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Impacto de la inteligencia artificial en salud pub= lica

 

Impact of artificial intelligence on public health

 


1

 

            https://orcid.org/0000-0001= -6505-5166

 

 

Escuel= a Superior Politécnica de Chimborazo

veronicag.lopez@espoch.edu.e= c =

2

Paul Roberto Pino Falconí

 =

            https://orcid.org/0000-0002= -1255-8154=

 

 

Escuel= a Superior Politécnica de Chimborazo

paul.pino@espoch.edu.ec

3

Te= lmo Marcelo Zambrano Nuñez

 

            https://orcid.org/0000-0003-3575-6361

 

 

Escuel= a Superior Politécnica de Chimborazo

telmo.zambrano@espoch.edu.ec= =

4

Efraín Rodrigo Romero Machado                  =                 https://orcid.org/0000-0003-2985-618X

Escuel= a Superior Politécnica de Chimborazo

eromero@espoch.edu.ec= =

 

 

 

 

 

 

 

Artículo de Investigación Cientí= fica y Tecnológica

Enviado: 16/07/2024

Revisado: 10/08/2024<= /span>

Aceptado: 25/09/2024<= /span>

Publicado:14/11/2024<= /span>

 DOI:     https://doi.org/10.33262/ap.v= 6i4.562

<= span style=3D'font-size:8.0pt;line-height:115%;font-family:"Times New Roman",s= erif; mso-fareast-font-family:"Times New Roman";color:blue;mso-font-kerning:0pt; mso-ligatures:none'> 

 

 

Cítese:=

 

 

López Ullauri, V. G., Pino Falconí, P. R., Zambrano Nuñez, T. M., &= amp; Romero Machado, E. R. (2024). Impacto de la inteligencia artificial en sa= lud publica. AlfaPublicaciones, 6(4), 158–173. https://doi.org/10.33262/ap.v6i4.562=

 

 

 

ALFA PUBLICACIONES, es una revista multidisciplinar, trimestral, que se publicará= en soporte electrónico tiene como misión contribuir a la   formación de profesionales competentes con visión humanística y crítica q= ue sean capaces de exponer sus resultados investigativos y científicos en la misma medida que se promueva mediante su intervención cambios positivos e= n la sociedad. https://alfapubli= caciones.com 

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Esta revista está protegida bajo una licencia Creative Commons Attribution Non Commercial No Derivatives 4.0 International. Copia de la licencia: http://creativecommons.org/licenses/by-nc-nd/4.0/

 

= Palabras claves: =

Inteligencia artificial, salud, sociedad, justicia

 

Resumen:

Intro= ducción: La inteligen= cia artificial (IA) ha evidenciado su capacidad para moldear una multitud de transformaciones, y el campo educativo no es una excepción. En la contemp= oránea era digital, la Inteligencia Artificial ha surgido como un instrumento potente que está transformando radicalmente los métodos de enseñanza y aprendizaje. Objetivo: Identificar las diferentes inteligencias artificiales que se utilizan en la educación e investigación Metod= ología: La revisión sistemática y bibliométrica se realiza con el propósito= de responder preguntas específicas mediante métodos de búsqueda que sean transparentes, sistemáticos y susceptibles de ser reproducidos. El objeti= vo principal es reconocer de forma precisa las fuentes de información con el propósito de reducir cualquier tipo de sesgo en el procedimiento de selec= ción Resultados: Las inteligencias artificiales actuales abarcan una amplia variedad de enfoques y aplicaciones, cada una diseñada para resolver problemas específicos. Entre las más destacadas se encuentran las IA generativas, como los modelos de lenguaje (por ejemplo, ChatGPT), que pueden crear texto, imágenes, música y código a partir de datos. También están las IA especializadas, como las de reconocimiento facial, procesamiento de voz y análisis de datos, que se utilizan en sect= ores como la salud, la seguridad y el comercio. Conclusión: En el estud= io de las aplicaciones de la inteligencia artificial en distintos campos de = la medicina, tanto clínica como quirúrgica, se ha identificado una tendencia hacia la mejora de la calidad de vida de los pacientes, la anticipación e= n el tratamiento de enfermedades y la automatización de procedimientos. Con el= fin de obtener respuestas más rápidas para la toma de decisiones que impacten= en la salud.  

 

 

Keywords:

Artificial intelligence, health, society, jus= tice

 

Abstract

Introduction: Artificial intelligence (AI) has demonstrated its ability to shape a multitude of transformations, and the educational field is no exception. In the contemporary digital age, Artificial Intelligence has emerged as a powerful tool that is radically transforming teaching and learning methods. Objective: To identify the different artificial intelligences that are used in education and research Metho= dology: The systematic and bibliometric review is carried out with the purpose of answering specific questions through search methods that are transparent, systematic and susceptible to reproduction. The main objective is to accurately recognize the sources of information in order to reduce any ty= pe of bias in the selection procedure Results: Current artificial int= elligences cover a wide variety of approaches and applications, each designed to sol= ve specific problems. Among the most notable are generative AIs, such as language models (e.g., ChatGPT), which can create text, images, music and code from data. There are also specialized AIs, such as facial recognitio= n, voice processing and data analysis, which are used in sectors such as hea= lth, security and commerce. Conclusion: In the study of the application= s of artificial intelligence in different fields of medicine, both clinical and surgical, a trend has been identified towards improving the quality of li= fe of patients, anticipating the treatment of diseases and automating procedures. In order to obtain faster responses for decision-making that impacts health.

 

 

 

 

1.&n= bsp;     Introducción

La inteligencia artificial (IA) está ejerciendo una influencia significativa e= n la cotidianidad de las personas. Se emplea en diversas aplicaciones de alto riesgo, tales como la atención médica, los negocios, el gobierno, la educac= ión y la justicia, promoviendo una sociedad más algorítmica (Kaur et al., 2022)= . La influencia de los algoritmos se intensifica a través de una creciente prese= ncia en todas las esferas, a menudo sin ser conscientes y, en ciertos casos, usurpando la identidad de otros actores sociales (García et al., 2023). La implementación de sistemas de Inteligencia Artificial en entornos educativos describe las oportunidades para su aplicación por parte de educadores y estudiantes (Flores y García, 2023), fomentando la creación de nuevos model= os pedagógicos.

La implementación de juegos digitales como herramientas pedagógicas y la detec= ción precoz del riesgo de deserción en la educación superior a través de la Inteligencia Artificial constituyen temas relevantes para la investigación = (Bañeres et al., 2023).

Adicionalmente, la integración de la Inteligencia Artificial en aplicaciones educativas pue= de mejorar las habilidades de aprendizaje de los estudiantes y resulta benefic= iosa para su difusión a través de diversos servicios y análisis (Alhumaid et al., 2023) de redes epistémicas, tal como lo señala Wang (2023). Para potenciar = el compromiso y la motivación estudiantil, se propone la implementación de un método de minería de datos educativos fundamentado en la Inteligencia Artificial, que facilite el reconocimiento y la identificación de estudiant= es.

El desarrollo temprano y personalizado de recomendaciones en el aula invertida= (Sayed et al., 2023; Huang et al., 2023).

La red neuronal y la inteligencia artificial

Resultaría altamente beneficioso adquirir una comprensión concisa de la operación de la inteligencia artificial (IA) sin la necesidad de profundizar en disciplinas como las matemáticas, la física, la informática y las redes neuronales, ent= re otras.  Esta simplificación facilit= aría una representación nítida, aunque no necesariamente exacta, de la Inteligen= cia Artificial. Es crucial enfatizar que, de acuerdo con los registros de Google Books, existe un considerable número de libros dedicados a este tópico.

El desarrollo de las redes neuronales implica diversos aspectos: a) la programación de una interfaz en web a través de la cual nos comunicamos; b)= un algoritmo complejo que involucra conocimientos avanzados de matemáticas y de programación (construcción de la red neuronal) para ejecutarlos; c) el entrenamiento previo de una red amplia que contenga básicamente todos los t= emas posibles de la humanidad (el cálculo de los valores numéricos previamente obtenidos para que la red arroje las respuestas correctas); y d) la infraestructura necesaria para ejecutar cálculos, que sólo pueden ser realizados por empresas con recursos económicos “infinitos” y conocimientos= muy especializados, tales como Microsoft, Google, Facebook e IMB, que son de alcance mundial.

Lo mencionado en el párrafo anterior implica que muchas naciones serán incapac= es de reproducir este tipo de tecnologías y mucho menos de estar a la vanguard= ia de sus transformaciones, lo que de alguna manera hace que países con escaso desarrollo económico se vuelvan aún más dependientes y vulnerables.  No obstante, sostenemos que es imperati= vo que los individuos en el campo de la docencia y la educación desarrollen actitu= des y habilidades para adquirir conocimientos sobre la Inteligencia Artificial = y su impacto en el proceso educativo. Retomando la metáfora de las redes neurona= les, se puede afirmar que existen múltiples métodos para su creación, optimizaci= ón, entre otros, lo que las convierte en un campo de investigación de gran relevancia, dado que se están constantemente diseñando y creando nuevos mét= odos de funcionamiento.

La IA en la salud

La empresa Softel, que forma parte del Ministerio de la Informática y las Comunicaciones (MIC), se ha especializado en el desarrollo de soluciones informáticas para el ámbito médico desde sus inicios. Entre sus aplicacione= s se encuentra Infotoxi, diseñada para el control y diagnóstico de intoxicaciones por sustancias tóxicas en centros especializados. Asimismo, han desarrollado Gerisoft, destinada a la atención primaria de la salud en la población adul= ta mayor, y SEAA, un sistema de ayuda diagnóstica utilizado en la atención primaria. Para el desarrollo de estos sistemas, se contó con la colaboració= n de médicos especialistas del Ministerio de Salud Pública (Minsap) que actuaron= como expertos en la materia. Estas aplicaciones fueron instaladas en diversas unidades del sistema de salud. (Cabrera et al., 2012)

El procesamiento de imágenes mediante métodos de segmentación basados en algoritmos de aprendizaje automático se emplea para obtener datos de resonancias magnéticas a gran escala. Esto permite realizar diagnósticos precisos y tomar decisiones médicas más acertadas, beneficiando al paciente tanto en el ámbito clínico como en el quirúrgico. Por otro lado, existen aplicaciones tecnológicas que se centran en la asistencia diagnóstica de lesiones cancerosas, como el uso de algoritmos de aprendizaje, como en el c= aso de un sistema de detección de cáncer de piel que evalúa diferentes entradas derivadas de una imagen de dermatoscopia. Por un lado, se examinan las características visuales identificadas mediante el uso de técnicas de aprendizaje profundo. Por otro lado, se considera la utilización de la zoni= ficación en el aprendizaje profundo con el fin de incrementar la exactitud en el pro= ceso de diagnóstico. (Walker et al., 2019)

El empleo de aprendizaje automático en la predicción de eventos o condiciones = de salud en el ámbito de la salud pública contribuye a la evaluación del riesgo asociado a dichos sucesos o enfermedades. Estos algoritmos pueden servir co= mo una herramienta de apoyo en la toma de decisiones para académicos, directiv= os de instituciones epidemiológicas, profesionales de la salud, y en los servi= cios médicos, tanto en entornos clínicos como quirúrgicos. Los algoritmos de aprendizaje automático poseen la capacidad de reconocer relaciones compleja= s y no lineales que se encuentran en los datos, lo cual tiene un impacto positi= vo en la capacidad predictiva de dichos modelos. Esto permite obtener respuest= as relevantes para los campos de la salud pública y la medicina. (Santos, 2018= )

En entornos domésticos inteligentes, se emplean diversas aplicaciones especial= izadas en la programación de algoritmos, como la técnica de retropropagación (backpropagation, BP), con el propósito de capacitar la red neuronal de ava= nce en la identificación de patrones de actividad humana. Además, se examina y valida el método de distancia entre clases para la elección de las características de los eventos detectados por los sensores de movimiento. Posteriormente, se analizan las eficiencias en la identificación de la actividad humana por parte de la red neuronal mediante el algoritmo de retropropagación (BP), en contraste con otros algoritmos de naturaleza probabilística como el clasificador Naïve Bayes (NB) y el Modelo Hidden Mar= kov (HMM).

Los resultados indican que la precisión de reconocimiento de actividad varía se= gún los distintos conjuntos de datos de dichas características. La elección de conjuntos de datos inapropiados incrementa la complejidad computacional y disminuye la precisión en la identificación de actividades. Por otra parte,= la red neuronal empleada por el algoritmo BP muestra un desempeño en la identificación de actividades humanas que es comparativamente superior al de los clasificadores NB y HMM. (Fang et al., 2014)

El sistema de aprendizaje automático tiene como objetivo mejorar la asistencia= a pacientes con insuficiencia cardíaca al proporcionar una evaluación de la gravedad y predicción de la enfermedad. Además, incluye una interfaz de ges= tión que permite comparar los distintos seguimientos de los pacientes. El sistem= a en cuestión se compone de un núcleo inteligente y una herramienta de gestión especializada que cumple la función de servir como interfaz para el entrenamiento y la utilización de inteligencia artificial, con énfasis en el aprendizaje automático. Como instrumento de gestión, permite al cardiólogo completar una base de datos supervisada apropiada para el aprendizaje automático durante sus consultas ambulatorias regulares. (Guidi et al., 201= 4)

2.&n= bsp;     Metodología

La revisión sistemática y bibliométrica se realiza con el propósito de respond= er preguntas específicas mediante métodos de búsqueda que sean transparentes, sistemáticos y susceptibles de ser reproducidos. El objetivo principal es reconocer de forma precisa las fuentes de información con el propósito de reducir cualquier tipo de sesgo en el procedimiento de selección (Díaz et a= l., 2021; Lame, 2019). Se realiza a continuación un proceso de extracción y codificación de datos de investigaciones con el propósito de sintetizar hallazgos y aplicar conocimientos en la práctica.

La estrategia de búsqueda desempeña un papel crucial en la labor investigativa académica, dado que posibilita la identificación y recolección de datos pertinentes para abordar un tema específico. La búsqueda de información imp= lica la planificación y realización de pasos estructurados y sistemáticos con el= fin de identificar fuentes relevantes, tales como artículos científicos y libro= s.

= 3.      Resultados<= /p>

Inteligencias artificiales

Las inteligencias artificiales actuales abarcan una amplia variedad de enfoques= y aplicaciones, cada una diseñada para resolver problemas específicos. Entre = las más destacadas se encuentran las IA generativas, como los modelos de lengua= je (por ejemplo, ChatGPT), que pueden crear texto, imágenes, música y código a partir de datos. También están las IA especializadas, como las de reconocimiento facial, procesamiento de voz y análisis de datos, que se utilizan en sectores como la salud, la seguridad y el comercio. Las IA autónomas, como los sistemas de conducción automatizada, combinan sensores, aprendizaje profundo y toma de decisiones en tiempo real. Por otro lado, la= s IA predictivas aplican análisis de datos y machine learning para anticipar tendencias y resultados, siendo clave en finanzas, logística y marketing. C= ada tipo de IA refleja el rápido avance tecnológico, pero también plantea desaf= íos éticos y sociales sobre su impacto en el futuro.

Tabla 1

Inteligencias artificiales

Inteligencia Artificial

Descripción

Comentario

 

 

 

CHAT GPT

Fun= ciona mediante el uso de técnicas de procesamiento del lenguaje natural y se entrena en una gran cantidad de texto para generar respuestas a preguntas= o sugerencias dadas por los usuarios. Chat GPT está construido sobre la fam= ilia GPT-3.5, considerado uno de los modelos de lenguaje más avanzados hasta la fecha (Brown et al., 2020).

Las inteligencias artificiales como Chat GPT, pueden realizar una gran cantid= ad de actividades, como resumir, ampliar información, traducir textos, hacer predicciones, crear guiones, escribir código y generar discursos todo est= o lo realiza gracias al aprendizaje automático.

 

 

 

DAL= L - E

Est= án programados para producir imágenes de altísima calidad en segundos, siendo capaces de disimular diversas técnicas, materiales, estilos, medios y composiciones con base en los procesos de Deep learning, generación y difusión probabilística que habilitan la traducción de comando escrito a imagen. (Braidotti et al., 2013)

Est= os programas brindan representaciones digitales confiables de pinturas, esculturas, dibujos, grabados, collages, fotografías, mapas, mosaicos, re= nderizados en tercera dimensión, entre otros, con la capacidad del usuario de guiar = la máquina con pocas palabras o frases.

 

 

 

 

 

Tabla 1

Inteligencias artificiales (continuación)

Int= eligencia Artificial

Descripción

Comentario

 COPY.AI

Cop= y.ai es una compañía de inteligencia artificial y procesamiento del lenguaje natural (PLN) fundada en 2017 (Martínez, 2022).

Sus principales características son: 

·&= nbsp;        Generación automatizada de contenido.

·&= nbsp;        Resumen automatizado de texto: puede resumir automáticamente grandes bloques de texto en un resumen conciso y preciso.=

Gen= eración automatizada de ideas: nos muestra ideas para contenido, títulos de blog, titulares, etc.

La empresa se especializa en crear de forma rápida y efectiva contenido de a= lta calidad que permiten a los usuarios crear contenido de alta calidad de fo= rma rápida y eficaz. De igual manera se centra en el contenido generado automáticamente, contenidos generados texto resúmenes de texto y generaci= ón de ideas.

 

 CANVAS

El modelo Canvas fue creado con el fin de establecer una relación lógica ent= re cada uno de los componentes de la organización y todos los factores que influyen para que tenga o no éxito. (Amit et al., 2001)

El objetivo principal de este modelo es evidenciar la eficacia de la idea y,= a través del establecimiento de todas sus características, determinar si la idea pierde credibilidad si no hay material sustentado para llevar el diagrama.

 

 

 

 

 

Tabla 1

Inteligencias artificiales (continuación)

Inteligencia Artificial

Descripción

Comentario

 NOTION AI

El = uso complementario de Notion y Notion AI puede funcionar como una plataforma = de portafolios electrónicos con un generador de AWCF, que ayuda a los estudiantes a promover la autorregulación y la observación, y a recibir andamiaje de maneras que otras herramientas de escritura de IA no pueden ofrecer.   (Lee I, 2017)

La inteligencia artificial tiene el potencial para mejorar la autorregulació= n, paso del proceso de escritura (como lluvia de ideas, edición, corrección y comentarios) en una sola página. 

 

 

 

 

 

SCR= IBBR

Scr= ibbr es una plataforma diseñada para ayudar a estudiantes y académicos a mejor= ar sus habilidades de escritura. Ofrece servicios de corrección de estilo, revisión de plagio y guías de citación, siendo especialmente valiosa para quienes enfrentan la escritura de trabajos académicos. Este documento ana= liza Scribbr a través de las perspectivas de diversos autores en el campo de la educación y la escritura.  (Purdue OWL, 2019).

Se presenta Scribbr como una herramienta útil para mejorar la escritura académica. La plataforma no solo ayuda a los estudiantes a corregir error= es, sino que también fomenta el desarrollo de habilidades de escritura a largo plazo a través de la combinación de tecnología y retroalimentación humana= . La investigación realizada por varios autores destaca la relevancia de herramienta

 

Inteligencias artificiales en educación

Las inteligencias artificiales están transformando la educación al personalizar= el aprendizaje y optimizar los procesos educativos. Herramientas como tutores virtuales y plataformas adaptativas utilizan IA para identificar las necesidades de cada estudiante, ajustando el contenido y el ritmo según su progreso. Además, los sistemas de evaluación automatizada agilizan la retroalimentación, permitiendo a los docentes enfocarse en aspectos más

La creciente digitalización ha propiciado el desarrollo de nuevos enfoques en inteligencia artificial, como la localización automática de neuronas y la c= irugía basada en la evidencia, que se apoyan en instrumentos quirúrgicos modulares. Estos avances prometen beneficios significativos gracias a la implementació= n de herramientas de asistencia innovadoras. (Miller et al., 2009)

Para el quirófano. El uso de videos capturados con cámaras endoscópicas o instal= adas en el techo mejora las habilidades y el rendimiento de los equipos quirúrgi= cos. Además, esta tecnología permite un mayor nivel de precisión durante los procedimientos médicos.

La inteligencia artificial se emplea en diversos procedimientos quirúrgicos en especialidades como oftalmología, neurocirugía y cirugía general. También se utiliza en la creación de sistemas inteligentes para el entrenamiento en toracocentesis y en el tratamiento de diversas afecciones quirúrgicas. (Nak= awala et al., 2018).

En la actualidad, se emplean modelos de regresión logística combinados con algoritmos de minería de datos para identificar los factores de riesgo quirúrgico en niños y estimar la probabilidad de complicaciones postoperato= rias. Existe un interés creciente en la aplicación del aprendizaje automático en = el ámbito médico, tanto para la mejora de los procesos y procedimientos quirúrgicos como para la educación y diagnóstico en el campo de la medicina= .

La implementación de tecnologías como la Inteligencia Artificial (IA) en las unidades de cuidados intensivos (UCI) es fundamental para disminuir eventos adversos y riesgos quirúrgicos, mejorar la seguridad de los pacientes y perfeccionar las habilidades técnicas de los profesionales de la salud. La = IA facilita la gestión de grandes cantidades de datos complejos y diversos en = las UCI, agilizando su procesamiento y convirtiéndolos en información más útil y manejable. De esta manera, es posible anticipar desenlaces desfavorables y apoyar la toma de decisiones médicas con el fin de mejorarlos. (Lovejoy et = al., 2018).

El personal médico debe estar preparado para enfrentar situaciones altamente complejas y estar disponible para la práctica clínica asistencial con la calidad humana adecuada.

Un aporte adicional se materializó en el desarrollo de una herramienta más pre= cisa basada en inteligencia artificial para la realización de biopsias en el col= on rectal, con especial énfasis en mejorar la detección de células cancerígena= s. La endocitoscopía asistida es una técnica novedosa que ha sido desarrollada recientemente. Esta técnica permite realizar biopsias ópticas utilizando un endoscopio ultra magnificado para observar células y analizarlas en tiempo = real durante una colonoscopia. (Mori et al., 2018).

La evaluación histológica de los pólipos identificados se expresa en términos = de la probabilidad de ser neoplásicos o no neoplásicos. El algoritmo utilizado= en este sistema de inteligencia artificial se fundamenta en la extracción auto= mática de características de una imagen, seguida por el proceso de aprendizaje.

automático. Con este sistema, se obtuvieron valores de sensibilidad, especificidad, precisión, valor predictivo positivo y valor predictivo negativo del 98%. (= Quan et al., 2013).

El modelo de inteligencia artificial demostró una sensibilidad destacada y un valor predictivo negativo que posiblemente alcanzó el umbral necesario para= la realización de una biopsia óptica. Se recomienda verificar este hallazgo con más pruebas, como un análisis del rendimiento del modelo de inteligencia artificial con una mayor cantidad de imágenes de entrenamiento en desarroll= o.

4.&n= bsp;     Conclusiones

 

·      =    En el estudio de las aplicaciones de la inteligencia artificial en distintos campos de la medicina, tanto clínica c= omo quirúrgica, se ha identificado una tendencia hacia la mejora de la calidad = de vida de los pacientes, la anticipación en el tratamiento de enfermedades y = la automatización de procedimientos. Con el fin de obtener respuestas más rápi= das para la toma de decisiones que impacten en la salud.

·      =    La mayoría de los artículos sobre Inteligencia Artificial encontrados provienen de la base de datos de MEDLIN= E y están escritos en inglés. La tendencia observada indica que los países desarrollados han sido líderes en la implementación de avances en el campo = de la medicina, especialmente en procedimientos quirúrgicos, y son los que más investigaciones han publicado al respecto.

·      =    Las publicaciones de los países menos desarrollados, incluidos los de habla hispana, reflejaron una relación directamente proporcional con el nivel de avance tecnológico en inteligencia artificial.

5.      Conflic= to de intereses

Los autores declaran que no existe conflic= to de intereses en relación con el artículo presentado.

6.      Declara= ción de contribución de los autores

Todos autores contribuyeron significativam= ente en la elaboración del artículo.

 

7.      Costos = de financiamiento

La presente investigación fue financiada e= n su totalidad con fondos propios de los autores.

8.&n= bsp;     Referencia Bibliográficas

Alhumaid, K., Naqbi, S.A., Elsori, D., y Mansoori, M.A. (2023). The adoption of artificial intelligence applicatio= ns in education. International Journal= of Data and Network Science, 7(1), 457-466. https://doi.org/10.5267/j.ijdns.2= 022.8.013

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3Deditorial1.pngWang, X., Liu,= Q., Pang, H., Tan, S.C., Lei, J., Wallace, M.P., y Li, L. (2023). What matters in AI-supported learning: A study of human-AI interactions in language learning using cluster analysis and epist= emic network analysis. Computers and Education, 194. https://doi.org/10.1016/j.compedu.2022.104703

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

El artículo que se publica es de exclusiva responsabilidad de los autores y no necesariamente reflejan el pensamiento de la Revi= sta Alfa Publicaciones.

 

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