Taller basado en el juego como estrategia pedagógica para la educación sexual en niños y niñas de 7 a 9 años.

Fortalecer los procesos que orientan la formación en educación sexual en los niños y niñas en edades de 7 a 9 años de dos instituciones educativas en el municipio de Soacha, a través del diseño y la implementación de talleres basados en el juego.Este documento da cuenta como en la actualidad aún es considerado inadecuado hablar de sexualidad desde la infancia, es por ello que se realizó un ejercicio de investigación en donde se busca fortalecer los procesos que se orientan a la hora de tratar el tema de educación sexual en las edades de 7 a 9 años, esto por medio de los talleres que se centran en el juego, en donde se evidencia la implementación de nuevas herramientas y estrategias pedagógicas. Es por eso que el proceso de investigación que se realizó retoma diferentes autores que fortalecen la importancia que tiene el juego durante la explicación de diferentes temas en la educación infantil, no solo refiriéndose a la educación sexual. Es allí en donde se evidencia que, mediante el juego orientado desde talleres, los infantes muestran gran interés acerca de los procesos de aprendizaje que permiten abordar estas temáticas, con el paso del tiempo se ha evidenciado cambios positivos frente a la participación tanto de estudiantes y padres de familia o cuidadores en estos espacios diferenciadores de la rutina académica. Es por ello que la implementación de nuevas estrategias pedagógicas frente a la educación sexual ha de hacer frente a diversos retos, por lo que es necesario una reorganización de los procesos de enseñanza- aprendizaje, en donde se sitúe un trabajo interactivo y colaborativo con niños, niñas y padres de familia o cuidadores, desde los talleres basados en el juego.This document shows that at present it is still considered inappropriate to speak of sexuality since childhood, that is why a research exercise was carried out in which it is sought to strengthen the processes that are oriented when dealing with the topic of sex education in the ages of 7 to 9 years, this by means of workshops that focus on the game, where the implementation of new pedagogical tools and strategies is evident. That is why the research process that was carried out takes up different authors that strengthen the importance of the game during the explanation of different topics in early childhood education, not only referring to sex education. It is there that it is evident that through the game oriented from workshops, the infants show great interest about the learning processes that allow to address these topics, With the passage of time, positive changes have been evidenced in the face of the participation of both students and parents or caregivers in these spaces that differentiate from the academic routine. That is why the implementation of new pedagogical strategies in the face of sex education has to face various challenges, so it is necessary a reorganization of the teaching processes learning, where interactive and collaborative work with children and parents or caregivers is located, from the workshops based on the game

Unconstrained estimation of HRV indices after removing respiratory influences from heart rate

Objective: This paper proposes an approach to better estimate the sympathovagal balance (SB) and the respiratory sinus arrhythmia (RSA) after separating respiratory influences from the heart rate (HR). Methods: The separation is performed using orthogonal subspace projections and the approach is first tested using simulated HR and respiratory signals with different spectral properties. Then, RSA and SB are estimated during autonomic blockade and stress using the proposed approach and the classical heart rate variability (HRV) analysis. Both real and ECG-derived respiration (EDR) are used and the reliability of the EDR is evaluated. Results: Mean absolute percentage errors lower than 1% were obtained after removing previously known respiratory signals from simulated HR. The proposed indices were able to improve the quantification of SB during autonomic withdrawal. In the stress data, differences ( $p < 0.003 ) among relaxed and stressful phases were found with the proposed approach, using both the real respiration and the EDR, but they disappeared when using the classical HRV. Conclusion: A better assessment of the autonomic nervous system' response to pharmacological blockade and stress can be achieved after removing respiratory influences from HR, and this can be done using either the real respiration or the EDR. Significance: This work can be used to better identify vagal withdrawal and increased sympathetic activation when the classical HRV analysis fails due to the respiratory influences on HR. Furthermore, it can be computed using only the ECG, which is an advantage when developing wearable systems with limited number of sensors

Obstructive Sleep Apnea Screening by Joint Saturation Signal Analysis and PPG-derived Pulse Rate Oscillations

Obstructive sleep apnea (OSA) is a high-prevalence disease in the general population, often underdiagnosed. The gold standard in clinical practice for its diagnosis and severity assessment is the polysomnography, although in-home approaches have been proposed in recent years to overcome its limitations. Today's ubiquitously presence of wearables may become a powerful screening tool in the general population and pulse-oximetry-based techniques could be used for early OSA diagnosis. In this work, the peripheral oxygen saturation together with the pulse-to-pulse interval (PPI) series derived from photoplethysmography (PPG) are used as inputs for OSA diagnosis. Different models are trained to classify between normal and abnormal breathing segments (binary decision), and between normal, apneic and hypopneic segments (multiclass decision). The models obtained 86.27% and 73.07% accuracy for the binary and multiclass segment classification, respectively. A novel index, the cyclic variation of the heart rate index (CVHRI), derived from PPI's spectrum, is computed on the segments containing disturbed breathing, representing the frequency of the events. CVHRI showed strong Pearson's correlation (r) with the apnea-hypopnea index (AHI) both after binary (r=0.94, p < 0.001) and multiclass (r=0.91, p < 0.001) segment classification. In addition, CVHRI has been used to stratify subjects with AHI higher/lower than a threshold of 5 and 15, resulting in 77.27% and 79.55% accuracy, respectively. In conclusion, patient stratification based on the combination of oxygen saturation and PPI analysis, with the addition of CVHRI, is a suitable, wearable friendly and low-cost tool for OSA screening at home

Autonomic dysfunction increases cardiovascular risk in the presence of sleep apnea

The high prevalence of sleep apnea syndrome (SAS) and its direct relationship with an augmented risk of cardiovascular disease (CVD) have raised SAS as a primary public health problem. For this reason, extensive research aiming to understand the interaction between both conditions has been conducted. The advances in non-invasive autonomic nervous system (ANS) monitoring through heart rate variability (HRV) analysis have revealed an increased sympathetic dominance in subjects suffering from SAS when compared with controls. Similarly, HRV analysis of subjects with CVD suggests altered autonomic activity. In this work, we investigated the altered autonomic control in subjects suffering from SAS and CVD simultaneously when compared with SAS patients, as well as the possibility that ANS assessment may be useful for the early stage identification of cardiovascular risk in subjects with SAS. The analysis was performed over 199 subjects from two independent datasets during night-time, and the effects of the physiological response following an apneic episode, sleep stages, and respiration on HRV were taken into account. Results, as measured by HRV, suggest a decreased sympathetic dominance in those subjects suffering from both conditions, as well as in subjects with SAS that will develop CVDs, which was reflected in a significantly reduced sympathovagal balance (p < 0.05). In this way, ANS monitoring could contribute to improve screening and diagnosis, and eventually aid in the phenotyping of patients, as an altered response might have direct implications on cardiovascular health

Otago Exercises Monitoring for Older Adults by a Single IMU and Hierarchical Machine Learning Models

Otago Exercise Program (OEP) is a rehabilitation program for older adults to improve frailty, sarcopenia, and balance. Accurate monitoring of patient involvement in OEP is challenging, as self-reports (diaries) are often unreliable. With the development of wearable sensors, Human Activity Recognition (HAR) systems using wearable sensors have revolutionized healthcare. However, their usage for OEP still shows limited performance. The objective of this study is to build an unobtrusive and accurate system to monitor OEP for older adults. Data was collected from older adults wearing a single waist-mounted Inertial Measurement Unit (IMU). Two datasets were collected, one in a laboratory setting, and one at the homes of the patients. A hierarchical system is proposed with two stages: 1) using a deep learning model to recognize whether the patients are performing OEP or activities of daily life (ADLs) using a 10-minute sliding window; 2) based on stage 1, using a 6-second sliding window to recognize the OEP sub-classes performed. The results showed that in stage 1, OEP could be recognized with window-wise f1-scores over 0.95 and Intersection-over-Union (IoU) f1-scores over 0.85 for both datasets. In stage 2, for the home scenario, four activities could be recognized with f1-scores over 0.8: ankle plantarflexors, abdominal muscles, knee bends, and sit-to-stand. The results showed the potential of monitoring the compliance of OEP using a single IMU in daily life. Also, some OEP sub-classes are possible to be recognized for further analysis.Comment: 10 page

DS-MS-TCN: Otago Exercises Recognition with a Dual-Scale Multi-Stage Temporal Convolutional Network

The Otago Exercise Program (OEP) represents a crucial rehabilitation initiative tailored for older adults, aimed at enhancing balance and strength. Despite previous efforts utilizing wearable sensors for OEP recognition, existing studies have exhibited limitations in terms of accuracy and robustness. This study addresses these limitations by employing a single waist-mounted Inertial Measurement Unit (IMU) to recognize OEP exercises among community-dwelling older adults in their daily lives. A cohort of 36 older adults participated in laboratory settings, supplemented by an additional 7 older adults recruited for at-home assessments. The study proposes a Dual-Scale Multi-Stage Temporal Convolutional Network (DS-MS-TCN) designed for two-level sequence-to-sequence classification, incorporating them in one loss function. In the first stage, the model focuses on recognizing each repetition of the exercises (micro labels). Subsequent stages extend the recognition to encompass the complete range of exercises (macro labels). The DS-MS-TCN model surpasses existing state-of-the-art deep learning models, achieving f1-scores exceeding 80% and Intersection over Union (IoU) f1-scores surpassing 60% for all four exercises evaluated. Notably, the model outperforms the prior study utilizing the sliding window technique, eliminating the need for post-processing stages and window size tuning. To our knowledge, we are the first to present a novel perspective on enhancing Human Activity Recognition (HAR) systems through the recognition of each repetition of activities

Heart Rate Variability Analysis Assessment for Asthma Control Stratification

Autonomic nervous system (ANS) has been suggested to play a major role in the pathogenesis of asthma. This hypothesis has motivated large research, revealing a reduced modulation of the heart rate in subjects with uncontrolled asthma, when compared to asthmatics with controlled symptomatology. In this work, we assessed ANS activity through heart rate variability analysis in a group of asthmatics classified attending to the control of their symptoms. This information was later used for training a logistic regression classifier aiming at differentiating between the levels of control in asthmatic patients. The accuracy of the classifier improved when including ANS information (71.77%, versus 64.73% when only clinical parameters were considered), suggesting that ANS assessment could contribute to better non-invasive asthma monitoring

A comparative study of ECG-derived respiration in ambulatory monitoring using the single-lead ECG

Cardiorespiratory monitoring is crucial for the diagnosis and management of multiple conditions such as stress and sleep disorders. Therefore, the development of ambulatory systems providing continuous, comfortable, and inexpensive means for monitoring represents an important research topic. Several techniques have been proposed in the literature to derive respiratory information from the ECG signal. Ten methods to compute single-lead ECG-derived respiration (EDR) were compared under multiple conditions, including different recording systems, baseline wander, normal and abnormal breathing patterns, changes in breathing rate, noise, and artifacts. Respiratory rates, wave morphology, and cardiorespiratory information were derived from the ECG and compared to those extracted from a reference respiratory signal. Three datasets were considered for analysis, involving a total 59 482 one-min, single-lead ECG segments recorded from 156 subjects. The results indicate that the methods based on QRS slopes outperform the other methods. This result is particularly interesting since simplicity is crucial for the development of ECG-based ambulatory systems

Utilidad de la resonancia magnética en el diagnóstico de apendicitis aguda

Comparar el resultado de la resonancia magnética en el diagnóstico de apendicitis aguda con el patrón de oro (estudio histopatológico o seguimiento clínico del paciente) con el fin de establecer la utilidad de ésta como prueba diagnóstica y poder incluirla dentro del algoritmo de estudio de esta patología cuando hay sospecha clínica y un resultado negativo o dudoso de la ecografía abdominalTo compare the results of magnetic resonance imaging in the diagnosis of acute appendicitis with the gold standard (histopathology or clinical follow-up of the patient) in order to establish the usefulness of it as a diagnostic test and to include it in the study algorithm of this pathology when there is clinical suspicion and a negative or equivocal abdominal ultrasound