A heuristic-based approach for assessing usability in electric powered wheelchairs: A preliminary investigation

Objective: An important issue related to electric powered wheelchair (EPW) is usability. Recent studies did not use heuristic evaluation and did not consider users’ and developers’ participation in the usability evaluation process of the EPW, especially when it has to be driven using alternative commands. Thus, this study investigates the use of heuristics to evaluate the usability of EPW driven by alternative commands, considering the opinion of users and assistive technology (AT) development professionals.MethodsThe study was carried out with 54 participants: 28 EPW users (Group I) and 26 AT developers (Group II). We built a set of 25 heuristics that affects EPW usability. Participants rated each of the 25 heuristics according to their importance for the usability of EPW using the five-point Likert scale. We used the R Software to perform the Wilcoxon Mann–Whitney test as a statistical comparisons test between Group I and II.ResultsThe results showed a statistically significant difference (p<0.05) between Group I and II in the evaluation of 16 heuristics. We identified an important set of heuristics that could help evaluate and improve the usability of EPW.ConclusionThe findings highlighted the importance of considering users’ and developers’ points of view in developing an EPW and its evaluation criteria. It could help the design of the device match the user's needs and expectations. The set of heuristics in this study can be adapted to evaluate other devices’ usability using the heuristic evaluation approach. (AU)

Objetivo: La usabilidad es una cuestión importante relacionada con las sillas de ruedas eléctricas (SRE). Los estudios recientes no han utilizado evaluaciones heurísticas ni han contemplado la participación de los usuarios y desarrolladores en el proceso de evaluación de dichas sillas, especialmente cuando deben conducirse utilizando comandos alternativos. Por ello, este estudio investiga el uso de la heurística para evaluar la usabilidad de las SRE impulsadas por comandos alternativos, considerando la opinión de los usuarios y los profesionales del desarrollo de la tecnología asistencial (TA).MétodosEl estudio se realizó con 54 participantes: 28 usuarios de SRE (Grupo I) y 26 desarrolladores de TA (Grupo II). Construimos un conjunto de 25 heurísticas que afectan a la usabilidad de las SRE. Los sujetos calificaron cada una de las 25 heurísticas de acuerdo con su importancia para la usabilidad de las SRE utilizando la escala de Likert de cinco puntos. Utilizamos el software R para realizar la prueba de Wilcoxon-Mann-Whitney como prueba de comparación estadística entre los Grupos I y II.ResultadosLos resultados reflejaron una diferencia estadística significativa (p < 0,05) entre los Grupos I y II en la evaluación de las 16 heurísticas. Identificamos un conjunto importante de heurísticas que podrían ayudar a evaluar y mejorar la usabilidad de las SRE.ConclusiónLos hallazgos subrayaron la importancia de estimar los puntos de vista de los usuarios y desarrolladores a la hora de desarrollar una SRE, así como sus criterios de evaluación. Estos podrían contribuir a que el diseño del dispositivo coincidiera con las necesidades y expectativas de los usuarios. El conjunto de heurísticas de este estudio puede adaptarse, para evaluar la usabilidad de otros dispositivos, utilizando el enfoque de evaluación heurística. (AU)

A study regarding the anterior cruciate ligament remnant: Differences in balance and postural control between remnant-preserving and remnant-non-preserving patients

Introduction: The anterior cruciate ligament (ACL) is the most frequently injured ligament of the knee. However, quantitative studies on evaluate the postural control influence resulted from the ACL remnant preservation or not are scarce. The aim of this study is to evaluate the postural control of patients submitted to ACL reconstruction with and without preservation of the injured remnant in pre and postoperative periods.MethodsEighteen patients underwent ACL reconstruction and separated into 2 groups according to the preservation or not of the remnant: (I) submitted to ACL reconstruction with preservation of the remnant (10 patients); (II) submitted to ACL reconstruction without preservation of the remnant (8 patients). They were assessed using the Lysholm score and force plate, which evaluated the patient's postural stability for remnant and non-remnant preservation in ACL reconstruction surgery.ResultsGroup I showed statistically significant subjective and objective improvements, both at 3 and 6 months. Additionally, improvement of the Lysholm test at 6 months in Group II was also statistically significant. Furthermore, the results of the Friedman test for the VCOP and VY variables of Group I, with support of the injured side in the force plate, showed a statistically significant difference both for pre and postoperative period at 3 months, compared to the 6-month postoperative period. The variables EAC and VX were statistically different for Group II, considering the preoperative period, 3 and 6 months postoperatively.ConclusionPreserving the ACL remnant in patients with ACL injuries has a positive impact on postural stability during recovery.(AU)

Introducción: El ligamento cruzado anterior (LCA) es el ligamento de la rodilla que se lesiona con mayor frecuencia. Sin embargo, escasean los estudios cuantitativos sobre la evaluación de la influencia del control postural derivada de la preservación, o no, del remanente del LCA. El objetivo de este estudio es evaluar el control postural de los pacientes sometidos a la reconstrucción del LCA, con y sin preservación del remanente lesionado, en los periodos previo y posterior a la cirugía.MétodosDieciocho pacientes sometidos a reconstrucción del LCA separados en 2 grupos, de acuerdo con la preservación o no preservación del remanente: I) sometidos a reconstrucción del LCA con preservación del remanente (10 pacientes), y II) sometidos a reconstrucción del LCA sin preservación del remanente (8 pacientes). Los pacientes fueron evaluados utilizando la puntuación de Lysholm y una placa de aplicación de fuerza, que evaluó la estabilidad postural del paciente para la preservación y no preservación del remanente en la cirugía de reconstrucción del LCA.ResultadosEl grupo I mostró mejoras subjetivas y objetivas estadísticamente significativas, transcurridos 3 y 6 meses. Además, la mejora de la prueba de Lysholm transcurridos 6 meses en el grupo II fue también estadísticamente significativa. Asimismo, los resultados de la prueba de Friedman para las variables VCOP y VY en el grupo I, con apoyo del lado lesionado en la placa de aplicación de fuerza, reflejaron una diferencia estadísticamente significativa en ambos períodos pre y postoperatorio transcurridos 3 meses, en comparación con el período postoperatorio transcurridos 6 meses. Las variables EAC y VX fueron estadísticamente diferentes para el grupo II, considerando el periodo preoperatorio, y los 3 y 6 meses postoperatorios.ConclusiónPreservar el remanente del LCA en los pacientes con lesiones en dicho ligamento tiene un impacto positivo en la estabilidad postural durante la recuperación.(AU)

A heuristic-based approach for assessing usability in electric powered wheelchairs: A preliminary investigation.

OBJECTIVE: An important issue related to electric powered wheelchair (EPW) is usability. Recent studies did not use heuristic evaluation and did not consider users' and developers' participation in the usability evaluation process of the EPW, especially when it has to be driven using alternative commands. Thus, this study investigates the use of heuristics to evaluate the usability of EPW driven by alternative commands, considering the opinion of users and assistive technology (AT) development professionals. METHODS: The study was carried out with 54 participants: 28 EPW users (Group I) and 26 AT developers (Group II). We built a set of 25 heuristics that affects EPW usability. Participants rated each of the 25 heuristics according to their importance for the usability of EPW using the five-point Likert scale. We used the R Software to perform the Wilcoxon Mann-Whitney test as a statistical comparisons test between Group I and II. RESULTS: The results showed a statistically significant difference (p<0.05) between Group I and II in the evaluation of 16 heuristics. We identified an important set of heuristics that could help evaluate and improve the usability of EPW. CONCLUSION: The findings highlighted the importance of considering users' and developers' points of view in developing an EPW and its evaluation criteria. It could help the design of the device match the user's needs and expectations. The set of heuristics in this study can be adapted to evaluate other devices' usability using the heuristic evaluation approach.

A study regarding the anterior cruciate ligament remnant: Differences in balance and postural control between remnant-preserving and remnant-non-preserving patients.

INTRODUCTION: The anterior cruciate ligament (ACL) is the most frequently injured ligament of the knee. However, quantitative studies on evaluate the postural control influence resulted from the ACL remnant preservation or not are scarce. The aim of this study is to evaluate the postural control of patients submitted to ACL reconstruction with and without preservation of the injured remnant in pre and postoperative periods. METHODS: Eighteen patients underwent ACL reconstruction and separated into 2 groups according to the preservation or not of the remnant: (I) submitted to ACL reconstruction with preservation of the remnant (10 patients); (II) submitted to ACL reconstruction without preservation of the remnant (8 patients). They were assessed using the Lysholm score and force plate, which evaluated the patient's postural stability for remnant and non-remnant preservation in ACL reconstruction surgery. RESULTS: Group I showed statistically significant subjective and objective improvements, both at 3 and 6 months. Additionally, improvement of the Lysholm test at 6 months in Group II was also statistically significant. Furthermore, the results of the Friedman test for the VCOP and VY variables of Group I, with support of the injured side in the force plate, showed a statistically significant difference both for pre and postoperative period at 3 months, compared to the 6-month postoperative period. The variables EAC and VX were statistically different for Group II, considering the preoperative period, 3 and 6 months postoperatively. CONCLUSION: Preserving the ACL remnant in patients with ACL injuries has a positive impact on postural stability during recovery.

RehaBEElitation: the architecture and organization of a serious game to evaluate motor signs in Parkinson's disease.

Background: The use of serious games (SG) has received increasing attention in health care, and can be applied for both rehabilitation and evaluation of motor signs of several diseases, such as Parkinson's disease (PD). However, the use of these instruments in clinical practice is poorly observed, since there is a scarcity of games that, during their development process, simultaneously address issues of usability and architectural design, contributing to the non-satisfaction of the actual needs of professionals and patients. Thus, this study aimed to present the architecture and usability evaluation at the design stage of a serious game, so-called RehaBEElitation, and assess the accessibility of the game. Methods: The game was created by a multidisciplinary team with experience in game development and PD, taking into consideration design guidelines for the development of SG. The user must control the movements of a bee in a 3D environment. The game tasks were designed to mimic the following movements found in the gold-standard method tool-Movement Disorder Society-Unified Parkinson's Disease Rating Scale (MDS-UPDRS)-for the assessment of individuals with PD: hand opening and closing, hand extension and flexion, hand adduction and abduction, finger tapping, and forearm supination and pronation. The user interacts with the game using a wearable interface device that embeds inertial and tactile sensors. The architecture of RehaBEElitation was detailed using the business process model (BPM) notation and the usability of the architecture was evaluated using the Nielsen-Shneiderman heuristics. Game accessibility was evaluated by comparing the overall scores of each phase between 15 healthy participants and 15 PD patients. The PD group interacted with the game in both the ON and OFF states. Results: The system was modularized in order to implement parallel, simultaneous and independent programming at different levels, requiring less computational effort and enabling fluidity between the game and the control of the interface elements in real time. The developed architecture allows the inclusion of new elements for patient status monitoring, extending the functionality of the tool without changing its fundamental characteristics. The heuristic evaluation contemplated all the 14 heuristics proposed by Shneiderman, which enabled the implementation of improvements in the game. The evaluation of accessibility revealed no statistically significant differences (p < 0.05) between groups, except for the healthy group and the PD group in the OFF state of medication during Phase 3 of the game. Conclusions: The proposed architecture was presented in order to facilitate the reproduction of the system and extend its application to other scenarios. In the same way, the heuristic evaluation performed can serve as a contribution to the advancement of the SG design for PD. The accessibility evaluation revealed that the game is accessible to individuals with PD.

Glaucoma and Telemedicine.

PRCIS: Teleglaucoma is the future, but there is a need for clearer regulation by government agencies and medical entities, as well as for studies to further demonstrate the cost-effectiveness and safety of teleglaucoma strategies at a global scale. ABSTRACT: The coronavirus disease 2019 pandemic drastically impacted global health, forcing institutions to provide alternative models of safe and reliable health care. In this context, telemedicine has been successfully used to overcome distance barriers and improve access to medical services. Teleglaucoma is the application of telemedicine to screen and monitor glaucoma, a chronic and progressive optic neuropathy. Teleglaucoma screening aims to detect the disease at an earlier stage, especially in high-risk populations and underserved areas, also identifying patients who require more urgent treatment. Teleglaucoma monitoring seeks to provide remote management through virtual clinics, where classic in-person visits are replaced by synchronous data collection (clinical measurements) performed by non-ophthalmologists and asynchronous review (decision-making) by ophthalmologists. This may be employed for low-risk patients with early disease, improving health care logistics, reducing the number of face-to-face consultations, and saving time and costs. New technologies may also allow home monitoring of patients in teleglaucoma programs, with the addition of artificial intelligence methods, which are expected to increase the accuracy of remote glaucoma screening/monitoring and support clinical decision-making. However, for the incorporation of teleglaucoma into clinical practice, a complex system for collection, transfer, flow, and interpretation of data is still necessary, in addition to clearer regulatory markers by government agencies and medical entities.

Wrist Rigidity Evaluation in Parkinson's Disease: A Scoping Review.

(1) Background: One of the main cardinal signs of Parkinson's disease (PD) is rigidity, whose assessment is important for monitoring the patient's recovery. The wrist is one of the joints most affected by this symptom, which has a great impact on activities of daily living and consequently on quality of life. The assessment of rigidity is traditionally made by clinical scales, which have limitations due to their subjectivity and low intra- and inter-examiner reliability. (2) Objectives: To compile the main methods used to assess wrist rigidity in PD and to study their validity and reliability, a scope review was conducted. (3) Methods: PubMed, IEEE/IET Electronic Library, Web of Science, Scopus, Cochrane, Bireme, Google Scholar and Science Direct databases were used. (4) Results: Twenty-eight studies were included. The studies presented several methods for quantitative assessment of rigidity using instruments such as force and inertial sensors. (5) Conclusions: Such methods present good correlation with clinical scales and are useful for detecting and monitoring rigidity. However, the development of a standard quantitative method for assessing rigidity in clinical practice remains a challenge.

Mentoria: vantagens e desafios da educação on-line durante a pandemia da Covid-19 / Mentoring: advantages and challenges of online education during the Covid-19 pandemic

Resumo: Introdução: A mentoria é uma importante estratégia de ensino em cursos de graduação e no treinamento profissional, especialmente no momento em que o mundo vivencia a pandemia da Covid-19. Essa estratégia possibilita aprendizado dinâmico e coletivo, ao mesmo tempo que minimiza os impactos sociais e emocionais gerados pela pandemia, sem comprometer o isolamento físico. Relato de experiência: A experiência dos alunos da UFMG com a mentoria nos formatos presencial (realizada em 2019) e virtual (durante a pandemia de 2020) demonstrou que, apesar de a modalidade virtual ter aspectos negativos, as vantagens são superiores. O aspecto mais vantajoso elencado por todos os mentorandos foi a possibilidade de discutir temas que iam além do aprendizado da medicina, como uma forma de preparação prática para a vida profissional. Discussão: A mentoria é uma estratégia singular de grande importância na educação médica. O formato misto, composto por reuniões virtuais e presenciais, foi considerado o melhor modelo para sua aplicação. Conclusão: Acreditamos que o presente relato estimulará outras instituições a adotar disciplinas no formato de mentoria, além da utilização do recurso remoto como estratégia de ensino.

Abstract: Introduction: Mentoring is an important teaching tool in undergraduate courses and in professional training, especially at a time when the world is experiencing the Covid-19 pandemic. This strategy enables dynamic and collective learning, while minimizing the social and emotional impacts generated by the pandemic, without compromising physical isolation. Experience report: The experience of UFMG students with mentoring in the face-to-face (held in 2019) and virtual (during the 2020 pandemic) format demonstrated that, although the virtual modality has negative aspects, these are outweighed by the advantages. The most advantageous aspect listed by all the mentors was the possibility of discussing topics that went beyond the learning of medicine, as a way of practical preparation for professional life. Discussion: Mentoring is a unique strategy of great importance in medical education. The mixed format, composed of virtual and face-to-face meetings, was considered the best model for its application. Conclusion: We believe that the present report will encourage other institutions to adopt disciplines in the form of mentoring, in addition to using the remote resource as a teaching strategy.

Force irradiation effects during upper limb diagonal exercises on contralateral muscle activation.

The aim of this study was to explore the force irradiation effects of upper limb isometric diagonal exercises on shoulder muscle activities. Interactions among diagonal directions, contraction intensities (moderate and maximum) and sex were assessed. Thirty healthy subjects (11 males) performed isometric unilateral diagonal exercises based on proprioceptive neuromuscular facilitation technique in an isokinetic dynamometer with their dominant upper limbs. The second diagonal for flexion and for extension were assessed while the participants performed their maximum isometric torque (MIT) and at 25% of their MIT. During the exercise the muscle activity of the medial deltoid, pectoralis major and upper trapezius in the non-dominant (non-exercised) upper limbs of the participants was recorded by surface electromyography. The highest muscle activity occurred in the upper trapezius during the diagonal for flexion (27% of maximum isometric voluntary contractions). Upper trapezius and pectoralis major were more active during the diagonal for flexion than diagonal for extension (p < 0.001), while similar values between both diagonals were observed for the medial deltoid (p > 0.05). In conclusion, we observed that force irradiation during upper limb diagonal exercises is affected by diagonal direction, contraction intensity and sex when performed by healthy participants.

Interface computacional 3D para biofeedback multimodal em tempo real / 3D computer interface for real time multimodal biofeedback

Este artigo descreve o projeto de um sistema computacional em tempo real para biofeedback multimodal. As informações biológicas ou psico-fisiológicas do paciente são detectadas por sensores específicos e processadas para prover feedback visual, por meio de ambientes virtuais tridimensionais e feedback auditivo. O dispositivo foi projetado para coleta e tratamento de seis sinais distintos: EMG, EEG, GSR, temperatura, frequência cardíaca e frequência respiratória. O aplicativo de software foi projetado em linguagem Visual C++ e utiliza técnicas de programação concorrente para permitir o tratamento adequado de todas as ações em tempo real. Os ambientes virtuais foram criados no software 3D Studio Max® e renderizados utilizando os recursos da biblioteca gráfica DirectX® da Microsoft Corp. O sistema desenvolvido resultou, conforme relatos dos voluntários, em sessões agradáveis e interessantes, que permitiam a escolha de diferentes tipos de ambientes virtuais capazes de se adequar às necessidades individuais. Todos os dados coletados durante as sessões de biofeedback são armazenados em um banco de dados específico, possibilitando a geração de relatórios para o terapeuta e permitindo o acompanhamento da evolução dos pacientes ao longo do tratamento. O sistema possui potencialidade para utilização como apoio ao tratamento de diversas patologias e disfunções, como demonstrado pelos experimentos realizados nas diferentes modalidades de biofeedback. Com este trabalho, os autores esperam ainda contribuir para o desenvolvimento de know-how nacional na área, à medida que disponibilizam técnicas avançadas para produção de hardware e software aplicáveis a tratamentos em biofeedback multimodal.

This article describes the design of a real-time multimodal biofeedback system. Biological or psycho-physiological information from the patients are detected by specific sensors and processed to provide visual feedback, by means of three-dimensional virtual environments and auditory feedback. The device has been designed to capture up to six biomedical signals: EMG, EEG, GSR, temperature, heart rate and respiratory rate. The software was designed using Visual C++ and uses concurrent programming techniques to allow proper treatment of all actions in real time. The virtual environments have been created with 3D Studio Max® and rendered using the resources of the DirectX® graphics library from Microsoft Corp. The developed system resulted, according to reports from volunteers, in enjoyable and interesting sessions, allowing the selection of different types of virtual environments able to adapt to individual needs. All data collected during the biofeedback sessions are stored in a specific database, allowing the generation of reports to the therapist and enabling him to monitor the progress of the patients throughout the treatment. The system has great potential to be uses as a supporting tool for the treatment of various diseases and disorders, as demonstrated by experiments performed on different types of biofeedback. Also, with this work, the authors hope to contribute to the further development of national expertise in the area, as they provide advanced techniques for the production of hardware and software applied to multimodal biofeedback treatments.

[Lung cancer and occupational exposures (asbestos not considered)]. / Cancer bronchique et expositions professionnelles (en dehors de l'amiante).

Lung cancer is associated to numerous occupational exposures, apart from asbestos. Today, the most frequent products observed in France were polycyclic aromatics hydrocarbons, silica, diesel exhaust, radon and some metal salts as chromium, nickel, cadmium, and beryllium. The main occupational exposures were described and tools for the screening of these exposures were proposed. The role of the general practitioner in the occupational diseases claims device is underlined.

Plan Nacional de Salud Ambiental Infantil

[Introducción]: El presente documento contiene el Plan Nacional de Salud Ambiental Infantil, el cual tiene como objetivo fortalecer las capacidades nacionales dirigidas a mejorar la situación de la salud ambiental de los niños y ninas en la República Dominicana. Fue formulado mediante un proceso participativo desarrollado como parte del Proyecto “Ambientes Saludables: Niñ@s Saludables” de la Organización Panamericana de la Salud (OPS/OMS). Su elaboración contempló, en sentido general, los siguientes pasos: 1. Levantamiento, revisión y estudio de documentos técnicos importantes, informes y registros. 2. Reunión-Taller Inicial, en el cual a través de la participación de las diferentes instituciones vinculadas a la salud ambiental infantil, se validó y complementó la información relacionada a las áreas institucional y legal del documento “Amenazas ambientales a la salud de la niñez”, y se identificaron las siguientes áreas prioritarias de intervención: a) Agua y Saneamiento; b) Residuos Sólidos; c) Contaminación Alimentaria, Plomo y Plaguicidas; d)Variabilidad y Cambios Climáticos (relacionada con los desastres, que causados por los cambios climáticos extremos, afectan la salud y el bienestar debido a las inundaciones, sequías y tormentas fuertes); e) Calidad del Aire en Interiores y Exteriores. 3. Elaboración del documento “Situación de la Salud Ambiental Infantil en la República Dominicana”. 4. Reunión –Taller para la definición de los lineamientos generales dirigidos a elaborar el Plan Nacional de Salud Ambiental Infantil, en el cual con la participación de técnicos de alto nivel de las diferentes instituciones vinculadas con este tema y mediante la aplicación de la Técnica Nominal de Grupos, se obtuvo la información que luego de sistematizada y organizada, sirvió de base a la formulación del Plan de referencia.