Animar al aprendizaje autónomo a través de gamificación en programación orientada a objetos

La programación orientada a objetos es una disciplina de difícil comprensión para los que se inician sin conocimientos previos y requiere de una ajustada combinación de teoría y práctica con el fin de adquirir las destrezas y habilidades necesarias para resolver problemas reales. Dentro de la enseñanza universitaria puede fácilmente perder su carácter práctico y convertirse en un conjunto de conceptos teóricos de difícil comprensión y aplicación en la práctica profesional. Este trabajo presenta el diseño, desarrollo y evaluación de un ciclo de innovación docente en la asignatura Fundamentos de Programación II del Grado en Ingeniería de las Tecnologías de Telecomunicación de la Universidad de Sevilla en la que se pretende formar a los estudiantes en la programación orientada a objetos mediante el lenguaje Java. La metodología de innovación emplea elementos de gamificación y trabajos en pequeños grupos con el fin de motivar a los estudiantes y enseñar, a través de la autonomía del estudiante, tanto contenidos conceptuales como actitudes de resolución de problemas claves para los futuros ingenieros

Contribuciones al diseño de arquitecturas de sistemas distribuidos abiertos para la provisión de servicios del cuidado de la salud y de soporte a la autonomía del ciudadano

Texto completo de TeseoEl dominio sanitario se ha visto enormemente influenciado por las Tecnologías de la Información y la Comunicación (TICs) en las últimas décadas. Consecuencia de esto son los avances en dispositivos, gestión de información y procesos asistenciales. En parte debido a la heterogeneidad tecnológica de las soluciones y a la ausencia de una metodología formal de aplicación de las TICs, en la actualidad el escenario sanitario está fragmentado en sistemas separados que rara vez cooperan entre sí para proveer capacidades avanzadas. Esto dificulta la mejora en la eficiencia de los procesos, la evolución del sistema sanitario y la reducción de costes al existir soluciones redundantes que en ocasiones coexisten en las organizaciones sanitarias. La práctica clínica también está evolucionando hacia escenarios descentralizados donde la asistencia a un individuo es compartida entre diferentes organizaciones sanitarias (en ocasiones incluso distribuidas geográficamente) y en los que la coherencia de la información así como su privacidad son requisitos indispensables para una mejora de la eficiencia. En este escenario descentralizado los individuos y no las organizaciones deben ser el centro de los procesos, sustituyendo el actual rol pasivo por uno activo en el mantenimiento y mejora de su salud. Garantizar la interoperatividad en un sistema distribuido es una de las necesidades fundamentales para facilitar el entendimiento entre las partes implicadas. La normalización en los distintos niveles de comunicación (sintáctico, semántico, organizativo, etc.) es la clave para la interoperatividad pero adoptar los esfuerzos normativos en ocasiones resulta una tarea ardua debido principalmente a la variedad de iniciativas normativas y el solapamiento entre ellas. Todos los aspectos relevantes de los sistemas distribuidos tanto de propósito general como específicos del dominio sanitario están cubiertos por esfuerzos normativos pero a menudo es necesario realizar una armonización entre iniciativas antes de aplicarlas al desarrollo de sistemas para no perder interoperatividad. En esta Tesis Doctoral se investiga, diseña y desarrolla un paradigma de sistema distribuido orientado al sujeto de la asistencia que permite la colaboración de sistemas, usuarios, organizaciones y dispositivos con el objetivo común de mejorar y mantener la salud del sujeto de la asistencia concreto. Este paradigma hereda los fundamentos del concepto de organización virtual (Virtual Organization) y se ha denominado Person-Oriented Virtual Organization (POVO). El principal requisito de diseño de este paradigma es la adopción de normas y estándares que potencien la interoperatividad de los sistemas desplegados y garantice una larga vida útil de los mismos a través de la reutilización ulterior de sus capacidades. Siguiendo este principio de diseño la arquitectura de POVO está basada en las especificaciones del estándar ISO/EN 12967 (HISA) específico del dominio sanitario y el marco de trabajo RM-ODP. Para establecer una adecuada base arquitectural, en esta Tesis Doctoral se analiza la norma HISA y se reestructura para que sea más fiel a los principios de diseño del marco de trabajo RM-ODP y siga la formalización determinada por el estándar ISO 19793 (UML4ODP). La especificación del estándar HISA se extiende con capacidades de seguridad y de gestión de semántica. Dichas extensiones están basadas en el análisis y armonización de la normativa aplicable buscando optimizar y facilitar la aplicación de la solución final. Al margen de la especificación de los principios arquitecturales y funciones básicas de la POVO, se particulariza dicho paradigma para el estilo arquitectural SOA y la tecnología de computación en Grid y se diseña y desarrolla un mecanismo de control de acceso orientado a la administración por parte del sujeto de la asistencia y basado en capacidades semánticas. El mecanismo de autorización sigue un esquema de control de acceso basado en atributos que, utilizando ontologías y reglas de inferencia, permite automatizar el proceso de toma de decisiones. Así cualquier sujeto de la asistencia puede determinar de forma sencilla sus preferencias de acceso sobre los recursos e información directamente relacionados con su salud. Estas preferencias son traducidas e integradas en la base de conocimiento y un motor de inferencia será el que autorice o deniegue los intentos de acceso en base a las políticas definidas por el sujeto de la asistencia. Las aportaciones de esta Tesis Doctoral, en líneas generales, ponen de manifiesto tres aspectos fundamentales en el ámbito de las TICs aplicadas al dominio sanitario. En primer lugar, el potencial que la normalización tiene para construir soluciones interoperables, reutilizables y con amplios horizontes temporales. Como consecuencia de ello es necesario potenciar las iniciativas normativas actuales y armonizar los solapamientos que existan entre ellas. Ejemplo de esto es la norma HISA cuya amplia adopción está ligada a la correcta integración con otras normas del mismo ámbito y su adecuada puesta en valor. En segundo lugar, los escenarios distribuidos con foco en el sujeto de la asistencia son el paso evolutivo natural de la asistencia sanitaria dadas las actuales (y futuras) coyunturas económicas y sociales. La tecnología está alcanzando una gran madurez en lo que a sistemas distribuidos se refiere pero aún queda camino por recorrer para poder construir soluciones fiables y eficientes que cubran los requisitos específicos de un escenario distribuido tan complejo como el que se presenta en esta Tesis Doctoral. Por último, el mecanismo de control de acceso diseñado y desarrollado sirve de prueba de concepto de cómo la tecnología actual puede otorgar a los individuos un papel activo en el mantenimiento de su salud y procesos relacionados sin necesidad de que tengan conocimientos tecnológicos avanzados

Internet of things in health: Requirements, issues, and gaps

Background and objectives: The Internet of Things (IoT) paradigm has been extensively applied to several sectors in the last years, ranging from industry to smart cities. In the health domain, IoT makes possible new scenarios of healthcare delivery as well as collecting and processing health data in real time from sensors in order to make informed decisions. However, this domain is complex and presents several tech- nological challenges. Despite the extensive literature about this topic, the application of IoT in healthcare scarcely covers requirements of this sector. Methods: A literature review from January 2010 to February 2021 was performed resulting in 12,108 articles. After filtering by title, abstract, and content, 86 were eligible and examined according to three requirement themes: data lifecycle; trust, security, and privacy; and human-related issues. Results: The analysis of the reviewed literature shows that most approaches consider IoT application in healthcare merely as in any other domain (industry, smart cities…), with no regard of the specific requirements of this domain. Conclusions: Future effort s in this matter should be aligned with the specific requirements and needs of the health domain, so that exploiting the capabilities of the IoT paradigm may represent a meaningful step forward in the application of this technology in healthcare.Consejería de Conocimiento, Investigación y Universidad, Junta de Andalucía P18-TPJ - 307

A Sensor-Based mHealth Platform for Remote Monitoring and Intervention of Frailty Patients at Home

Frailty syndrome is an independent risk factor for serious health episodes, disability, hospitalization, falls, loss of mobility, and cardiovascular disease. Its high reversibility demands personalized interventions among which exercise programs are highly efficient to contribute to its delay. Information technology-based solutions to support frailty have been recently approached, but most of them are focused on assessment and not on intervention. This paper describes a sensor-based mHealth platform integrated in a service-based architecture inside the FRAIL project towards the remote monitoring and intervention of pre-frail and frail patients at home. The aim of this platform is constituting an efficient and scalable system for reducing both the impact of aging and the advance of frailty syndrome. Among the results of this work are: (1) the development of elderly-focused sensors and platform; (2) a technical validation process of the sensor devices and the mHealth platform with young adults; and (3) an assessment of usability and acceptability of the devices with a set of pre-frail and frail patients. After the promising results obtained, future steps of this work involve performing a clinical validation in order to quantify the impact of the platform on health outcomes of frail patients.Consejería de Conocimiento, Investigación y Universidad P18-TPJ-307

Aplicación de la especificación Data Distribution Service (DDS) al control de glucosa en pacientes diabéticos

En este trabajo se ha investigado la posibilidad de utilizar el estándar DDS (Data Distribution Service) desarrollado por el OMG (Object Management Group) para la monitorización en tiempo real del nivel de glucosa en pacientes diabéticos. Dicho estándar sigue el patrón publicador/suscriptor de modo que, en la prueba de concepto desarrollada, los sensores del punto de cuidado son publicadores de los valores de glucosa de los pacientes y diferentes supervisores se suscriben a esa información. Estos supervisores reaccionan de la forma más adecuada a los valores y la evolución del nivel de glucosa en el paciente, por ejemplo, registrando el valor de la muestra o generando una alarma. El software de intermediación que soporta la comunicación de datos sigue el estándar DDS. Esto facilita por un lado la escalabilidad e interoperatividad de la solución desarrollada y por otro la monitorización de niveles de glucosa y la activación de protocolos predefinidos en tiempo real. La investigación se enmarca dentro del proyecto intramural PERSONA del CIBER-BBN, cuyo objetivo es el diseño de herramientas de soporte a la decisión para la monitorización continua de pacientes personalizadas e integradas en una plataforma tecnológica para diabetes

A Sensor-Based mHealth Platform for Remote Monitoring and Intervention of Frailty Patients at Home

Frailty syndrome is an independent risk factor for serious health episodes, disability, hospitalization, falls, loss of mobility, and cardiovascular disease. Its high reversibility demands personalized interventions among which exercise programs are highly efficient to contribute to its delay. Information technology-based solutions to support frailty have been recently approached, but most of them are focused on assessment and not on intervention. This paper describes a sensor-based mHealth platform integrated in a service-based architecture inside the FRAIL project towards the remote monitoring and intervention of pre-frail and frail patients at home. The aim of this platform is constituting an efficient and scalable system for reducing both the impact of aging and the advance of frailty syndrome. Among the results of this work are: (1) the development of elderly-focused sensors and platform; (2) a technical validation process of the sensor devices and the mHealth platform with young adults; and (3) an assessment of usability and acceptability of the devices with a set of pre-frail and frail patients. After the promising results obtained, future steps of this work involve performing a clinical validation in order to quantify the impact of the platform on health outcomes of frail patients

Empowering citizens with access control mechanisms to their personal health resources

Background: Advancements in information and communication technologies have allowed the development of new approaches to the management and use of healthcare resources. Nowadays it is possible to address complex issues such as meaningful access to distributed data or communication and understanding among heterogeneous systems. As a consequence, the discussion focuses on the administration of the whole set of resources providing knowledge about a single subject of care (SoC). New trends make the SoC administrator and responsible for all these elements (related to his/her demographic data, health, well-being, social conditions, etc.) and s/he is granted the ability of controlling access to them by third parties. The subject of care exchanges his/her passive role without any decision capacity for an active one allowing to control who accesses what. Purpose: We study the necessary access control infrastructure to support this approach and develop mechanisms based on semantic tools to assist the subject of care with the specification of access control policies. This infrastructure is a building block of a wider scenario, the Person-Oriented Virtual Organization (POVO), aiming at integrating all the resources related to each citizen’s health-related data. The POVO covers the wide range and heterogeneity of available healthcare resources (e.g., information sources, monitoring devices, or software simulation tools) and grants each SoC the access control to them. Methods: Several methodological issues are crucial for the design of the targeted infrastructure. The distributed system concept and focus are reviewed from the service oriented architecture (SOA) perspective. The main frameworks for the formalization of distributed system architectures (Reference Model-Open Distributed Processing, RM-ODP; and Model Driven Architecture, MDA) are introduced, as well as how the use of the Unified Modelling Language (UML) is standardized. The specification of access control policies and decision making mechanisms are essential keys for this approach and they are accomplished by using semantic technologies (i.e., ontologies, rule languages, and inference engines). Results: The results are mainly focused on the security and access control of the proposed scenario. An ontology has been designed and developed for the POVO covering the terminology of the scenario and easing the automation of administration tasks. Over that ontology, an access control mechanism based on rule languages allows specifying access control policies, and an inference engine performs the decision making process automatically. The usability of solutions to ease administration tasks to the SoC is improved by the Me-As-An-Admin (M3A) application. This guides the SoC through the specification of personal access control policies to his/her distributed resources by using semantic technologies (e.g., metamodeling, model-to-text transformations, etc.). All results are developed as services and included in an architecture in accordance with standards and principles of openness and interoperability. Conclusions: Current technology can bring health, social and well-being care actually centered on citizens, and granting each person the management of his/her health information. However, the application of technology without adopting methodologies or normalized guidelines will reduce the interoperability of solutions developed, failing in the development of advanced services and improved scenarios for health delivery. Standards and reference architectures can be cornerstones for future-proof and powerful developments. Finally, not only technology must follow citizen-centric approaches, but also the gaps needing legislative efforts that support these new paradigms of healthcare delivery must be identified and addressed

How technology is empowering patients? A literature review

Background The term ‘Patient Empowerment’ (PE) is a growing concept – so in popularity as in application – covering situations where citizens are encouraged to take an active role in the management of their own health. This concept is serving as engine power for increasing the quality of health systems, but a question is still unanswered, ‘how PE will be effectively achieved?’ Beyond psychological implications, empowerment of patients in daily practice relies on technology and the way it is used. Unfortunately, the heterogeneity of approaches and technologies makes difficult to have a global vision of how PE is being performed. Objective To clarify how technology is being applied for enhancing patient empowerment as well as to identify current (and future) trends and milestones in this issue. Search strategy Searches for relevant English language articles using Medline, Scopus, ACM Digital Library, Springer Link, EBSCO host and ScienceDirect databases from the year 2000 until October 2012 were conducted. Among others, a selection criterion was to review articles including terms ‘patient’ and ‘empowerment’ in title, abstract or as keywords. Main results and conclusions Results state that practical approaches to empower patients vary in scope, aim and technology. Health literacy of patients, remote access to health services, and self-care mechanisms are the most valued ways to accomplish PE. Current technology already allows establishing the first steps in the road ahead, but a change of attitude by all stakeholders (i.e. professionals, patients, policy makers, etc.) is required

Easing the development of healthcare architectures following RM-ODP principles and healthcare standards

RM-ODP has been widely accepted and used in the field of system and software model engineering and of enterprise computing within different environments. One of these specific domains is healthcare, in which the international standard Health Information Services Architecture (HISA) is applied under the directives of RM-ODP. HISA presents a flexible architecture identifying common use cases, actors, information, and services and easing its extension with specific services, systems and information. The HISA standard follows system specification through the RM-ODP viewpoints but it does not consider other features of the reference model, such as the Enterprise language or the UML4ODP specification. In this paper, we introduce the rationale and specification of the three technology-independent viewpoints of an HISA-based architecture conforming to RM-ODP and UML4ODP. Moreover, we evaluate how easy it is to extend this architecture to introduce specific services and elements. As proof of concept we explore security and privacy issues (i.e., requirements, actors, information objects, etc.) and enrich the architecture with suitable objects and services, mainly from access control standardization efforts. In addition, a detailed discussion about the divergences between RM-ODP and HISA is presented. The main contribution of our work is to develop (guided by RM-ODP, HISA, and other standards) a methodology and tools allowing healthcare service developers and designers to build solutions conforming to standards and leveraging the benefits of distribution and interoperability. These tools consist of the specification of three technology-independent viewpoints according to the guidelines of HISA, RM-ODP and UML4ODP for the healthcare domain, and they will be freely available. In parallel, these viewpoints are extended with access control issues, and the adequacy of the HISA extension mechanism is evaluated

Privilege Management Infrastructure for Virtual Organizations in Healthcare Grids

This paper is focused on the management of virtual organizations (VO) inside healthcare environments where grid technology is used as middleware for a healthcare services-oriented architecture (HSOA). Some of the main tasks considered for the provision of an efficient VOmanagement aremanagement of users, assignation of roles to users, assignation of privileges to roles, and definition of resources access policies. These tasks are extremely close to privilege management infrastructures (PMI), so we face VOmanagement services as part of the PMI supporting access control to healthcare resources inside the HSOA. In order to achieve a completely open and interoperable PMI, we review and apply standards of security and architectural design. Moreover, semantic technologies are introduced in decision points for access control allowing the management of a high degree of descriptors by means of ontologies and infer the decision making through rules and reasoners