Personalized Gamification for Learning: A Reactive Chatbot Architecture Proposal.

A key factor for successfully implementing gamified learning platforms is making students interact with the system from multiple digital platforms. Learning platforms that try to accomplish all their objectives by concentrating all the interactions from users with them are less effective than initially believed. Conversational bots are ideal solutions for cross-platform user interaction. In this paper, an open student-player model is presented. The model includes the use of machine learning techniques for online adaptation. Then, an architecture for the solution is described, including the open model. Finally, the chatbot design is addressed. The chatbot architecture ensures that its reactive nature fits into our defined architecture. The approach's implementation and validation aim to create a tool to encourage kids to practice multiplication tables playfully.

The Human Gastric Juice: A Promising Source for Gastric Cancer Biomarkers.

Gastric cancer (GC) is a major public health problem worldwide, with high mortality rates due to late diagnosis and limited treatment options. Biomarker research is essential to improve the early detection of GC. Technological advances and research methodologies have improved diagnostic tools, identifying several potential biomarkers for GC, including microRNA, DNA methylation markers, and protein-based biomarkers. Although most studies have focused on identifying biomarkers in biofluids, the low specificity of these markers has limited their use in clinical practice. This is because many cancers share similar alterations and biomarkers, so obtaining them from the site of disease origin could yield more specific results. As a result, recent research efforts have shifted towards exploring gastric juice (GJ) as an alternative source for biomarker identification. Since GJ is a waste product during a gastroscopic examination, it could provide a "liquid biopsy" enriched with disease-specific biomarkers generated directly at the damaged site. Furthermore, as it contains secretions from the stomach lining, it could reflect changes associated with the developmental stage of GC. This narrative review describes some potential biomarkers for gastric cancer screening identified in gastric juice.

Gender and Age Differences in Preferences on Game Elements and Platforms.

This paper analyzes different player type models and game elements in the literature, particularly focusing on the case of online games. Research based on an exploratory study is presented; it aims to explore the different types of interaction with gameful digital applications. The study is based on a survey and provides findings from the literature review and empirical insights about users' differences and preferences regarding game elements. The results reveal demographics regarding player profiles and the relationships between gender, age, culture, and the influence of different game design elements and platforms. The main contribution of this study fulfills the need for knowledge about the relationship between game element design, platforms/devices, and players (types and preferences).

Intramedullary percutaneous fixation of metacarpal fractures: screw versus connected K-wires.

The purpose of the present study was to determine clinical and radiographic outcomes in patients treated with limited-open retrograde intramedullary headless screw fixation for metacarpal neck and shaft fractures (group I) versus percutaneous antegrade and retrograde intramedullary double pinning linked by a connector (group II). We designed a retrospective comparative study, with the inclusion of two groups (20 patients each) of metacarpal unstable fractures. Both groups showed similar outcomes at the final follow-up, except for extension lag (significantly better in group II) and return to sport (significantly better in group I). Intramedullary screw fixation did not accelerate bone union and range of motion recovery in the early follow-up. In conclusion, limited-open retrograde intramedullary headless screw fixation and percutaneous connected antegrade and retrograde intramedullary double pinning are both reliable techniques of fixation for metacarpal neck and shaft fractures. LEVEL OF EVIDENCE: III.

The COVID-19 pandemic: A call to action for health systems in Latin America to strengthen quality of care.

The Covid-19 and other recent pandemics has highlighted existing weakness in health systems across the Latin-America and the Caribbean (LAC) region to effectively prepare for and respond to Public Health Emergencies. It has been stated that quality of care will be among the most influential factors on Covid 19 mortality rates and low systems performance is the common case in these countries. More comprehensive and system level strategies are required to address the challenges. These must focus on redesigning and strengthening health systems to make them more resilient to the changing needs of populations and based on quality improvement methods that have shown rigorously evaluated positive effects in previous local and regional experiences. A call to action is being made by the Latin American Consortium for Quality, Patient Safety and Innovation (CLICSS) and they provide specific recommendations for decision makers.

Active Game-Based Solutions for the Treatment of Childhood Obesity.

Obesity is one of the biggest health problems globally that, together with sedentarism, requires solutions that increase the enthusiasm towards physical activity. Therefore, this paper describes two solutions based on active games using the Kinect sensor and biometric sensors, designed for the outpatient treatment of childhood obesity. The solutions were applied in an intervention program based on active video games and motor games, developed with children in treatment for childhood obesity. An ad hoc questionnaire was used to assess the level of satisfaction, fun, learning, and behavior changes in the children of the experimental group that developed the intervention. The results showed a high index of satisfaction with the intervention program, as well as with the games developed. It is concluded that active video games and group games are highly motivating and can promote behavior change towards healthier life habits in children.

Ischemic gastritis and severe diabetic ketoacidosis.

Ischemic gastritis (IG) is an extremely rare entity due to the rich gastric vascularization. The present case is the ideal setting to suspect this condition.

The neural correlates of low social integration as a risk factor for suicide.

Low social integration is commonly described in acutely suicidal individuals. Neural mechanisms underlying low social integration are poorly understood in depressed and suicidal patients. We sought to characterize the neural response to low social integration in acutely suicidal patients. Adult depressed patients within 3 days of a suicide attempt (n = 10), depressed patients with suicidal ideation (n = 9), non-suicidal depressed patients (n = 15), and healthy controls (N = 18) were administered the Cyberball Game while undergoing functional magnetic resonance imaging. We used complementary functional connectivity and region of interest data analysis approaches. There were no group differences in functional connectivity within neural network involving the pain matrix, nor in insula neural activity or the insula during either social inclusion. Superior anterior insula activity exhibited an inverted U-shaped curve across the suicide risk spectrum during social inclusion. Superior insula activity during social inclusion correlated with depression severity and psychological pain. Dorsal anterior cingulate cortex activity during social exclusion correlated with physical pain severity. Neural responses in the anterior insula significantly correlated with depression severity and with psychological pain during social inclusion, whereas dACC activity significantly correlated with physical pain during social exclusion. Recent suicidal behavior seems associated with a distinct neural response to social exclusion independently of presence of depression or suicidal thoughts.

Health Promotion for Childhood Obesity: An Approach Based on Self-Tracking of Data.

At present, obesity and overweight are a global health epidemic. Traditional interventions for promoting healthy habits do not appear to be effective. However, emerging technological solutions based on wearables and mobile devices can be useful in promoting healthy habits. These applications generate a considerable amount of tracked activity data. Consequently, our approach is based on the quantified-self model for recommending healthy activities. Gamification can also be used as a mechanism to enhance personalization, increasing user motivation. This paper describes the quantified-self model and its data sources, the activity recommender system, and the PROVITAO App user experience model. Furthermore, it presents the results of a gamified program applied for three years in children with obesity and the process of evaluating the quantified-self model with experts. Positive outcomes were obtained in children's medical parameters and health habits.

Buprenorphine use for pain and suicidal ideation in severely suicidal patients.

OBJECTIVE: Chronic pain is frequently comorbid with opioid abuse and severe depression, a combination that greatly compounds suicide risk. In addition to the therapeutic value of buprenorphine in addiction and analgesia, growing evidence suggests potential use as an antidepressant. Data supporting buprenorphine antisuicidal properties are scarce. We aim to contribute to the discussion of buprenorphine antisuicidal potential in patients with significant psychiatric and medical comorbidity. METHODS: We performed a chart review of suicidal adult depressed patients with comorbid chronic pain and opioid use disorder who received off-label buprenorphine in outpatient and inpatient settings in a university hospital between 2013 and 2016. RESULTS: Four of the patients had an early positive response. However, only three continue to adhere to treatment for six months or longer. CONCLUSIONS: More severe opioid use disorder seems to more negatively influence clinical outcome, independently of cluster b personality traits. Identification of patients who could benefit from buprenorphine will require further studies.

Index of the Mayo Endoscopy and Ulcerative Colitis Endoscopy Index of Severity: are they equally valid?

INTRODUCTION: endoscopy plays an essential role in the management of patients with ulcerative colitis (UC), as it allows us to visualize and assess the severity of the disease. Different scores have been devised to standardize the findings because such assessments are not always objective. AIMS: the aim of this study was to assess the interobserver variability between the Index of Mayo Endoscopy (IME) and the Ulcerative Colitis Endoscopy Index of Severity (UCEIS), analyzing the severity of the endoscopic lesions in patients with UC. The secondary aim was to analyze if the cathartic preparation affected the degree of concordance amongst the endoscopists. MATERIAL AND METHODS: this was a single-cohort observational, comparative study in which a colonoscopy was performed in patients with UC, as the normal clinical practice. The results were classified according to the IME and the UCEIS by three endoscopic specialists. In order to assess the degree of interobserver correlation, the Kappa index for IME was used and the intraclass correlation coefficient was used for UCEIS. RESULTS: sixty-seven patients were included in the study. The average age was 51 (SD ± 16.7) and the average Mayo Clinic index was 3.07 (SD ± 2.54). The weighted Kappa index between endoscopists A and B for the IME was 0.8, 0.52 between A and C and 0.49 between B and C. The intraclass correlation coefficient for UCEIS was 0.922 between the three endoscopists (95 % CI: 0.832-0.959). A better interobserver correlation was found when the cathartic preparation was ≥ 8 based on the Boston Scale. CONCLUSIONS: there was a higher correlation between the different endoscopists for the UCEIS than for the IME. Thus, this should be considered to be the best index to use in the clinical practice. A good cleansing preparation is important to improve the interobserver correlation.

Magnesium Exchanged Zirconium Metal-Organic Frameworks with Improved Detoxification Properties of Nerve Agents.

UiO-66, MOF-808 and NU-1000 metal-organic frameworks exhibit a differentiated reactivity toward [Mg(OMe)2(MeOH)2]4 related to their pore accessibility. Microporous UiO-66 remains unchanged while mesoporous MOF-808 and hierarchical micro/mesoporous NU-1000 materials yield doped systems containing exposed MgZr5O2(OH)6 clusters in the mesoporous cavities. This modification is responsible for a remarkable enhancement of the catalytic activity toward the hydrolytic degradation of P-F and P-S bonds of toxic nerve agents, at room temperature, in unbuffered aqueous solutions.

Better recurrence-free survival after stent bridge to surgery compared to emergency surgery for obstructive left-sided colonic cancer in patients with stage III status of the American Joint Committee on Cancer (AJCC): a bicentric retrospective study.

PURPOSE: Stenting as a bridge to surgery (SBTS) can transform an emergency surgery (ES) into an elective surgery in patients with symptomatic left-sided malignant colonic obstruction. Concerns have been raised regarding short-term morbidity and long-term oncologic outcomes, with contrasting results reported in the literature. Our main aim is to evaluate not only long-term oncologic outcomes but also short-term postoperative outcomes of stented patients who underwent elective surgery compared to those who had ES. METHODS: From January 2006 to May 2012, we retrospectively identified patients with confirmed left-sided colorectal cancer obstruction. This was done in two centers of reference of colorectal diseases in southern Spain with patients who were treated with curative intent either with ES or SBTS. The short- and long-term results were compared between both groups. RESULTS: There were 71 patients in the stenting group and 66 in the emergency surgery group, with similar demographic data. Initial stoma creation rates were lower in the SBTS group (16.9% vs. 54.5%, p < 0.005) and the primary anastomosis rate was higher in the same group (83.1% vs. 45.5%, p < 0.005). Five-year recurrence-free survival (RFS) rates were comparable between groups (75.3 vs. 59.8%, p = 0.220), but RFS rates at 5 years for AJCC pathologic stage III were higher in the stenting group (69.7% vs 30%, p = 0.004). Both groups were comparable regarding overall and cancer-specific survival outcomes. CONCLUSIONS: The use of SBTS reduces ostomy rates in patients with obstructive colon malignancies. Long-term survival results are similar. Patients in the SBTS group with stage III AJCC status showed a higher 5-year recurrence-free survival rate than those in the ES group.

Serious games for rehabilitation: Gestural interaction in personalized gamified exercises through a recommender system.

One of the principal problems of rehabilitation is that therapy sessions can be boring due the repetition of exercises. Serious games, and in particular exergames in rehabilitation, can motivate, engage and increase patients' adherence to their treatment. Also, the automatic personalization of exercises to each patient can help therapists. Thus, the main objective of this work is to build an intelligent exergame-based rehabilitation system consisting of a platform with an exergame player and a designer tool. The intelligent platform includes a recommender system which analyzes user interactions, along with the user's history, to select new gamified exercises for the user. The main contributions of this paper focus, first, on defining a recommender system based on different difficulty levels and user skills. The recommender system offers the ability to provide the user with a personalized game mode based on his own history and preferences. The results of a triple validation with experts, users and rehabilitation center professionals reveal a positive impact on gestural interaction and rehabilitation uses. Also, different methods are presented for testing the rehabilitation recommender system.

'Adiós Bacteriemias': a multi-country quality improvement collaborative project to reduce the incidence of CLABSI in Latin American ICUs.

QUALITY PROBLEM: The incidence of central line-associated bloodstream infections (CLABSI) in Latin America has been estimated at 4.9 episodes per 1000 central line (CL) days, compared to a pooled incidence of 0.9 in the United States. CLABSI usually result from not adhering to standardized health procedures and can be prevented using evidence-based practices. INITIAL ASSESSMENT: The first phase of the 'Adiós Bacteriemias' Collaborative was implemented in 39 intensive care units (ICUs) from Latin America from September 2012 to September 2013 with a 56% overall reduction in the incidence of CLABSI. CHOICE OF SOLUTION: Bundles of care for the processes of insertion and maintenance of CLs have proven to be effective in the reduction of CLABSI across different settings. IMPLEMENTATION: Building on the results of the first phase, we implemented a second phase of the 'Adiós Bacteriemias' Collaborative between June 2014-July 2015. We adapted the Breakthrough Series (BTS) Collaborative model to guide the adoption of bundles of care for CLABSI prevention through virtual learning sessions and continuous feedback. EVALUATION: Eighty-three ICUs from five Latin American countries actively reported process and outcome measures. The overall reduction in the CLABSI incidence rate was 22% (incidence rate 0.78; 95% CI 0.65, 0.95), from 2.58 episodes per 1000 CL days at baseline to 2.02 episodes per 1000 CL days (P < 0.01) during the intervention period. LESSONS LEARNED: Adiós Bacteriemias was effective in reducing the incidence of CLABSI and improving the adherence to good practices for CL insertion and maintenance processes in participating ICUs in Latin America.

Improving Cognitive Visual-Motor Abilities in Individuals with Down Syndrome.

Down syndrome causes a reduction in cognitive abilities, with visual-motor skills being particularly affected. In this work, we have focused on this skill in order to stimulate better learning. The proposal relies on stimulating the cognitive visual-motor skills of individuals with Down Syndrome (DS) using exercises with a gestural interaction platform based on the KINECT sensor named TANGO:H, the goal being to improve them. To validate the proposal, an experimental single-case study method was designed using two groups: a control group and an experimental one, with similar cognitive ages. Didactic exercises were provided to the experimental group using visual cognitive stimulation. These exercises were created on the TANGO:H Designer, a platform that was designed for gestural interaction using the KINECT sensor. As a result, TANGO:H allows for visual-motor cognitive stimulation through the movement of hands, arms, feet and head. The "Illinois Test of Psycholinguistic Abilities (ITPA)" was applied to both groups as a pre-test and post-test in its four reference sections: visual comprehension, visual-motor sequential memory, visual association, and visual integration. Two checks were made, one using the longitudinal comparison of the pre-test/post-test of the experimental group, and another that relied on comparing the difference of the means of the pre-test/post-test. We also used an observational methodology for the working sessions from the experimental group. Although the statistical results do not show significant differences between the two groups, the results of the observations exhibited an improvement in visual-motor cognitive skills.

Effects of a Gamified Educational Program in the Nutrition of Children with Obesity.

Obesity is considered a global epidemic of the twenty-first century by the World Health Organization (WHO). Specifically, the Canary Islands has the highest level of this disease in Europe and 40% of children in Spain are overweight or obese. This increase is a direct result of changes in the lifestyles of the population and its nutrition. Because of this, we have designed an educational program based on motor games, active videogames and virtual learning environments to improve the long-term health of children. This article presents and analyzes the results of a study on the nutritional knowledge and adherence to the Mediterranean diet of 46 obese children aged 6 to 12 years in the Canary Islands who participated in an educational program. The study design was quasi-experimental, with two groups (experimental and control). A long-term longitudinal study (3 years) was carried out. A set of evaluation instruments was used for the different phases. The results show significant improvements between the experimental and control groups in terms of their knowledge of healthy nutrition and their adherence to the Mediterranean diet. As a main conclusion, we emphasize that a gamified educational intervention program supported by ICT helps to motivate and promote improvements in the nutrition of children.

Lunate Grafting Into the Radius for Lunate Fossa Reconstruction in Madelung Deformity.

A 40-year-old woman presented with Madelung deformity and severe arthritic changes at both the radiocarpal and the distal radioulnar joints. She was treated by using her lunate as an osteochondral graft into the radius allowing reconstruction of the lunate fossa. The scaphoid and triquetrum were removed concomitantly and a Sauve-Kapandji procedure was performed. Complete bone healing was achieved. Ten years later, an excellent functional result was maintained, with a pain-free wrist, an acceptable wrist joint range of motion, as well as a favorable aesthetic appearance. This procedure may be indicated for patients with severe Madelung deformity with painful radiocarpal and distal radioulnar joints associated with severe arthritis changes.

[Functioning of Psychosocial Care centers in four cities in BrazilActuación de los Centros de Atención Psicosocial en cuatro centros urbanos en Brasil]. / Atuação dos Centros de Atenção Psicossocial em quatro centros urbanos no Brasil.

OBJECTIVE: To describe the functioning of Psychosocial Care centers (CAPS) in four Brazilian cities. METHODS: In this cross-sectional study (AcesSUS), 917 CAPS users were interviewed in the cities of Campinas, São Paulo, Porto Alegre, and Fortaleza. Only CAPS focused on severe mental disorders in adults were included, that is, CAPS focusing on substance abuse and on children and adolescents were excluded. Users answered a multiple choice questionnaire about their path from primary health care services until reaching the CAPS and hospital care in relation to mental health problems. RESULTS: Care by a psychiatrist and use of medications were reported by 90.7% to 99.7% of CAPS users in association with multiprofessinal care and therapeutic groups. Access to medication was interrupted in the 6 months prior to the interview, especially in Fortaleza (70%) and Porto Alegre (50%). In all cities, less than 10% of users had a psychiatric hospital admission after treatment at the CAPS was started. CONCLUSIONS: The transition from a hospital-centered model to a community-based model is well under way in Brazil, with concrete achievements. However, there is heterogeneity among different care networks, which entails the need for contextualized analysis of each individual location, with identification of difficulties that prevent the adequate functioning of these care networks in the psychosocial paradigm.

OBJETIVO: Describir la actuación de los Centros de Atención Psicosocial (CAPS) en cuatro centros urbanos en Brasil. MÉTODOS: Se realizó un estudio transversal (AcesSUS) por medio de una entrevista a 917 usuarios en seguimiento en los CAPS de Campinas, São Paulo, Porto Alegre y Fortaleza. Se incluyeron solo los tipos de CAPS donde se tratan trastornos mentales graves en adultos, con exclusión de los centrados en el uso de sustancias y servicios para niños y adolescentes. Los usuarios respondieron a un cuestionario de opción múltiple sobre su recorrido entre los servicios de atención primaria, los CAPS y los hospitales en relación con los trastornos de salud mental. RESULTADOS: Se notificaron servicios de atención psiquiátrica y uso de medicamentos, junto con atención multiprofesional y participación en grupos terapéuticos, en una proporción de 90,7% a 99,7% de los usuarios en seguimiento en los CAPS. El acceso a medicamentos se interrumpió en los 6 meses anteriores a la entrevista, particularmente en Fortaleza (70%) y Porto Alegre (50%). En todos los municipios, menos de 10% de los usuarios estuvieron internados en instituciones psiquiátricas después de iniciar el tratamiento en los CAPS. CONCLUSIONES: La transición del modelo hospitalario al comunitario sigue en curso de implementación en Brasil, con adelantos comprobados. Sin embargo, la situación es diversa en las diferentes redes de atención, lo cual exige un análisis contextualizado de cada localidad y la determinación de las dificultades que impiden el funcionamiento adecuado de esas redes en el paradigma psicosocial.

The reverse Sauvé-Kapandji procedure for the treatment of (posttraumatic) proximal radioulnar synostosis.

Proximal radioulnar synostosis is a rare but highly disabling posttraumatic complication in periarticular elbow injuries. Surgical treatment is an option for functionally limiting proximal radioulnar synostosis; however, the approach can endanger local neurovascular structures, especially if the synostosis affects the level of the bicipital tuberosity. We report two cases of proximal radioulnar synostosis with a preoperative prono-supination range of motion of 0° and 15° treated by a reverse Sauvé-Kapandji procedure resecting a 1-cm section of the radial shaft distal to the bicipital tuberosity and leaving the synostosis in place. An improvement in prono-supination arc of motion of 82.5° was achieved at 2 years of follow-up with no complications associated with the technique. The reverse Sauvé-Kapandji procedure could be an option in the treatment of proximal radioulnar synostosis in selected cases.