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BACKGROUND Cognitive stimulation of older people helps to prevent, and even treat, age-related diseases, such as Mild Cognitive Impairment. Playing games reduces the probability of suffering from this pathology related to the loss of the ability to carry out some instrumental activities of daily living. OBJECTIVE This work describes the design and development of a serious game for the cognitive stimulation of the elderly with exercises related to the daily life task of shopping, presenting also a pilot study for its preliminary usability validation. METHODS The designed serious game includes four exercises consisting of shopping in a hypermarket, ordering products, payments and organizing the purchase, dealing thus with the most frequent cognitive problems of elderly associated to episodic declarative memory, naming, calculation and organization, respectively. RESULTS 19 older people participated in the pilot study for the usability validation of the serious game, indicating that they like the aesthetic and interesting topic of the game. It has a high level of entertainment and could be useful in daily life for mental stimulation. It is intuitive, but the ease of use and readability of the instructions could be improved. CONCLUSIONS This study suggests that the innovative serious game developed could be accepted by older people for their cognitive stimulation in order to prevent or treat Mild Cognitive Impairment, although a long-term intervention test should be performed. Its ecological validity design with everyday tasks, adaptable level of difficulty and motivational mechanisms include a differentiating factor compared to similar serious games.

Background: The implantation of Minimally Invasive Surgery (MIS) leads to the specialization of nurses in this surgical field. However, there is no standard curriculum of MIS Nursing in Europe. Spanish and Portuguese nurses are inexperienced and have poor training in MIS. For that, a blended learning course for nursing education in MIS (Lapnurse) has been developed. This work aims to detail the course design and to preliminary validate by experts its online theoretical module. Methods: Lapnurse consists of an online module with nine theoretical lessons and a face-to-face module with three practical lessons. The e-learning environment created to provide the online module, with didactic contents based on surgical videos and innovative 3D designs, has been validated by two technicians (functionality) and four nurses with teaching experience in MIS (usability and content). Results: The E-learning platform meets all technical requirements, provides whole and updated multimedia contents correctly applied for educational purposes, incorporates interactivity with 3D designs, and has an attractive, easy-to-use and intuitive design. Conclusions: The lack of knowledge in MIS of Spanish and Portuguese nurses could be addressed by the blended learning course created, Lapnurse, where the e-learning environment that provides theoretical training has obtained a positive validation.

INTRODUCTION New non-invasive technologies for improving early diagnosis of colorectal cancer (CRC) are demanded by clinicians. Optical Coherence Tomography (OCT) provides sub-surface structural information and offers diagnosis capabilities of colon polyps, further improved by machine learning methods. Databases of OCT images are necessary to facilitate algorithms development and testing. MATERIALS AND METHODS A database has been acquired from rat colonic samples with a Thorlabs OCT system with 930nm centre wavelength that provides 1.2KHz A-scan rate, 7μm axial resolution in air, 4μm lateral resolution, 1.7mm imaging depth in air, 6mm x 6mm FOV, and 107dB sensitivity. The colon from anaesthetised animals has been excised and samples have been extracted and preserved for ex-vivo analysis with the OCT equipment. RESULTS This database consists of OCT 3D volumes (C-scans) and 2D images (B-scans) of murine samples from: 1) healthy tissue, for ground-truth comparison (18 samples; 66 C-scans; 17,478 B-scans); 2) hyperplastic polyps, obtained from an induced colorectal hyperplastic murine model (47 samples; 153 C-scans; 42,450 B-scans); 3) neoplastic polyps (adenomatous and adenocarcinomatous), obtained from clinically validated Pirc F344/NTac-Apcam1137 rat model (232 samples; 564 C-scans; 158,557 B-scans); and 4) unknown tissue (polyp adjacent, presumably healthy) (98 samples; 157 C-scans; 42,070 B-scans). CONCLUSIONS A novel extensive ex-vivo OCT database of murine CRC model has been obtained and will be openly published for the research community. It can be used for classification/segmentation machine learning methods, for correlation between OCT features and histopathological structures, and for developing new non-invasive in-situ methods of diagnosis of colorectal cancer.

INTRODUCTION New endoscopic technologies developed to improve colorectal cancer diagnosis need to be validated on animal models, which already exist for neoplastic polyps, but not for hyperplasia. For that, a hyperplastic model of growth in colon has been created on murine animal. For its characterization, a first pilot study was performed, and this study aims to validate the results. MATERIALS AND METHODS 30 Pirc (Polyposis In the Rat Colon) rats, wild type strain (F344/NTac-Apcam1137), were used. The hyperplastic model was induced by laparotomy with a non-resorbable suture, not stenosing, placed through the colon wall. Then, colonic biopsies were extracted weekly from the growth around the suture. RESULTS After the second follow-up, hyperplastic growths are already found. The reproducibility of the model has been obtained and the optimal time determined, after induction of the model. According to our knowledge, this is the first induced colonic hyperplasia model in rats. It solves limitations of other traditional models that only produce hypertrophy, where hyperplasia appears when iatrogenic effects occur as undesired results in a non-standardised or reproducible form. CONCLUSIONS This work has successfully developed a preclinical model of colonic hyperplasia in rats that recreates important characteristics of human hyperplasia, such as the generation of new cells in the colonic mucosa and tissue growth, as well as the corresponding angiogenesis. The new hyperplastic model created could be used for the validation of endoscopic technology, and other studies. It would be useful to improve optical biomarkers of colorectal cancer and to discriminate between endoscopic findings.

Background The high incidence and mortality rate of colorectal cancer require new technologies to improve its early diagnosis. This study aims at extracting the medical needs related to the endoscopic technology and the colonoscopy procedure currently used for colorectal cancer diagnosis, essential for designing these demanded technologies. Methods Semi-structured interviews and an online survey were used. Results Six endoscopists were interviewed and 103 were surveyed, obtaining the demanded needs that can be divided into: a) clinical needs, for better polyp detection and classification (especially flat polyps), location, size, margins and penetration depth; b) computer-aided diagnosis (CAD) system needs, for additional visual information supporting polyp characterization and diagnosis; and c) operational/physical needs, related to limitations of image quality, colon lighting, flexibility of the endoscope tip, and even poor bowel preparation. Conclusions This study shows some undertaken initiatives to meet the detected medical needs and challenges to be solved. The great potential of advanced optical technologies suggests their use for a better polyp detection and classification since they provide additional functional and structural information than the currently used image enhancement technologies. The inspection of remaining tissue of diminutive polyps (

Elderly population is constantly increasing and ageing is causing demographic, epidemiological and anthropological changes such as to make active and healthy ageing increasingly pivotal. With the objective to extend life expectancy in good health, it is important to raise awareness about the adoption of those factors that favor active ageing, such as a healthy lifestyle with proper nutrition, regular physical activity, a good management of stress, sleep and emotion, but also with an active participation in the social, economic, cultural, spiritual and civil issues of the community. Cultural heritage is the set of physical artifacts and intangible attributes of a past group or society, maintained in the present and left as a legacy for future generations. But it is important to raise awareness among the older population to promote intangible cultural heritage linked to active ageing. This work details the design and development of videos created for this purpose. Through interviews to older people about intangible cultural heritage, active ageing and quality of life, six categories of the first one have been selected: traditional games, handcraft, dance, folklore and traditional festivals, classical literature, painting and poetry. Eight videos within these categories have been created, with subtitles translated into five languages and descriptive metadata. Elder people have a fundamental role in maintaining and passing cultural heritage down, as they have past memories of the socio-cultural environment (things, places, people and experiences) and can be an important source of information for the sharing and disseminating their knowledge to new generations.

The promotion of cultural heritage is an area in which older people can be actively involved, as their experiences and memories are an active and relevant source of information. However, older people are not fully aware of this. Therefore, it is important to promote a campaign of awareness towards them in this aspect, since this would also contribute to favor an active ageing, enhancing certain cognitive capacities. New technologies are an increasingly useful mean for this active ageing, with mobile phones, tablets and computers being used more and more commonly among the older population. The development of mobile applications for use with these devices is on the increase, solving the limitations that the elderly population would have towards the use of these new technologies. The aim of this project is to design an app for the dissemination among the elderly of the awareness of active ageing linked to cultural heritage. Taking into account the requirements associated with the limitations of the elderly for its correct use, a very simple app for Android platform has been designed for Smartphone devices through which they can access content corresponding to different cultural areas, mainly composed of videos in which elderly people promote cultural heritage. This app, which has an interface very simple with few buttons and easy menus, supposes an important means to promote active ageing using cultural heritage, involving them more and more in the use of new technologies.

(1) Background: Clinicians demand new tools for early diagnosis and improved detection of colon lesions that are vital for patient prognosis. Optical coherence tomography (OCT) allows microscopical inspection of tissue and might serve as an optical biopsy method that could lead to in-situ diagnosis and treatment decisions, (2) Methods: A database of murine (rat) healthy, hyperplastic and neoplastic colonic samples with more than 94,000 images was acquired. A methodology that includes a data augmentation processing strategy and a deep learning model for automatic classification (benign vs. malignant) of OCT images is presented and validated over this dataset. Comparative evaluation is performed both over individual B-scan images and C-scan volumes, (3) Results: A model was trained and evaluated with the proposed methodology using six different data splits to present statistically significant results. Considering this, 0.9695 (±0.0141) sensitivity and 0.8094 (±0.1524) specificity were obtained when diagnosis was performed over B-scan images. On the other hand, 0.9821 (±0.0197) sensitivity and 0.7865 (±0.205) specificity were achieved when diagnosis was made considering all the images in the whole C-scan volume, (4) Conclusions: The proposed methodology based on deep learning showed great potential for the automatic characterization of colon polyps and future development of the optical biopsy paradigm.

Introduction: Surgeons’ cognitive workload should be controlled during a surgical intervention for a successful and safe performance. Eye tracking technologies could be used for cognitive workload monitoring by analyzing the pupil size and blink frequency of surgeons. This work aims to study the surgeons’ cognitive workload watching an advanced laparoscopic video. Methods: 16 surgeons (5 experts, 11 novices) participated in the study watching a colectomy video consisting of eight steps with introductory titles. Surgeons’ gaze was recorded with eye tracking glasses while visualizing the video, from which pupil size and blink frequency were analyzed. Results: Pupil diameter of surgeons increased during the visualization of steps and decreased during the titles. Two specific steps of the intervention produced the highest pupil diameter of surgeons. When the pupil diameter increased the blink frequency decreased. Pupil diameter tended to decrease as the video is watched, which is mainly due to expert surgeons, who had a lower pupil diameter than novices. Conclusions: Eye tracking technologies allow monitoring the cognitive workload of surgeons in surgical procedures. Larger pupil size and shorter blink frequency means greater cognitive workload. Such metrics could be used to objectively label the difficult tasks within the surgical procedure. Surgical videos used for training of surgeons should be short, according to micro-learning, since cognitive workload decreases over time while visualizing them. Based on proposed metrics, eye tracking technologies could be used to distinguish the level of experience of surgeons, since cognitive workload is sensitive to the skill level of surgeons.

Extrusion bioprinting is one of the most studied additive manufacturing technologies thanks to the huge possibilities in the creation of engineered tissues that it provides. Despite all research performed about bioprinting there is not enough information on how inlet velocities affect the pressure distribution. In this way, we have carried out CFD simulations to check how different inlet velocities can affect the pressure distribution in the tip of a nozzle.

Background The progressive development of Minimally Invasive Surgery (MIS) implies the need to train health professionals in such field, for which e-learning and blended learning methods are increasingly been used. Most nurses lack experience and training in MIS, so a laparoscopic blended learning course for nursing has been created. Objectives To perform the validation of the online theoretical module of such course to evaluate student perception and satisfaction, sociability and usability metrics, and also the interest of nurses in blended learning. Design A quantitative design has been used. Participants 24 nurses participated in the validation tests performing the online module of the course. Methods Subjective (questionnaires) and objective (performance statistics) metrics were analysed. Results The e-learning environment has ease of access, good layout, consistency and intuitive navigation. Chat and forums have not been used and nurses miss a moderator. Participants consider that videos provide added value to the course, and contents are easily understandable and of high quality. However, questionnaires are not well balanced in difficulty and few interactive 3D designs have been viewed. Participants consider blended learning as the most effective training method for its flexibility in time and place. Conclusions This study suggests that a simple, easy-to-use and attractive e-learning environment has been developed to train nurses in MIS. However, installation of additional software should be avoided. A moderator/tutor should manage forums to encourage user participation, using conversational agents. But nevertheless, chats have no interest. Questionnaires for content evaluation should be designed with efficiency and equity. Videos designed according to micro-learning, with audio and interactivity, should be included. These courses should be designed to meet factors to promote the engagement of students. Blended learning is considered by nurses as ideal method for training, but further research to assess whether it improves learning outcomes is needed.

Introduction: E-learning web environments, including the new TELMA platform, are increasingly being used to provide cognitive training in minimally invasive surgery (MIS) to surgeons. A complete validation of this MIS elearning platform has been performed to determine whether it complies with the three web quality dimensions: usability, content and functionality. Methods: 21 Surgeons participated in the validation trials. They performed a set of tasks in the TELMA platform, where an e-MIS validity approach was followed. Subjective (questionnaires and checklists) and objective (web analytics) metrics were analysed to achieve the complete validation of usability, content and functionality. Results: The TELMA platform allowed access to didactic content with easy and intuitive navigation. Surgeons performed all tasks with a close-to-ideal number of clicks and amount of time. They considered the design of the website to be consistent (95.24%), organised (90.48%) and attractive (85.71%). Moreover, they gave the content a high score (4.06 out of 5) and considered it adequate for teaching purposes. The surgeons scored the professional language and content (4.35), logo (4.24) and recommendations (4.20) the highest. Regarding functionality, the TELMA platform received an acceptance of 95.24% for navigation and 90.48% for interactivity. Conclusions: According to the study, it seems that TELMA had an attractive design, innovative content and interactive navigation, which are three key features of an e-learning platform. TELMA successfully met the three criteria necessary for consideration as a website of quality by achieving more than 70% of agreements regarding all usability, content and functionality items validated; this constitutes a preliminary requirement for an effective e-learning platform. However, the content completeness, authoring tool and registration process required improvement. Finally, the e-MIS validity methodology used to measure the three dimensions of web quality in this work can be applied to other clinical areas or training fields.

[Resumen] Este artículo presenta un modelo de simulación del sistema cardiovascular en el entorno de Matlab/Simulink, más concretamente de la zona de mayor riesgo cardiovascular, la arteria carótida. Está basado en un modelo eléctrico del sistema que describe la dinámica de contracción del corazón, así como su carácter cíclico y autónomo. Como primer paso, este modelo se generaliza para contemplar también la dinámica de la arteria carótida izquierda. A partir de él, y haciendo una serie de equivalencias entre dominios, se obtiene un modelo hidráulico que emula el comportamiento del sistema cardiovascular en esa zona y que, a diferencia del anterior, no presenta carácter autónomo. Para el diseño del control, se hace uso de la estrategia de linealización por realimentaón. Se incluyen simulaciones, tanto del modelo eléctrico completo como del hidráulico propuesto, para demostrar el correcto funcionamiento del simulador desarrollado. El objetivo final de este trabajo es la construcción de una plataforma de ensayo para robots nadadores tipo flagelo eucariótico y bacteriano de pequeñas dimensiones a partir del modelo hidráulico desarrollado que permita emular las condiciones en las que se encontrarían estos robots navegando por el sistema circulatorio humano. Junta de Extremadura; GR15178 Ministerio de Economía y Competitividad; DPI2016-80547-R