clinical practice. Therefore, an action protocol is set, in which all the actions to accomplish, when are they done and the order in which they should be accomplished is designed. Due to the flexibility needed in trauma protocols considering the unpredictable circumstances that they may appear, several possibilities for each trauma protocol are envisioned. Finally, this is done for four different trauma scenarios. Incorporating trauma protocols into the WBTS developed is the next step taken on this Thesis. This allows to compare how a trainee performed with respect to the trauma protocols set in an automated manner. This is an important aspect to be able to build an automated evaluation system. On the other hand, another essential part is to develop metrics that allow to measure the level of performance with respect to the treatment that should be provided to the simulated trauma patient. The metrics developed in this Thesis consider all trauma relevant aspects allowing to analyze how the performance was done with respect to the actions accomplished during the first minutes of treatment, whether the minimum actions to take along the treatment are done and how well the whole treatment compared to the trauma management protocol set was performed. Therefore, new metrics have been developed. Some of these metrics come from the confusion matrix; two of them, the subsequences and the diagonal scores have been developed specifically within this Thesis and a global alignment has been created based on the Needleman-Wunsch algorithm. This algorithm was modified according to specific trauma management requirements. These requirements are very relevant, as the time to stabilize a trauma patient is short and quick actions need to be taken. Therefore, to take actions that are not exactly the ones that should be accomplished will take time, which will not leave enough to counteract. Consequently, new parameters are included within this algorithm to reward actions that are correctly done or that are similar to the ones to accomplish, or to punish the actions that are not correctly performed or that have a negative impact on the vital signs of the patient or that are, simply, not done. Finally, the developed metrics in this Thesis are used in an experimental test obtaining successful results. These results measure the knowledge acquired using the WBTS presented and show an improvement after a two weeks training period. The results obtained in this Thesis confirm the investigated research hypotheses and objectives

The Need for Trauma Management Training and Evaluation on a Prehospital Setting

Trauma is one of the leading causes of death in the world, being the main cause of death in people under 45 years old. The epidemiology of these deaths shows an important peak during the first hour after a traumatic event. Therefore, learning how to manage traumatic injuries in a prehospital setting is of great importance. Medical students from Universidad Autónoma performed 66 different simulations to stabilize a trauma patient on a prehospital scene by using a web-based trauma simulator. Then, a panel of trauma experts evaluated the simulations performed, observing that, on average, an important number of simulations were scored below 5, being the score values provided from 0, minimum, to 10, maximum. Therefore, the first need detected is the need to further train prehospital trauma management in undergraduate education. Additionally, a deeper analysis of the scores provided by the experts was performed. It showed a great dispersion in the scores provided by the different trauma experts per simulation. Therefore, a second need is identified, the need to develop a system to objectively evaluate trauma management

Clinical application of the upper limb motion analysis during wheelchair propulsion

Manual wheelchair propulsion results in a physical demand on the upper extremities that, due to its repetitive nature, leads to chronic pain, specially at wrist and shoulder joints. These problems are increasing because life expectancy of patients with spinal cord injury has incremented during recent years. In fact, the consequence of the long-term use of the wheelchair presents a biomechanical challenge as the upper extremities are not designed to support propulsion repetitive movements. Analyzing the manual wheelchair propulsion gesture with a biomechanical approach provides objective data on the loads and movements that the upper limb supports. Therefore, transferring this biomechanical analysis towards the clinical field through an application will help the facultatives on taking decisions. In this paper, an application which provides flexibility, all the needed information and a report with the key data of a propulsion test has been developed

A systematic methodology to analyze the impact of hand-rim wheelchair propulsion on the upper limb

Manual wheelchair propulsion results in physical demand of the upper limb extremities that, because of its repetitive nature, can lead to chronic pathologies on spinal cord injury patients. The aim of this study was to design and test a methodology to compare kinematic and kinetic variables of the upper limb joints when propelling different wheelchairs. Moreover, this methodology was used to analyze the differences that may exist between paraplegic and tetraplegic patients when propelling two different wheelchairs. Five adults with paraplegia and five adults with tetraplegia performed several propulsion tests. Participants propelled two different wheelchairs for three minutes at 0.833 m/s (3 km/h) with one minute break between the tests. Kinematic and kinetic variables of the upper limb as well as variables with respect to the propulsion style were recorded. Important differences in the kinetic and kinematic variables of the joints of the upper limb were found when comparing paraplegic and tetraplegic patients. Nevertheless, this difference depends on the wheelchair used. As expected, in all tests, the shoulder shows to be the most impacted joint

Neurodata Tracker: Software for computational assessment of hand motor skills based on optical motion capture in a virtual environment

Objectives Deficits affecting hand motor skills negatively impact the quality of life of patients. The NeuroData Tracker platform has been developed for the objective and precise evaluation of hand motor deficits. We describe the design and development of the platform and analyse the technological feasibility and usability in a relevant clinical setting. Methods A software application was developed in Unity (C#) to obtain kinematic data from hand movement tracking by a portable device with two cameras and three infrared sensors (leap motion®). Four exercises were implemented: (a) wrist flexion-extension (b) finger-grip opening-closing (c) finger spread (d) fist opening-closing. The most representative kinematic parameters were selected for each exercise. A script in Python was integrated in the platform to transform real-time kinematic data into relevant information for the clinician. The application was tested in a pilot study comparing the data provided by the tool from ten healthy subjects without any motor impairment and ten patients diagnosed with a stroke with mild to moderate hand motor deficit. Results The NeuroData Tracker allowed the parameterization of kinematics of hand movement and the issuance of a report with the results. The comparison of the data obtained suggests the feasibility of the tool for detecting differences between patients and healthy subjects. Conclusions This new platform based on optical motion capturing provides objective measurement of hand movement allowing quantification of motor deficits. These findings require further validation of the tool in larger trials to verify its usefulness in the clinical setting