Leiomioma intraligamentario degenerado como simulador de patología maligna de ovario. Reporte de un caso / Degenerated intraligamentary leiomioma as a simulator of malignant ovarian pathology. Report of a case

Los leiomiomas son tumores mesenquimatosos benignos que se presentan como la neoplasia uterina más común en mujeres en edad reproductiva. Según su crecimiento, se puede ver comprometido su aporte sanguíneo, ocurriendo cambios degenerativos por la carencia de oxígeno, lo cual le confiere un aspecto atípico que puede generar confusión con el diagnostico. Se describe caso de paciente de 47 años de edad, quien consulta por aumento progresivo de volumen de circunferencia abdominal de 7 meses de evolución, referida a la consulta de ginecología oncológica por gran masa tumoral retrouterina de probable origen ovárico con elevado riesgo de malignidad. Luego de realizar estudios preoperatorios es llevada a quirófano, obteniéndose como diagnóstico definitivo, leiomioma con degeneración hialina e hidrópica focal. Los leiomiomas con cambios degenerativos pueden simular tumores malignos de ovario, por lo cual deben ser considerados como un diagnóstico diferencial antes de intervenciones quirúrgicas por tumores abdominopélvicos de gran tamaño(AU)

Leiomyomas are benign mesenchymal tumors that occur as the most common uterine neoplasm in women of reproductive age. Depending on its growth, its blood supply may be compromised, causing degenerative changes due to lack of oxygen, which gives it an atypical appearance that may cause confusion with the diagnosis. The case of a 47-year-old patient is described, who consults for a progressive increase in the volume of abdominal circumference of 7 months of evolution, referred to the gynecology oncology consultation due to a large retrouterine tumor mass of probable ovarian origin with a high risk of malignancy. After performing preoperative studies, she was taken to the operating room, obtaining as a definitive diagnosis, leiomyoma with hyaline and focal hydropic degeneration. Leiomyomas with degenerative changes can simulate malignant ovarian tumors, which is why they should be considered as a differential diagnosis before surgical interventions for large abdominopelvic tumors(AU)

Study of machine learning techniques for outcome assessment of leptospirosis patients.

Leptospirosis is a global disease that impacts people worldwide, particularly in humid and tropical regions, and is associated with significant socio-economic deficiencies. Its symptoms are often confused with other syndromes, which can compromise clinical diagnosis and the failure to carry out specific laboratory tests. In this respect, this paper presents a study of three algorithms (Decision Tree, Random Forest and Adaboost) for predicting the outcome (cure or death) of individuals with leptospirosis. Using the records contained in the government National System of Aggressions and Notification (SINAN, in portuguese) from 2007 to 2017, for the state of Pará, Brazil, where the temporal attributes of health care, symptoms (headache, vomiting, jaundice, calf pain) and clinical evolution (renal failure and respiratory changes) were used. In the performance evaluation of the selected models, it was observed that the Random Forest exhibited an accuracy of 90.81% for the training dataset, considering the attributes of experiment 8, and the Decision Tree presented an accuracy of 74.29 for the validation database. So, this result considers the best attributes pointed out by experiment 10: time first symptoms medical attention, time first symptoms ELISA sample collection, medical attention hospital admission time, headache, calf pain, vomiting, jaundice, renal insufficiency, and respiratory alterations. The contribution of this article is the confirmation that artificial intelligence, using the Decision Tree model algorithm, depicting the best choice as the final model to be used in future data for the prediction of human leptospirosis cases, helping in the diagnosis and course of the disease, aiming to avoid the evolution to death.

PhyberSIM: a tool for the generation of ground truth to evaluate brain fiber clustering algorithms.

Diffusion Magnetic Resonance Imaging tractography is a non-invasive technique that produces a collection of streamlines representing the main white matter bundle trajectories. Methods, such as fiber clustering algorithms, are important in computational neuroscience and have been the basis of several white matter analysis methods and studies. Nevertheless, these clustering methods face the challenge of the absence of ground truth of white matter fibers, making their evaluation difficult. As an alternative solution, we present an innovative brain fiber bundle simulator that uses spline curves for fiber representation. The methodology uses a tubular model for the bundle simulation based on a bundle centroid and five radii along the bundle. The algorithm was tested by simulating 28 Deep White Matter atlas bundles, leading to low inter-bundle distances and high intersection percentages between the original and simulated bundles. To prove the utility of the simulator, we created three whole-brain datasets containing different numbers of fiber bundles to assess the quality performance of QuickBundles and Fast Fiber Clustering algorithms using five clustering metrics. Our results indicate that QuickBundles tends to split less and Fast Fiber Clustering tends to merge less, which is consistent with their expected behavior. The performance of both algorithms decreases when the number of bundles is increased due to higher bundle crossings. Additionally, the two algorithms exhibit robust behavior with input data permutation. To our knowledge, this is the first whole-brain fiber bundle simulator capable of assessing fiber clustering algorithms with realistic data.

Image Guided Interpedicular Screw Placement Simulation System for Training and Skill Evaluation. Proof of Concept.

BACKGROUND: The SpineST-01 system is an image-guided vertebrae cannulation training system. During task execution, the computer calculates performance-based metrics displaying different visual perspectives (lateral view, axial view, anteroposterior view) with the position of the instrument inside the vertebra. Finally, a report with the metrics is generated as performance feedback. METHODS: A training box holds a 3D printed spine section. The computer works with 2 orthogonally disposed cameras, tracking passive markers placed on the instrument. Eight metrics were proposed to evaluate the execution of the surgical task. A preliminary study with 25 participants divided into 3 groups (12 novices, 10 intermediates, and 3 expert) was conducted to determine the feasibility of the system and to evaluate and assess the performance differences of each group using Kruskal-Wallis analysis and Mann-Whitney U analysis. In both analyses, a P value ≤ 0.05 was considered statistically significant. RESULTS: When comparing experts versus novices and all 3 groups, statistical analysis showed significant differences in 6 of the 8 metrics: axial angle error (°), lateral angle error (°), average speed (mm/second), progress between shots (mm), Time (seconds), and shots. The metrics that did not show any statistically significant difference were time between shots (seconds), and speed between shots (mm/second). Also, the average result comparison placed the experts as the best performance group. CONCLUSIONS: Initial testing of the SpineST-01 demonstrated potential for the system to practice image-guided cannulation tasks on lumbar vertebrae. Results showed objective differences between experts, intermediates, and novices in the proposed metrics, making this system a feasible option for developing basic navigation system skills without the risk of radiation exposure and objectively evaluating task performance.

Integrating Modular Pipelines with End-to-End Learning: A Hybrid Approach for Robust and Reliable Autonomous Driving Systems.

Autonomous driving navigation relies on diverse approaches, each with advantages and limitations depending on various factors. For HD maps, modular systems excel, while end-to-end methods dominate mapless scenarios. However, few leverage the strengths of both. This paper innovates by proposing a hybrid architecture that seamlessly integrates modular perception and control modules with data-driven path planning. This innovative design leverages the strengths of both approaches, enabling a clear understanding and debugging of individual components while simultaneously harnessing the learning power of end-to-end approaches. Our proposed architecture achieved first and second place in the 2023 CARLA Autonomous Driving Challenge's SENSORS and MAP tracks, respectively. These results demonstrate the architecture's effectiveness in both map-based and mapless navigation. We achieved a driving score of 41.56 and the highest route completion of 86.03 in the MAP track of the CARLA Challenge leaderboard 1, and driving scores of 35.36 and 1.23 in the CARLA Challenge SENSOR track with route completions of 85.01 and 9.55, for, respectively, leaderboard 1 and 2. The results of leaderboard 2 raised the hybrid architecture to the first position, winning the edition of the 2023 CARLA Autonomous Driving Competition.

Reliability of the carousel simulator for assessing labor cervical dilation in medical obstetrics education.

OBJECTIVE: To determine the reliability of the Carousel simulator in medical education for obstetric examinations. Cervical dilation examination training in pregnant women exposes patients to additional uncomfortable and health-risk procedures, a gold standard, and does not objectively evaluate the medical student's competence. METHOD: We studied the reliability of training internship medical students in obstetrics. Participating students were assigned to take the examination of digital assessment of the cervical dilation on the simulator. Classes performed 12 consecutive randomly blind predetermined cervical dilation examinations using the Carousel simulator. The exact answer and the answer with certainty within ±1 cm were registered and analyzed. Incorrect or outlier answers were considered with a cutoff of ≥2 cm from the dilation. A dispersion graph for each centimeter of dilation simulation was constructed. RESULTS: Sixty-six medical obstetricians took part, performing 396 examinations. Thus, we observed 49 outliers (12.37%) in simulated assessments. According to the analysis, we did not observe outliers from dilation 1 to 4 cm; dilation 7 to 9 cm had a higher index of outlier measurements. We did not consider any dilation simulation dispersion graphic as a null correlation. A strong correlation was seen in the dilation 1 to 6 cm and the dilation 10 cm. The dilations 7, 8, and 9 cm showed a weak correlation. CONCLUSION: The Carousel simulator model is a reliable method for student learning. The simulator is an essential study tool capable of reducing the embarrassment and possible harm caused by the excessive and repetitive number of in vivo digital vaginal examinations. Novel studies are proposed to improve the simulator device and method, mainly to estimate the adequate repetitions and training needed before in vivo practice.

A low-cost, DIY tourniquet simulator with built-in self-assessment for prehospital providers in Guatemala city.

BACKGROUND: Hemorrhage is the leading cause of preventable death after trauma. In high-income countries first responders are trained in hemorrhage control techniques but this is not the case for developing countries like Guatemala. We present a low-cost training model for tourniquet application using a combination of virtual and physical components. METHODS: The training program includes a mobile application with didactic materials, videos and a gamified virtual reality environment for learning. Additionally, a physical training model of a bleeding lower extremity is developed allowing learners to practice tourniquet application using inexpensive and accessible materials. Validation of the simulator occurred through content and construct validation. Content validation involved subjective assessments by novices and experts, construct validation compared pre-training novices with experts. Training validation compared pre and post training novices for improvement. RESULTS: Our findings indicate that users found the simulator useful, realistic, and satisfactory. We found significant differences in tourniquet application skills between pre-training novices and experts. When comparing pre- and post-training novices, we found a significantly lower bleeding control time between the groups. CONCLUSION: This study suggests that this training approach can enhance access to life-saving skills for prehospital personnel. The inclusion of self-assessment components enables self-regulated learning and reduces the need for continuous instructor presence. Future improvements involve refining the tourniquet model, validating it with first-responder end users, and expanding the training program to include other skills.

Analysis of Wi-SUN FAN Network Formation Time.

The Wi-SUN FAN (Wireless Smart Ubiquitous Network Field Area Network) standard is attracting great interest in various applications such as smart meters, smart cities and Internet of Things (IoT) devices due to the attractive features that the standard offers, such as multihop and mesh topologies, a relatively high data rate, frequency hopping, and interoperability between manufacturers. However, the process of connecting nodes in Wi-SUN FAN networks, which includes discovering, joining, and forming the network, has been shown to be slow, especially in multihop environments, which has motivated research and experimentation to analyze this process. In the existing literature, to measure network formation time, some authors have performed experiments with up to 100 devices, which is a costly and time-consuming methodology. Others have used simulation tools that are difficult to replicate, because little information is available about the methodology used or because they are proprietary. Despite these efforts, there is still a lack of information to adequately assess the formation time of Wi-SUN FAN networks, since the experimental tests reported in the literature are expensive and time-consuming. Therefore, alternatives such as computer simulation have been explored to speed up performance analysis in different scenarios. With this perspective, this paper is focused on the implementation of the Wi-SUN FAN network formation process using the Contiki-NG open source operating system and the Cooja simultor, where a functionality was added that makes it possible to efficiently analyze the network performance, thereby facilitating the implementation of new techniques to reduce network training time. The simulation tool was integrated into Contiki-NG and has been used to estimate the network formation times in various indoor environments. The correspondence between the experimental and numerical results obtained shows that our proposal is efficient to study the formation process of this type of networks.

An electrogram-guided transvenous temporary pacemaker implant simulator.

INTRODUCTION: Transvenous temporary pacemaker (TvTP) implantation is a critical procedure often performed under time limitations, playing a crucial role in patient survival. However, the amount of training provided for resident cardiologists is variable, due to the availability of patients. Thus, the use of simulators for this cardiologic procedure could be used as training tools. OBJECTIVE: The present study aimed to develop a simulator system for TvTP implantation based on electrograms, called ETTIS (Electrogram-guided Transvenous Temporary-pacemaker Implantation Simulator), and to evaluate its educational potential and cardiology residents' perceived learning efficacy as a training tool. METHODOLOGY: The development of the ETTIS involved three stages: (1) Adaptation of an anatomical mannequin; (2) Design and manufacture of electronic circuits and software capable of identifying the catheter contact site within the heart chambers and reproducing electrograms in both surfaces (mode-on) and intracavitary (mode-off); (3) To evaluate its educational potential, a modified Likert questionnaire was administered to nine cardiology experts. Additionally, to evaluate the perceived learning efficacy, another modified Likert questionnaire was given to six cardiology residents both before and after training with the ETTIS. Descriptive statistics with measures of position and dispersion were employed, and the weighted Kappa test was used for agreement analysis. RESULTS: A high rate of acceptance (over 90%) was found among experts who evaluated the ETTIS. The cardiology residents showed significant self-perceived learning gains, as evidenced by a lack of agreement between their responses to a questionnaire before and after training. CONCLUSION: The ETTIS is a promising tool for medical training, displaying both educational potential and efficacy. It has been shown to be effective in learning a variety of skills, including cardiac catheterization and electrophysiology. Additionally, the ETTIS is highly engaging and allows cardiology residents to practice in a safe and controlled environment.

A Video Game for Entrepreneurship Learning in Ecuador: Development Study.

BACKGROUND: Games have been a part of human life since ancient times and are taught to children and adults who want to simultaneously have fun and learn. Nevertheless, in the third decade of this century, technology invites us to consider using video games to learn topics such as entrepreneurship. However, developing a serious game (SG) is difficult because everyone who forms part of the game development team requires adequate learning resources to acquire the necessary information and improve their game development skills. OBJECTIVE: This work aimed to detail the experience gained in developing ATIC (Aprende, Trabaja, Innova, Conquista [learn, work, innovate, conquer]), an SG proposed for teaching and learning entrepreneurship. METHODS: To develop a videogame, first, we established a game development team formed by professors, professionals, and students who have different roles in this project. Scrum was adopted as a project management method. To create concept art for the video game, designers collected ideas from various games, known as "getting references." In contrast, narratology considers the life of a recent university graduate immersed in real life, considering locations, characteristics, and representative characters from an essential city of Ecuador. RESULTS: In a Unity 3D video game in ATIC, the life of a university student who graduates and ventures into a world full of opportunities, barriers, and risks, where the player needs to make decisions, is simulated. The art of this video game, including sounds and music, is based on the landscape and characteristics of and characters from Cuenca, Ecuador. The game aims to teach entrepreneurs the mechanisms and processes to form their businesses. Thus, we developed the following elements of an SG: (1) world, (2) objects, (3) agents, and (4) events. CONCLUSIONS: The narrative, mechanics, and art of video games are relevant. However, project management tools such as leaderboards and appointments are crucial to influencing individuals' decision to continue to play, or not play, an SG. Developing a serious video game is not an easy task. It was essential to consider many factors, such as the video game audience, needs of learning, context, similarities with the real world, narrative, game mechanics, game art, and game sounds. However, overall, the primary purpose of a serious video game is to transmit knowledge in a fun way and to give adequate and timely feedback to the gamer. Finally, nothing is possible if the members of game development team are not satisfied with the project and not clear about their roles.

Development of a lumbar puncture virtual simulator for medical students training: A preliminary evaluation.

BACKGROUND: Lumbar puncture is an essential medical procedure whose objective is to obtain cerebrospinal fluid. Lumbar puncture is considered a complex procedure, mainly for novice residents who suffer from stress and low confidence, which may result in harm to the patient. METHODS: The LPVirSim, has been developed in four stages: i) requirements analysis through user-centred design; ii) prototyping of the virtual environment and the haptic component; iii) preliminary tests with Ph.D. students and physicians using two haptic devices (Omega.7 and Sigma.7); iv) a user study where physicians evaluated the usability and user experience. RESULTS: The LPVirSim integrates non-technical skills and the possibility of representing different patients for training. Usability increased from 61.76 to 68.75 in the preliminary tests to 71.43 in the user study. CONCLUSIONS: All the results showed good usability and demonstrated that the simulator arouses interest and realistically represents a Lumbar puncture, through the force and visual feedback.

Simulation-based bronchoscopy training: Randomized trial comparing worked example to video introduction.

INTRODUCTION: Learning the complex skill of bronchoscopy involves the integration of cognitive domains and motor skills. The development of simulators has opened up new possibilities in bronchoscopy training. This study aimed at evaluating how effective the modeling example methodology is in training this skill and assessed its effect on cognitive load in learning. METHODS: Forty-seven medical students participating in a simulator-based bronchoscopy training program were randomly allocated to a control group, receiving a video lesson, and the modeling example group. They were evaluated by the simulator's metrics at different time points: pre-, posttest, and 15 days and 12 months after training. Cognitive load was assessed with the modified Paas scale. RESULTS: Simulation-based training was effective for both groups, based on simulator metrics (p < .05). The modeling example group outperformed the control group in all measures at posttest and after 15 days (p < .001). After 12 months, there was a decline in skill in both groups, but the modeling example group performed better (p < .001). Simulation-based training reduced cognitive load, more strongly so in the modeling example group (p < .001). CONCLUSION: The modeling example group showed substantial benefits over the control group, both in reducing the cognitive load in learning and in retaining knowledge and skill after 15 days and 12 months.

Self-made transvaginal ultrasound simulator: new training equipment in ultrasound evaluation of controlled ovarian stimulation and oocyte retrieval.

Aim: We sought to create and describe a self-made simulator designed and created for teaching purposes: a high-fidelity ultrasound phantom for demonstrating antral follicle count, ultrasound supervision of controlled of ovarian stimulation, and ultrasound-guided oocyte retrieval. Materials and methods: The uterus and ovaries of the ultrasound phantom were made from beef tongue, a male condom, latex gloves, cotton suture threads, bi-distilled water, and ultrasound gel. The components were placed in a pelvis created using three-dimensional (3D) printing. The phantom was presented to and evaluated by a group of 14 physicians pursuing a postgraduate course in reproductive medicine. Two training stations were structured: one to simulate antral follicle count and controlled ovarian stimulation and the other to simulate ultrasound-guided oocyte retrieval. Future specialists were requested to complete a feedback questionnaire evaluating the self-made simulator and the two practice stations. Results: The transvaginal ultrasound phantom was successfully created, making it possible to simulate antral follicle count, ultrasound control of ovarian hyperstimulation, and oocyte retrieval, and to capture ultrasound images. A review of the answers provided in the feedback questionnaire showed that the phantom had a good appearance and design, was realistic, helped to improve motor coordination, and could be a useful tool in the training of specialists in assisted reproduction. Conclusion: This phantom was designed to enable instruction and practice in the evaluation of ovarian follicles and ultrasound-guided oocyte retrieval in a supervised training environment. This self-made simulator is proposed as a training tool that could be included in the curricular structure of residency and postgraduate programs in reproductive medicine.

Augmented reality for training formation flights: An analysis of human factors.

Pilot training has been, for decades, aided by flight simulators with different characteristics and degrees of fidelity. However, many studies indicate that, despite the recognized contribution of simulator training, actual flying practice is still necessary, depending on the trained task. This work introduces the proposal of using augmented reality for in-flight training, where elements in the environment outside the aircraft are displayed through an augmented reality headset to create a simulation scenario. The training of basic formation flight is used as an example, as it requires flying with at least two aircraft, resulting in high operational costs and risk of collision between aircraft. In this case, the augmented reality system replaces the real leader aircraft with a projection. In order to evaluate the Technology Readiness Level (TRL) of this proposal, this work presents a prototype of an augmented reality system integrated into a flight simulator to conduct an evaluation campaign. We investigate how the introduction of the augmented reality system impacts on human factors, such as stress and workload, as well as performance. Although the results obtained in a simulated environment are not equivalent to those from an in-flight campaign, the experimental campaign performed in the flight simulator provides a way of evaluating the impact on the pilot of some aspects of the proposed solution, such as the performance of occlusion routines and some ergonomic aspects of the augmented reality headset.

Face, content, and construct validity of the virtual immersive operating room simulator for training laparoscopic procedures.

BACKGROUND: The aim of this work is to present the face, content, and construct validation of the virtual immersive operating room simulator (VIORS) for procedural training of surgeons' laparoscopic psychomotor skills and evaluate the immersive training experience. METHODS: The VIORS simulator consists of an HMD Oculus Rift 2016 with a visor on a 1080 × 1200 pixel OLED screen, two positioning sensors with two adapted controls to simulate laparoscopic instruments, and an acrylic base to simulate the conventional laparoscopic setup. The immersion consists of a 360° virtual operating room environment, based on the EndoSuite at Hospital Infantil de Mexico Federico Gomez, which reproduces a configuration of equipment, instruments, and common distractions in the operating room during a laparoscopic cholecystectomy procedure. Forty-five surgeons, residents, and medicine students participated in this study: 27 novices, 13 intermediates, and 5 experts. They completed a questionnaire on the realism and operating room immersion, as well as their capabilities for laparoscopic procedural training, scored in the 5-point Likert scale. The data of instrument movement were recorded and analyzed using 13 movement analysis parameters (MAPs). The experience during training with VIORS was evaluated through NASA-TLX. RESULTS: The participants were enthusiastic about the immersion and sensation levels of the VIORS simulator, with positive scores on the realism and its capabilities for procedural training using VIORS. The results proved that the VIORS simulator was able to differentiate between surgeons with different skill levels. Statistically significant differences were found in nine MAPs, demonstrating their construct validity for the objective assessment of the procedural laparoscopic performance. At cognitive level, the inversion experience proves a moderate mental workload when the laparoscopic procedure is carried out. CONCLUSION: The VIORS simulator has been successfully presented and validated. The VIORS simulator is a useful and effective device for the training of procedural laparoscopic psychomotor skills.

A three-dimensionally printed otological model for cholesteatoma mastoidectomy training.

PURPOSE: To relate the creation and expert validation (face and content validity) of an affordable three-dimensional (3-D) printed model of temporal bones with chronic otitis media with cholesteatoma (COMC) as a simulator for mastoidectomy. METHODS: We performed computed tomography (CT) of the temporal bones of a patient with COMC followed at the University of São Paulo (USP) Hospital with 3-D Slicer to create a 3-D model of the affected bone using light-curing resin and silicone (cholesteatoma). The final 3-D printed images were scored by 10 otologists using a customized version of the Michigan Standard Simulation Scale Experience (MiSSES). Internal consistency and inter-rater reliability were assessed using Cronbach's α and intraclass correlations. RESULTS: Otologists consistently scored the model positively for fidelity, educational value, reactions, and the overall model quality. Nine otologists agreed that the model was a good educational device for surgical training of COMC. All experts deemed the model ready-or nearly ready-for use. The final cost of the model, including raw materials and manufacturing, was 120 USD. CONCLUSIONS: Using 3-D printing technology, we created the first anatomically accurate, low-cost, disease-reproducing 3-D model of temporal bones for mastoidectomy training for cholesteatoma.

The use of transcutaneous Vagal Nerve Stimulation as an effective countermeasure for Simulator Adaptation Syndrome.

This research focused on investigating the effectiveness of Transcutaneous Vagal Nerve Stimulation (tVNS) as compared to Galvanic Cutaneous Stimulation (GCS) at mitigating Simulator Adaptation Syndrome (SAS). Fifty drivers (mean age = 23.04 ± 17.71 years old, twenty-two men) participated in a driving simulation experiment. The total scores of the Simulator Sickness Questionnaire, head movements (body balance index), and driving performance variables were measured under five stimulation conditions: i) baseline (no stimulation delivered), ii) sham GCS, iii) sham tVNS, iv) active GCS, and v) active tNVS. The results showed that tVNS alleviated SAS and improved driving performance variables more effectively than GCS. We conclude that GCS and tVNS have similar neurological mechanisms to reduce SAS, providing possible explanations for the greater effectiveness of tVNS. We encourage the use of tVNS to decrease SAS.

Low-cost colonoscopic simulator and colonoscope to train basic skills in colonoscopy during undergraduate studies

Objective: To develop a low-cost simulator model and a colonoscope with materials that are easily accessible to offer training on colonoscopy skills during undergraduate studies. Since this is the procedure of choice for colorectal cancer screening, the general practitioner must be able to recognize its main indications, preparation, and complications. Methods: Using materials such as a mannequin, a vehicle inspection camera, a conduit, polyvinyl chloride (PVC) pipe, acrylic, wood, and red paint, we built a simulator and a 150-cm long and 20-to-25-mm thick colonoscope. The colonoscope's handle and handhold were made of acrylic, the colonoscope's mobile end was made with articulated PVC rings, and the up and down movements were performed according to the traction of the steel cables. The camera attached to its distal end enables connection to a smartphone to view the image. In the simulator, the conduit was inserted into the mannequin to simulate the curvatures of the colon. Red spray paint was used to simulate the staining of the colonic mucosa in the inner region of the mannequin and the adventitial layer in the outer region. Results: We were able to build a simulator and a colonoscope with a total amount of R $ 182.82 (roughly US$ 36.50). Both were tested and proved to be useful in the acquisition of psychomotor and cognitive skills in colonoscopy. Conclusion The simulator and colonoscope developed by us are cost-effective, useful in the acquisition of psychomotor and cognitive skills in colonoscopy, and can facilitate the structuring of a training program for undergraduate students. (AU)

Methodology for the Development of Augmented Reality Applications: MeDARA. Drone Flight Case Study.

Industry 4.0 involves various areas of engineering such as advanced robotics, Internet of Things, simulation, and augmented reality, which are focused on the development of smart factories. The present work presents the design and application of the methodology for the development of augmented reality applications (MeDARA) using a concrete, pictorial, and abstract approach with the intention of promoting the knowledge, skills, and attitudes of the students within the conceptual framework of educational mechatronics (EMCF). The flight of a drone is presented as a case study, where the concrete level involves the manipulation of the drone in a simulation; the graphic level requires the elaboration of an experiential storyboard that shows the scenes of the student's interaction with the drone in the concrete level; and finally, the abstract level involves the planning of user stories and acceptance criteria, the computer design of the drone, the mock-ups of the application, the coding in Unity and Android Studio, and its integration to perform unit and acceptance tests. Finally, evidence of the tests is shown to demonstrate the results of the application of the MeDARA.

ECG Patient Simulator Based on Mathematical Models.

In this work, we propose a versatile, low-cost, and tunable electronic device to generate realistic electrocardiogram (ECG) waveforms, capable of simulating ECG of patients within a wide range of possibilities. A visual analysis of the clinical ECG register provides the cardiologist with vital physiological information to determine the patient's heart condition. Because of its clinical significance, there is a strong interest in algorithms and medical ECG measuring devices that acquire, preserve, and process ECG recordings with high fidelity. Bearing this in mind, the proposed electronic device is based on four different mathematical models describing macroscopic heartbeat dynamics with ordinary differential equations. Firstly, we produce full 12-lead ECG profiles by implementing a model comprising a network of heterogeneous oscillators. Then, we implement a discretized reaction-diffusion model in our electronic device to reproduce ECG waveforms from various rhythm disorders. Finally, in order to show the versatility and capabilities of our system, we include two additional models, a ring of three coupled oscillators and a model based on a quasiperiodic motion, which can reproduce a wide range of pathological conditions. With this, the proposed device can reproduce around thirty-two cardiac rhythms with the possibility of exploring different parameter values to simulate new arrhythmias with the same hardware. Our system, which is a hybrid analog-digital circuit, generates realistic ECG signals through digital-to-analog converters whose amplitudes and waveforms are controlled through an interactive and friendly graphic interface. Our ECG patient simulator arises as a promising platform for assessing the performance of electrocardiograph equipment and ECG signal processing software in clinical trials. Additionally the produced 12-lead profiles can be tested in patient monitoring systems.