TY - JOUR A1 - Afonso, Luis Claudio Sugi A1 - Pereira, Clayton R. A1 - Weber, Silke A. T. A1 - Hook, Christian A1 - Falcão, Alexandre X. A1 - Papa, Joao Paulo T1 - Hierarchical learning using deep optimum-path forest JF - Journal of Visual Communication and Image Representation N2 - Bag-of-Visual Words (BoVW) and deep learning techniques have been widely used in several domains, which include computer-assisted medical diagnoses. In this work, we are interested in developing tools for the automatic identification of Parkinson’s disease using machine learning and the concept of BoVW. The proposed approach concerns a hierarchical-based learning technique to design visual dictionaries through the Deep Optimum-Path Forest classifier. The proposed method was evaluated in six datasets derived from data collected from individuals when performing handwriting exams. Experimental results showed the potential of the technique, with robust achievements. KW - Handwriting dynamics KW - Hierarchical representation KW - Optimum-path forest KW - Parkinson’s disease Y1 - 2020 U6 - https://doi.org/10.1016/j.jvcir.2020.102823 VL - 71 IS - August PB - Elsevier ER - TY - CHAP A1 - Altenbuchner, Amelie A1 - Weber, Karsten ED - Haltaufderheide, Joschka ED - Hovemann, Johanna ED - Vollmann, Jochen T1 - Geriatric trauma patients as research subjects in a technology-driven research project BT - A preliminary field report T2 - Aging between Participation and Simulation N2 - This article highlights methodological and ethical challenges in research with adults of older and oldest age, by presenting field experiences of the current research project “Motion Monitoring of Geriatric Trauma Patients - Explorative Study on the Rehabilitation Process after Hip Fracture Using Sensor-based Data”. Depiction of the survey situation, with regard to the subjects in particular, can serve as practical examples for designing future research projects. The group of older adults is a rather large and growing group for which research is required, especially concerning their heterogeneity, their individual autonomy and quality of life. It is assumed, that research designs of studies on the target group must be specifically adjusted, in particular when considering the attribution of vulnerability of the group members. At the same time, it is not clear yet what exact specifics of the subjects and target group must be considered in research designs, as surprisingly little is known about the target group as subjects and corresponding theories have been insufficiently tested. The exploratory long-term design of the research project presented in the second section of this chapter has a positive evaluation of an ethics committee. Still ethical challenges occurred in the field situation, that are illustrated in the third section of this chapter, by providing information on the patients, their role as research subjects, how they were recruited, how an informed consensus was reached, and in some cases how participation was rejected or abandoned. After a summary, the end of the paper is marked by recommendations on how to design future research projects. Cumulatively it must always be expected that interaction between researchers and research subjects of this target group can become very intensive, what requires to follow clearly defined procedures and at the same time to be prepared to act flexibly. Y1 - 2020 SN - 9783110677485 U6 - https://doi.org/10.1515/9783110677485-006 SP - 87 EP - 104 PB - De Gruyter CY - Berlin u.a. ER - TY - CHAP A1 - Auer, Simon A1 - Kubowitsch, Simone A1 - Krutsch, Werner A1 - Renkawitz, Tobias A1 - Süß, Franz A1 - Dendorfer, Sebastian T1 - Effect of mental demand on knee forces in professional youth soccer players T2 - ISBS Proceedings Archive N2 - Soccer is one of the most popular sports all around the world. It is an injurious type of sport with a focus on lower extremities and high psychological pressure during matches. The stressor is linked with injuries and an increased musculoskeletal loading. This study investigates the influence of cognitive stress on the load profile of the knee joint. Twelve professional youth soccer players performed highly dynamic runs with and without additional cognitive stress. The runs were analysed with a musculoskeletal simulation software. The data analysis shows no difference in knee joint reaction loading under additional mental stress compared to the baseline. Yet running times are significantly lower in the baseline. While there is no increase in the joint loads, the running times indicate an altered movement behaviour when the subjects are exposed to additional mental demand. KW - Kniegelenk KW - Körperliche Belastung KW - Stress KW - Computersimulation Y1 - 2020 UR - https://commons.nmu.edu/isbs/vol38/iss1/28 VL - 38 IS - 1, Art. 28 ER - TY - JOUR A1 - Auer, Simon A1 - Kurbowitsch, Simone A1 - Süß, Franz A1 - Renkawitz, Tobias A1 - Krutsch, Werner A1 - Dendorfer, Sebastian T1 - Mental stress reduces performance and changes musculoskeletal loading in football-related movements JF - Science and Medicine in Football N2 - Purpose: Football players have a high risk of leg muscle injuries, especially when exposed to mental stress. Hence, this study investigated the musculoskeletal response of elite youth football players during highly dynamic movements under stress. The hypothesis is that mental stress reduces performance and changes the muscular forces exerted. Materials & methods: Twelve elite youth football players were subjected to mental stress while performing sports-specific change-of-direction movements. A modified version of the d2 attention test was used as stressor. The kinetics are computed using inverse dynamics. Running times and exerted forces of injury-prone muscles were analysed. Results: The stressor runs were rated more mentally demanding by the players (p = 0.006, rs = 0.37) with unchanged physical demand (p = 0.777, rs = 0.45). This resulted in 10% longer running times under stress (p < 0.001, d = −1.62). The musculoskeletal analysis revealed higher peak muscle forces under mental stress for some players but not for others. Discussion: The study shows that motion capture combined with musculoskeletal computation is suitable to analyse the effects of stress on athletes in highly dynamic movements. For the first time in football medicine, our data quantifies an association between mental stress with reduced football players’ performance and changes in muscle force. KW - Biomechanics KW - muscle injury KW - attention KW - musculoskeletal simulation Y1 - 2020 U6 - https://doi.org/10.1080/24733938.2020.1860253 VL - 5 IS - 4 SP - 323 EP - 329 PB - Taylor & Francis ER - TY - JOUR A1 - Aurbach, Maximilian A1 - Spicka, Jan A1 - Süß, Franz A1 - Dendorfer, Sebastian T1 - Evaluation of musculoskeletal modelling parameters of the shoulder complex during humeral abduction above 90° JF - Journal of Biomechanics N2 - Based on electromyographic data and force measurements within the shoulder joint, there is an indication that muscle and resulting joint reaction forces keep increasing over an abduction angle of 90°. In inverse dynamics models, no single parameter could be attributed to simulate this force behaviour accordingly. The aim of this work is to implement kinematic, kinetic and muscle model modifications to an existing model of the shoulder (AnyBody™) and assess their single and combined effects during abduction up to 140° humeral elevation. The kinematics and the EMG activity of 10 test subjects were measured during humeral abduction. Six modifications were implemented in the model: alternative wrapping of the virtual deltoid muscle elements, utilization of a three element Hill model, strength scaling, motion capture driven clavicle elevation/protraction, translation of the GH joint in dependency of the acting forces and an alteration of the scapula/clavicle rhythm. From the six modifications, 16 different combinations were considered. Parameter combinations with the Hill model changed the resultant GH joint reaction force and led to an increase in force during abduction of the humerus above 90°. Under the premise of muscle activities and forces within the GH joint rising after 90° of humeral abduction, we propose that the Hill type muscle model is a crucial parameter for accurately modelling the shoulder. Furthermore, the outcome of this study indicates that the Hill model induces the co-contraction of the muscles of the shoulder without the need of an additional stability criterion for an inverse dynamics approach. KW - Shoulder joint KW - Musculoskeletal modelling KW - EMG KW - Glenohumeral joint reaction force KW - Muscle model KW - Schultergelenk KW - Bewegungsapparat KW - Biomechanik KW - Simulation Y1 - 2020 U6 - https://doi.org/10.1016/j.jbiomech.2020.109817 VL - 106 IS - June PB - Elsevier ER - TY - JOUR A1 - Aurbach, Maximilian A1 - Špička, Jan A1 - Süß, Franz A1 - Vychytil, J. A1 - Havelková, Leonard A1 - Ryba, T. A1 - Dendorfer, Sebastian T1 - Torus obstacle method as a wrapping approach of the deltoid muscle group for humeral abduction in musculoskeletal simulation JF - Journal of Biomechanics N2 - Musculoskeletal models of the shoulder complex are valuable research aids to investigate tears of the supraspinatus and the resulting mechanical impact during abduction of the humerus. One of the major contributors to this motion is the deltoid muscle group and for this, an accurate modeling of the lines of action is indispensable. The aim of this work was to utilize a torus obstacle wrapping approach for the deltoids of an existing shoulder model and assess the feasibility of the approach during humeral abduction. The shoulder model from the AnyBody™ modeling system was used as a platform. The size of the tori is based on a magnetic resonance imaging (MRI) approach and several kinematic couplings are implemented to determine the trajectories of the tori during abduction. To assess the model behavior, the moment arms of the virtual muscle elements and the resultant glenohumeral joint reaction force (GHJF) were compared with reference data from the literature during abduction of the humerus in the range 20°–120°. The root mean square error for the anterior, lateral and posterior part between the simulated muscle elements and reference data from the literature was 3.9, 1.7 and 5.8 mm, respectively. The largest deviation occurred on the outer elements of the muscle groups, with 12.6, 10.4 and 20.5 mm, respectively. During abduction, there is no overlapping of the muscle elements and these are in continuous contact with the torus obstacles, thus enabling a continuous force transmission. This results in a rising trend of the resultant GHJF. The torus obstacle approach as a wrapping method for the deltoid muscles provides a guided muscle pathing by simultaneously approximating the curvature of the deltoid muscle. The results from the comparison of the simulated moment arms and the resultant GHJF are in accordance with those in the literature in the range 20°–120° of abduction. Although this study shows the strength of the torus obstacle as a wrapping approach, the method of fitting the tori according to MRI data was not suitable. A cadaver study is recommended to better validate and mathematically describe the torus approach. KW - Muscoloskeletal model KW - AnyBody Modeling System KW - MRI KW - Shoulder joint complex KW - Muscle trajectory KW - Torus KW - Wrapping Y1 - 2020 U6 - https://doi.org/10.1016/j.jbiomech.2020.109864 VL - 109 IS - August PB - Elsevier ER - TY - JOUR A1 - Birkenmaier, Clemens A1 - Dornia, Christian A1 - Lehle, Karla A1 - Müller, Thomas A1 - Gruber, Michael Andreas A1 - Philipp, Alois A1 - Krenkel, Lars T1 - Analysis of Thrombotic Deposits in Extracorporeal Membrane Oxygenators by High-resolution Microcomputed Tomography: A Feasibility Study JF - ASAIO Journal / American Society for Artificial Internal Organs N2 - Coagulative disorders, especially clotting during extracorporeal membrane oxygenation, are frequent complications. Direct visualization and analysis of deposits in membrane oxygenators using computed tomography (CT) may provide an insight into the underlying mechanisms causing thrombotic events. However, the already established multidetector CT1 (MDCT) method shows major limitations. Here, we demonstrate the feasibility of applying industrial micro-CT (μCT) to circumvent these restrictions. Three clinically used membrane oxygenators were investigated applying both MDCT and μCT. The scans were analyzed in terms of clot volume and local clot distribution. As validation, the clot volume was also determined from the fluid volume, which could be filled into the respective used oxygenator compared to a new device. In addition, cross-sectional CT images were compared with crosscut oxygenators. Based on the μCT findings, a morphological measure (sphericity) for assessing clot structures in membrane oxygenators is introduced. Furthermore, by comparing MDCT and μCT results, an augmentation of the MDCT method is proposed, which allows for improved clot volume determination in a clinical setting. Y1 - 2020 U6 - https://doi.org/10.1097/MAT.0000000000001089 SN - 1538-943X VL - 66 IS - 8 SP - 922 EP - 928 PB - Lippincott Williams & Wilkins ER - TY - JOUR A1 - Brabenec, Tomas A1 - Poborsky, Frantisek A1 - Saßmannshausen, Sean Patrick T1 - The Difference between Preferred & Common Stocks in Europe from the Market Perspective JF - Journal of Competitiveness N2 - Companies listed on the stock market must devote a great deal of attention to their market position. They must increase their competitive advantage in the undeniably key process of the issuance of stocks. As the issuance of preferred stocks has increased after the last crisis and in the current period of low interest rates in Europe, they are becoming more favoured investment instruments, we decided to analyse the real properties of preferred stocks in Europe in order to increase the efficiency of joint-stock companies. Using a dataset comprising all companies having both common and preferred stocks issued and traded on European markets between 2009- 2016, we determined the relationship of risk (measured by beta coefficients) and price volatility among common and preferred stocks and bonds in Europe. Our findings show beta coefficients of preferred stocks as systematically lower than beta coefficients of common stocks. Considering a difference of up to 10% as negligible, however, preferred stocks showed a similar or higher beta coefficient than corresponding common stocks of the same company in 53% of cases, whereas for 33% of cases, the difference is only ±10%. Coefficients of variation in prices showed a similar relationship, with only a negligible portion of preferred stocks bearing fixed (stable) dividends. This result implies that currently traded preferred stocks in Europe in fact do not possess such characteristics they are typically said to have, and in many cases they incur as comparable a risk as do common stocks. This essential information should help to increase the efficiency and competitiveness of joint-stock companies. KW - preferred stocks KW - common stocks KW - beta coefficient KW - stock valuation KW - competitiveness Y1 - 2020 U6 - https://doi.org/10.7441/joc.2020.03.04 VL - 12 IS - 3 SP - 64 EP - 81 PB - Tomas Bata University in Zlín ER - TY - CHAP A1 - Chang, Ching-Sheng A1 - Lin, Jin-Fa A1 - Lee, Ming-Ching A1 - Palm, Christoph ED - Tolxdorff, Thomas ED - Deserno, Thomas M. ED - Handels, Heinz ED - Maier, Andreas ED - Maier-Hein, Klaus H. ED - Palm, Christoph T1 - Semantic Lung Segmentation Using Convolutional Neural Networks T2 - Bildverarbeitung für die Medizin 2020. Algorithmen - Systeme - Anwendungen. Proceedings des Workshops vom 15. bis 17. März 2020 in Berlin N2 - Chest X-Ray (CXR) images as part of a non-invasive diagnosis method are commonly used in today’s medical workflow. In traditional methods, physicians usually use their experience to interpret CXR images, however, there is a large interobserver variance. Computer vision may be used as a standard for assisted diagnosis. In this study, we applied an encoder-decoder neural network architecture for automatic lung region detection. We compared a three-class approach (left lung, right lung, background) and a two-class approach (lung, background). The differentiation of left and right lungs as direct result of a semantic segmentation on basis of neural nets rather than post-processing a lung-background segmentation is done here for the first time. Our evaluation was done on the NIH Chest X-ray dataset, from which 1736 images were extracted and manually annotated. We achieved 94:9% mIoU and 92% mIoU as segmentation quality measures for the two-class-model and the three-class-model, respectively. This result is very promising for the segmentation of lung regions having the simultaneous classification of left and right lung in mind. KW - Neuronales Netz KW - Segmentierung KW - Brustkorb KW - Deep Learning KW - Encoder-Decoder Network KW - Chest X-Ray Y1 - 2020 SN - 978-3-658-29266-9 U6 - https://doi.org/10.1007/978-3-658-29267-6_17 SP - 75 EP - 80 PB - Springer Vieweg CY - Wiesbaden ER - TY - JOUR A1 - Corsten, Sabine A1 - Lauer, Norina T1 - Biography work in long-term residential aged care with tablet support to improve the quality of life and communication – study protocol for app development and evaluation JF - International Journal of Health Professions N2 - Hintergrund Ältere Menschen in Pflegeeinrichtungen haben ein hohes Risiko, an Depressionen zu erkranken. Die Auswirkungen früher Interventionen wie Biografiearbeit auf die Lebensqualität älterer, institutionalisierter Personen sind unerforscht. Ziel Entwicklung und Evaluation einer tablet-gestützten Intervention zur Biografiearbeit in der stationären Langzeitpflege zur Steigerung der Lebensqualität älterer Menschen. Design Die Studie wird in einem randomisierten Pre-Test-Post-Test-Kontrollgruppen-Design mit Follow-up-Testung im Gruppen- und Einzel-Setting durchgeführt. Die Teilnehmenden werden randomisiert der experimentellen Intervention (Tablet-gestützte biografische Arbeit) oder der Kontrollintervention (geplant Tablet-gestütztes Spiel), die jeweils von älteren, ehrenamtlich Helfenden unterstützt werden, zugewiesen. Insgesamt werden 80 Bewohner/-innen und 16 Ehrenamtliche rekrutiert. Primärer Outcome ist die Lebensqualität der Bewohner/-innen und der ehrenamtlich Helfenden, gemessen mit dem World Health Organization Quality of Life Assessment for older adults. Sekundärer Outcome sind Selbstwertgefühl und Lebenszufriedenheit. Darüber hinaus werden Kommunikationsfähigkeit und die funktionale Unabhängigkeit der Bewohner/-innen untersucht. Methode In der ersten Projektphase wird eine App im Sinne eines benutzerzentrierten, agilen Entwicklungsprozesses konzipiert, die multimodal lebensgeschichtliche Themen aufbereitet und mit Schlüsselfragen verknüpft. Für ältere Ehrenamtliche, die den Einsatz der App in den Institutionen begleiten, wird ein Workshop entwickelt. In der zweiten Phase wird die von der App angeregte biografische Arbeit im Gruppen- und Einzel-Setting durchgeführt. Diskussion Dies ist das erste bekannte Programm, das auf ältere Menschen in Pflegeeinrichtungen und ältere Ehrenamtliche zugeschnitten ist und darauf abzielt, Depressionen durch digital unterstützte biografische Arbeit vorzubeugen. N2 - Background Older adults in care facilities face a high risk of experiencing depression. The impact that early interventions like biographical work have on the quality of life for older adults in such facilities is unknown. Aim To develop and evaluate a tablet-supported intervention for biographical work in long-term residential aged care to increase the quality of life for older adults. Design The study will be conducted in a randomized pretest–posttest control group design with follow-up testing in group and single settings. Participants will be randomized to the experimental intervention (tablet-supported biographic work) or the control intervention (planned tablet-supported game playing), each guided by senior volunteers. A total of 80 residents and 16 volunteers will be recruited. The primary outcome for the residents and volunteers will be quality of life as measured with the World Health Organization Quality of Life Assessment-for older adults. Secondary measures will be self-esteem and life satisfaction. In addition, we will examine residents’ ability to communicate and their functional independence. Method The first stage of the project involves developing an app. The app is developed in a user-centered, agile development process. It will use multimedia to prepare life history topics and links them to key questions. Next, a workshop is developed for the volunteers who accompany the use of the app in the institutions. During the second phase, biographic work stimulated by the app will be conducted in groups or individually with residents. Discussion This is the first known program tailored to older adults in care facilities and senior volunteers that aims to prevent depression by providing digitally supported biographic work. T2 - Biografiearbeit in Senioreneinrichtungen mit Tablet-Unterstützung zur Verbesserung der Lebensqualität und Kommunikation (BaSeTaLK) – Studienprotokoll zur App-Entwicklung und Evaluation Y1 - 2020 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:898-opus4-8446 VL - 7 IS - 1 SP - 13 EP - 23 ER - TY - JOUR A1 - de Campos Silva, Elen Farinelli A1 - Baima, Julio Pinheiro A1 - Ribeiro de Barros, Jaqueline A1 - Tanni, Suzana A1 - Schreck, Thomas A1 - Saad-Hossne, Rogerio A1 - Sassaki, Ligia Yukie T1 - Risk factors for ulcerative colitis-associated colorectal cancer A retrospective cohort study BT - A retrospective cohort study JF - Medicine N2 - Inflammatory bowel disease is associated with an increased risk of colorectal cancer. The study aims to identify the risk factors for ulcerative colitis-colorectal cancer and to perform a survival curve analysis of the outcome. This retrospective cohort study included 254 patients from March 2016 to October 2017. Age, age at diagnosis, follow-up time, smoking status, and family history of colorectal cancer were analyzed as risk factors for colorectal cancer. The mean patient age was 46.6 +/- 16.9 years; 5.5% of the patients were smokers and 49.6% had pancolitis. Six patients (2.36%) had colorectal cancer, which was associated with age at diagnosis (odds/hazard ratio 1.059 [95% confidence interval: 1.001-1.121];P = .04), family history of colorectal cancer (12.992 [1.611-104.7];P = .02), and follow-up time (0.665 [0.513-0.864];P = .002). Active smoking was the main identified risk factor, after both logistic (8.477 [1.350-53.232];P = .02) and Cox proportional-hazards (32.484 [2.465-428.1];P = .008) regression analysis. The risk of colorectal cancer was 3.17% at 10 years and 4.26% at 20 years of follow-up. Active smoking and family history were identified as risk factors for colorectal cancer. These findings should aid the early identification of patients who require vigorous surveillance, and prevent exposure to risk factors. KW - ALCOHOL KW - colorectal cancer KW - CONSENSUS KW - INFLAMMATORY-BOWEL-DISEASE KW - MECHANISMS KW - METAANALYSIS KW - NATURAL-HISTORY KW - PREVALENCE KW - PROGRESSION KW - risk factors KW - smoking KW - ulcerative colitis Y1 - 2020 U6 - https://doi.org/10.1097/MD.0000000000021686 VL - 99 IS - 32 SP - 1 EP - 6 PB - Lippincott ER - TY - JOUR A1 - De Pieri, Enrico A1 - Atzori, Federica A1 - Ferguson, Stephen J. A1 - Dendorfer, Sebastian A1 - Leunig, Michael A1 - Aepli, Martin T1 - Contact force path in total hip arthroplasty: effect of cup medialisation in a whole-body simulation JF - HIP International N2 - Background: Cup medialisation down to the true acetabular floor in total hip arthroplasty with a compensatory femoral offset increase seems to be mechanically advantageous for the abductor muscles due to the relocation of the lever arms (body weight lever arm decreased, abductor lever arm increased). However, limited information is currently available about the effects of this reconstruction type at the head cup interface, compared to an anatomical reconstruction that maintains the natural lever arms. Through a whole-body simulation analysis, we compared medialised versus anatomical reconstruction in THA to analyse the effects on: (1) contact force magnitude at the head cup interface; (2) contact force path in the cup; and (3) abductor activity. Methods: Musculoskeletal simulations were performed to calculate the above-mentioned parameters using inverse dynamics analysis. The differences between the virtually implanted THAs were calculated to compare the medialised versus anatomical reconstruction. Results: Cup medialisation with compensatory femoral offset increase led to: (1) a reduction in contact force magnitude at the head cup interface up to 6.6%; (2) a similar contact force path in the cup in terms of sliding distance and aspect ratio; and (3) a reduction in abductor activity up to 17.2% (gluteus medius). Conclusions: In our opinion, these potential biomechanical gains do not generally justify a fully medialised reconstruction, especially in younger patients that are more likely to undergo revision surgery in their lifetime. Cup medialisation should be performed until sufficient press fit and bony coverage of a properly sized and oriented cup can be achieved. KW - Cup medialisation KW - femoral offset KW - hip contact force KW - total hip anthroplasty KW - total hip replacement KW - Hüftgelenkprothese KW - Kontaktkraft KW - Biomechanische Analyse KW - Simulation Y1 - 2020 U6 - https://doi.org/10.1177/1120700020917321 VL - 31 IS - 5 SP - 624 EP - 631 PB - Sage ER - TY - JOUR A1 - Ebigbo, Alanna A1 - Mendel, Robert A1 - Probst, Andreas A1 - Manzeneder, Johannes A1 - Prinz, Friederike A1 - Souza Jr., Luis Antonio de A1 - Papa, João Paulo A1 - Palm, Christoph A1 - Messmann, Helmut T1 - Real-time use of artificial intelligence in the evaluation of cancer in Barrett’s oesophagus JF - Gut N2 - Based on previous work by our group with manual annotation of visible Barrett oesophagus (BE) cancer images, a real-time deep learning artificial intelligence (AI) system was developed. While an expert endoscopist conducts the endoscopic assessment of BE, our AI system captures random images from the real-time camera livestream and provides a global prediction (classification), as well as a dense prediction (segmentation) differentiating accurately between normal BE and early oesophageal adenocarcinoma (EAC). The AI system showed an accuracy of 89.9% on 14 cases with neoplastic BE. KW - Speiseröhrenkrankheit KW - Diagnose KW - Maschinelles Lernen KW - Barrett's esophagus KW - Deep learning KW - real-time Y1 - 2020 U6 - https://doi.org/10.1136/gutjnl-2019-319460 VL - 69 IS - 4 SP - 615 EP - 616 PB - BMJ CY - London ER - TY - GEN A1 - Ebigbo, Alanna A1 - Mendel, Robert A1 - Tziatzios, Georgios A1 - Probst, Andreas A1 - Palm, Christoph A1 - Messmann, Helmut T1 - Real-Time Diagnosis of an Early Barrett's Carcinoma using Artificial Intelligence (AI) - Video Case Demonstration T2 - Endoscopy N2 - Introduction We present a clinical case showing the real-time detection, characterization and delineation of an early Barrett’s cancer using AI. Patients and methods A 70-year old patient with a long-segment Barrett’s esophagus (C5M7) was assessed with an AI algorithm. Results The AI system detected a 10 mm focal lesion and AI characterization predicted cancer with a probability of >90%. After ESD resection, histopathology showed mucosal adenocarcinoma (T1a (m), R0) confirming AI diagnosis. Conclusion We demonstrate the real-time AI detection, characterization and delineation of a small and early mucosal Barrett’s cancer. KW - Artificial Intelligence KW - Barrett's Carcinoma KW - Speiseröhrenkrebs KW - Künstliche Intelligenz KW - Diagnose Y1 - 2020 U6 - https://doi.org/10.1055/s-0040-1704075 VL - 52 IS - S 01 PB - Thieme ER - TY - JOUR A1 - Geith, Markus A. A1 - Eckmann, Jakob D. A1 - Haspinger, Daniel Ch. A1 - Agrafiotis, Emmanouil A1 - Maier, Dominik A1 - Szabo, Patrick A1 - Sommer, Gerhard A1 - Schratzenstaller, Thomas A1 - Holzapfel, Gerhard A. T1 - Experimental and mathematical characterization of coronary polyamide-12 balloon catheter membranes JF - PLoS One N2 - The experimental quantification and modeling of the multiaxial mechanical response of polymer membranes of coronary balloon catheters have not yet been carried out. Due to the lack of insights, it is not shown whether isotropic material models can describe the material response of balloon catheter membranes expanded with nominal or higher, supra-nominal pressures. Therefore, for the first time, specimens of commercial polyamide-12 balloon catheters membranes were investigated during uniaxial and biaxial loading scenarios. Furthermore, the influence of kinematic effects on the material response was observed by comparing results from quasi-static and dynamic biaxial extension tests. Novel clamping techniques are described, which allow to test even tiny specimens taken from the balloon membranes. The results of this study reveal the semi-compliant, nonlinear, and viscoelastic character of polyamide-12 balloon catheter membranes. Above nominal pressure, the membranes show a pronounced anisotropic mechanical behavior with a stiffer response in the circumferential direction. The anisotropic feature intensifies with an increasing strain-rate. A modified polynomial model was applied to represent the realistic mechanical response of the balloon catheter membranes during dynamic biaxial extension tests. This study also includes a compact set of constitutive model parameters for the use of the proposed model in future finite element analyses to perform more accurate simulations of expanding balloon catheters. KW - Catheters KW - Anisotropy KW - Polymers KW - Viscoelasticity KW - Coronary stenting KW - Finite element analysis KW - Deformation KW - Adhesives Y1 - 2020 U6 - https://doi.org/10.1371/journal.pone.0234340 VL - 15 IS - 6 SP - 1 EP - 22 PB - PLOS ER - TY - JOUR A1 - Geith, Markus A. A1 - Nothdurfter, Laurenz A1 - Heiml, Manuel A1 - Agrafiotis, Emmanouil A1 - Gruber, Markus A1 - Sommer, Gerhard A1 - Schratzenstaller, Thomas A1 - Holzapfel, Gerhard A. T1 - Quantifying stent-induced damage in coronary arteries by investigating mechanical and structural alterations JF - Acta Biomaterialia N2 - Vascular damage develops with diverging severity during and after percutaneous coronary intervention with stent placement and is the prevailing stimulus for in-stent restenosis. Previous work has failed to link mechanical data obtained in a realistic in vivo or in vitro environment with data collected during imaging processes. We investigated whether specimens of porcine right coronary arteries soften when indented with a stent strut shaped structure, and if the softening results from damage mechanisms inside the fibrillar collagen structure. To simulate the multiaxial loading scenario of a stented coronary artery, we developed the testing device ‘LAESIO’ that can measure differences in the stress-stretch behavior of the arterial wall before and after the indentation of a strut-like stamp. The testing protocol was optimized according to preliminary experiments, more specifically equilibrium and relaxation tests. After chemical fixation of the specimens and subsequent tissue clearing, we performed three-dimensional surface and second-harmonic generation scans on the deformed specimens. We analyzed and correlated the mechanical response with structural parameters of high-affected tissue located next to the stamp indentation and low-affected tissue beyond the injured area. The results reveal that damage mechanisms, like tissue compression as well as softening, fiber dispersion, and the lesion extent, are direction-dependent, and the severity of them is linked to the strut orientation, indentation pressure, and position. The findings highlight the need for further investigations by applying the proposed methods to human coronary arteries. Additional data and insights might help to incorporate the observed damage mechanisms into material models for finite element analyses to perform more accurate simulations of stent-implantations. KW - Percutaneous coronary intervention KW - Stent KW - Mechanical properties KW - Damage mechanism KW - Vascular injury KW - Coronary artery KW - Indentation test KW - Softening KW - Second-harmonic generation imaging KW - Micro-structure Y1 - 2020 U6 - https://doi.org/10.1016/j.actbio.2020.08.016 VL - 116 IS - October SP - 285 EP - 301 PB - Elsevier ER - TY - JOUR A1 - Grabitz, Peter A1 - Friedmann, Zoe A1 - Gepp, Sophie A1 - Hess, Leonard U. A1 - Specht, Lisa A1 - Struck, Maja A1 - Tragert, Sophie Kira A1 - Walther, Tobias A1 - Klemperer, David T1 - Quantity and quality of conflict of interest policies at German medical schools BT - a cross-sectional study and survey JF - BMJ open N2 - OBJECTIVES: To assess the quantity and evaluate the quality of policies and curricula focusing on conflicts of interests (COI) at medical schools across Germany. DESIGN: Cross-sectional study, survey of medical schools, standardised web search. SETTING: Medical schools, Germany. PARTICIPANTS: 38 German medical schools. - INTERVENTIONS: We collected relevant COI policies, including teaching activities, by conducting a search of the websites of all 38 German medical schools using standardised keywords for COI policies and teaching. Further, we surveyed all medical schools' dean's offices. Finally, we adapted a scoring system for results we obtained with 13 categories based on prior similar studies. MAIN OUTCOMES AND MEASURES: Presence or absence of COI-related policies, including teaching activities at medical school. The secondary outcome was the achieved score on a scale from 0 to 26, with high scores representing restrictive policies and sufficient teaching activities. RESULTS: We identified relevant policies for one medical school via the web search. The response rate of the deans' survey was 16 of 38 (42.1%). In total, we identified COI-related policies for 2 of 38 (5.3%) German medical schools, yet no policy was sufficient to address all COI-related categories that were assessed in this study. The maximum score achieved was 12 of 26. 36 (94.7%) schools scored 0. No medical school reported curricular teaching on COI. CONCLUSIONS: Our results indicate a low level of action by medical schools to protect students from undue commercial influence. No participating dean was aware of any curriculum or instruction on COI at the respective school and only two schools had policies in place. The German Medical Students Association and international counterparts have called for a stronger focus on COI in the classroom. We conclude that for German medical schools, there is still a long way to go. KW - Conflict of Interest KW - Cross-Sectional Studies KW - Curriculum KW - Germany KW - Humans KW - Policy KW - Schools, Medical Y1 - 2020 U6 - https://doi.org/10.1136/bmjopen-2020-039782 VL - 10 IS - 9 SP - 1 EP - 8 PB - BMJ Publishing Group ER - TY - JOUR A1 - Hartmann, Robin A1 - Weiherer, Maximilian A1 - Schiltz, Daniel A1 - Seitz, Stephan A1 - Lotter, Luisa A1 - Anker, Alexandra A1 - Palm, Christoph A1 - Prantl, Lukas A1 - Brébant, Vanessa T1 - A Novel Method of Outcome Assessment in Breast Reconstruction Surgery: Comparison of Autologous and Alloplastic Techniques Using Three-Dimensional Surface Imaging JF - Aesthetic Plastic Surgery N2 - Background Breast reconstruction is an important coping tool for patients undergoing a mastectomy. There are numerous surgical techniques in breast reconstruction surgery (BRS). Regardless of the technique used, creating a symmetric outcome is crucial for patients and plastic surgeons. Three-dimensional surface imaging enables surgeons and patients to assess the outcome’s symmetry in BRS. To discriminate between autologous and alloplastic techniques, we analyzed both techniques using objective optical computerized symmetry analysis. Software was developed that enables clinicians to assess optical breast symmetry using three-dimensional surface imaging. Methods Twenty-seven patients who had undergone autologous (n = 12) or alloplastic (n = 15) BRS received three-dimensional surface imaging. Anthropomorphic data were collected digitally using semiautomatic measurements and automatic measurements. Automatic measurements were taken using the newly developed software. To quantify symmetry, a Symmetry Index is proposed. Results Statistical analysis revealed that there is no dif- ference in the outcome symmetry between the two groups (t test for independent samples; p = 0.48, two-tailed). Conclusion This study’s findings provide a foundation for qualitative symmetry assessment in BRS using automatized digital anthropometry. In the present trial, no difference in the outcomes’ optical symmetry was detected between autologous and alloplastic approaches. KW - Breast reconstruction KW - Breast symmetry KW - Digital anthropometry KW - Mammoplastik KW - Dreidimensionale Bildverarbeitung KW - Autogene Transplantation KW - Alloplastik Y1 - 2020 U6 - https://doi.org/10.1007/s00266-020-01749-4 VL - 44 SP - 1980 EP - 1987 PB - Springer CY - Heidelberg ER - TY - JOUR A1 - Huber, Michaela A1 - Schlosser, Daniela A1 - Stenzel, Susanne A1 - Maier, Johannes A1 - Pattappa, Girish A1 - Kujat, Richard A1 - Striegl, Birgit A1 - Docheva, Denitsa T1 - Quantitative Analysis of Surface Contouring with Pulsed Bipolar Radiofrequency on Thin Chondromalacic Cartilage JF - BioMed Research International N2 - The purpose of this study was to evaluate the quality of surface contouring of chondromalacic cartilage by bipolar radio frequency energy using different treatment patterns in an animal model, as well as examining the impact of the treatment onto chondrocyte viability by two different methods. Our experiments were conducted on 36 fresh osteochondral sections from the tibia plateau of slaughtered 6-month-old pigs, where the thickness of the cartilage is similar to that of human wrist cartilage. An area of 1 cm(2) was first treated with emery paper to simulate the chondromalacic cartilage. Then, the treatment with RFE followed in 6 different patterns. The osteochondral sections were assessed for cellular viability (live/dead assay, caspase (cell apoptosis marker) staining, and quantitative analysed images obtained by fluorescent microscopy). For a quantitative characterization of none or treated cartilage surfaces, various roughness parameters were measured using confocal laser scanning microscopy (Olympus LEXT OLS 4000 3D). To describe the roughness, the Root-Mean-Square parameter (Sq) was calculated. A smoothing effect of the cartilage surface was detectable upon each pattern of RFE treatment. The Sq for native cartilage was Sq=3.8 +/- 1.1 mu m. The best smoothing pattern was seen for two RFE passes and a 2-second pulsed mode (B2p2) with an Sq=27.3 +/- 4.9 mu m. However, with increased smoothing, an augmentation in chondrocyte death up to 95% was detected. Using bipolar RFE treatment in arthroscopy for small joints like the wrist or MCP joints should be used with caution. In the case of chondroplasty, there is a high chance to destroy the joint cartilage. KW - CHONDROCYTE DEATH KW - energy KW - HUMAN ARTICULAR-CARTILAGE KW - MONOPOLAR KW - THERMAL CHONDROPLASTY Y1 - 2020 U6 - https://doi.org/10.1155/2020/1242086 SP - 1 EP - 8 PB - HINDAWI ER - TY - CHAP A1 - Jahn, Sabrina A1 - Mottok, Jürgen T1 - Work in Progress: Towards an Academic Secure Software Engineering Curriculum for Engineers T2 - 2020 IEEE Global Engineering Education Conference (EDUCON): 27-30 April 2020, Porto, Portugal N2 - In the age of the Internet of Things, it is becoming increasingly important to integrate knowledge about the development of secure systems (Secure Software Engineering) into academic teaching. However, teaching IT Security and Secure Software Engineering to non-computer scientists is rare. Therefore, we focus our research on the integration of IT Security into software engineering education of non-computer scientists, particularly electrical engineers, by means of inductive teaching- and learning-arrangements. After collecting students' preconceptions of IT Security and Secure Software Engineering in prior work, this paper now contributes with a first mapping of these preconceptions with corresponding learning content as well as suitable inductive teaching methods to be able to create new lecture and exercise units and improve academic learning and teaching in both areas. Y1 - 2020 U6 - https://doi.org/10.1109/EDUCON45650.2020.9125210 SP - 1713 EP - 1717 ER - TY - CHAP A1 - Klopp, Marco A1 - Gold-Veerkamp, Carolin A1 - Abke, Jörg A1 - Borgeest, Kai A1 - Reuter, Rebecca A1 - Jahn, Sabrina A1 - Mottok, Jürgen A1 - Sedelmaier, Yvonne A1 - Lehmann, Alexander A1 - Landes, Dieter T1 - Totally Different and yet so Alike: Three Concepts to Use Scrum in Higher Education T2 - Proceedings of the 4th European Conference on Software Engineering Education (ECSEE '20): June 2020, Seeon/Bavaria, Germany N2 - Software process models are important in software projects in order to give the work of a project guidelines or a framework. However, teaching process models in higher education seems to be quite challenging. This has to do with the fact that undergraduates have no experience with projects in which process models are used. The theoretical mediation of process models is initially on a very abstract level. For this reason, we chose to combine two didactic approaches, namely problem-based learning and project work. Various traditional plan-driven process models have been expanded in courses in Software Engineering with agile process models. The Scrum Framework is the focus of consideration of this paper. Three Universities of Applied Sciences which cooperate in the EVELIN project focused on Scrum as a process model and integrated it into their teaching. Since the respective concepts of implementation differ, they should be presented and compared in this article to presents some practice approaches. The goal of this presentation of is a uniform evaluation in order to obtain insights from different perspectives. This comparison can draw conclusions for possible necessary improvements of the respective concepts. Y1 - 2020 U6 - https://doi.org/10.1145/3396802.3396817 SP - 12 EP - 21 ER - TY - CHAP A1 - Koenig, Eric A1 - Guertler, Katherine A1 - Żarnowska, Dorota A1 - Horbačauskienė, Jolita T1 - Developing English language competence for global engineers T2 - 2020 IEEE Global Engineering Education Conference (EDUCON): 27-30 April 2020, Porto, Portugal N2 - English language skills are essential to professional communication in international engineering environments. Given the concomitant degree of specialization, university-level coursework in English for Specific Purposes is an essential component of engineering student preparation. This large-scale survey of university students of engineering in three European countries provides important insight into the most relevant language skills, with the goal of informing communicative, task-based curricula for Technical English courses. KW - English as a foreign language KW - English for engineers KW - English for specific purposes KW - professional communication KW - technical English Y1 - 2020 U6 - https://doi.org/10.1109/EDUCON45650.2020.9125208 SP - 242 EP - 249 ER - TY - JOUR A1 - Maier, Johannes A1 - Weiherer, Maximilian A1 - Huber, Michaela A1 - Palm, Christoph T1 - Optically tracked and 3D printed haptic phantom hand for surgical training system JF - Quantitative Imaging in Medicine and Surgery N2 - Background: For surgical fixation of bone fractures of the human hand, so-called Kirschner-wires (K-wires) are drilled through bone fragments. Due to the minimally invasive drilling procedures without a view of risk structures like vessels and nerves, a thorough training of young surgeons is necessary. For the development of a virtual reality (VR) based training system, a three-dimensional (3D) printed phantom hand is required. To ensure an intuitive operation, this phantom hand has to be realistic in both, its position relative to the driller as well as in its haptic features. The softest 3D printing material available on the market, however, is too hard to imitate human soft tissue. Therefore, a support-material (SUP) filled metamaterial is used to soften the raw material. Realistic haptic features are important to palpate protrusions of the bone to determine the drilling starting point and angle. An optical real-time tracking is used to transfer position and rotation to the training system. Methods: A metamaterial already developed in previous work is further improved by use of a new unit cell. Thus, the amount of SUP within the volume can be increased and the tissue is softened further. In addition, the human anatomy is transferred to the entire hand model. A subcutaneous fat layer and penetration of air through pores into the volume simulate shiftability of skin layers. For optical tracking, a rotationally symmetrical marker attached to the phantom hand with corresponding reference marker is developed. In order to ensure trouble-free position transmission, various types of marker point applications are tested. Results: Several cuboid and forearm sample prints lead to a final 30 centimeter long hand model. The whole haptic phantom could be printed faultless within about 17 hours. The metamaterial consisting of the new unit cell results in an increased SUP share of 4.32%. Validated by an expert surgeon study, this allows in combination with a displacement of the uppermost skin layer a good palpability of the bones. Tracking of the hand marker in dodecahedron design works trouble-free in conjunction with a reference marker attached to the worktop of the training system. Conclusions: In this work, an optically tracked and haptically correct phantom hand was developed using dual-material 3D printing, which can be easily integrated into a surgical training system. KW - Handchirurgie KW - 3D-Druck KW - Lernprogramm KW - Zielverfolgung KW - HaptiVisT KW - Dual-material 3D printing KW - hand surgery training KW - metamaterial KW - tissue imitating phantom hand Y1 - 2020 U6 - https://doi.org/10.21037/qims.2019.12.03 N1 - Corresponding author: Christoph Palm VL - 10 IS - 02 SP - 340 EP - 455 PB - AME Publishing Company CY - Hong Kong, China ER - TY - JOUR A1 - Nigg, Claudio R. A1 - Phu, Tatiana A1 - Mnich, Carina T1 - Strategies to prevent (STOP) substance use: a website for adolescents in Hawaii JF - Journal of Substance Use N2 - Background: Adolescent substance use is a global and local (Hawaii) problem. Therefore, the study goal was to develop and investigate the effect of an adolescent substance use prevention intervention website in Hawaii. Methods: A website was developed including drug overviews, health effects, how to stay away, external prevention and treatment resources, and an evaluation. Three grade 11 classes completed a baseline (T1) survey based on website content and a follow-up (T2) assessment after a 15-minute website interaction. - Results: At T1, 63/72 and at T2, 62 students participated (16–17 years old; 92% female; 87.2% Filipino). The number correct increased from 48.0% (SD = 14.5) at T1 to 82.0% (SD = 15.3) at T2 (t(59) = 13.5, p < .001). Eleven of twelve topics improved (p < .5) which addressed mental disorder drug use, workplace meth-use in Hawaii, Americans in need of drug/alcohol treatment, stimulant drugs, side effects of drugs, drug related domestic/child abuse, short-term drug effects, Hawaii and national methuse, chemicals in drugs, how to stay away, and ways of treatment. Conclusions: Adolescents improved their substance use prevention understanding. This is promising considering the brief, inexpensive, potentially scalable intervention which can be implemented within high school curricula. KW - adolescents KW - PREVENTION KW - Substance use KW - website Y1 - 2020 U6 - https://doi.org/10.1080/14659891.2019.1664659 VL - 25 IS - 1 SP - 88 EP - 94 PB - Taylor&Francis ER - TY - JOUR A1 - Ott, Tankred A1 - Palm, Christoph A1 - Vogt, Robert A1 - Oberprieler, Christoph T1 - GinJinn: An object-detection pipeline for automated feature extraction from herbarium specimens JF - Applications in Plant Sciences N2 - PREMISE: The generation of morphological data in evolutionary, taxonomic, and ecological studies of plants using herbarium material has traditionally been a labor-intensive task. Recent progress in machine learning using deep artificial neural networks (deep learning) for image classification and object detection has facilitated the establishment of a pipeline for the automatic recognition and extraction of relevant structures in images of herbarium specimens. METHODS AND RESULTS: We implemented an extendable pipeline based on state-of-the-art deep-learning object-detection methods to collect leaf images from herbarium specimens of two species of the genus Leucanthemum. Using 183 specimens as the training data set, our pipeline extracted one or more intact leaves in 95% of the 61 test images. CONCLUSIONS: We establish GinJinn as a deep-learning object-detection tool for the automatic recognition and extraction of individual leaves or other structures from herbarium specimens. Our pipeline offers greater flexibility and a lower entrance barrier than previous image-processing approaches based on hand-crafted features. KW - Deep Learning KW - herbarium specimens KW - object detection KW - visual recognition KW - Deep Learning KW - Objekterkennung KW - Maschinelles Sehen KW - Pflanzen Y1 - 2020 U6 - https://doi.org/10.1002/aps3.11351 SN - 2168-0450 VL - 8 IS - 6 SP - e11351 PB - Wiley, Botanical Society of America ER - TY - JOUR A1 - Prantl, Lukas A1 - Eigenberger, Andreas A1 - Gehmert, Sebastian A1 - Haerteis, Silke A1 - Aung, Thiha A1 - Rachel, Reinhard A1 - Jung, Ernst Michael A1 - Felthaus, Oliver T1 - Enhanced Resorption of Liposomal Packed Vitamin C Monitored by Ultrasound JF - Journal of Clinical Medicine N2 - Vitamin C is an essential nutrient for humans and is involved in a plethora of health-related functions. Several studies have shown a connection between vitamin C intake and an improved resistance to infections that involves the immune system. However, the body cannot store vitamin C and both the elevated oral intake, and the intravenous application have certain disadvantages. In this study, we wanted to show a new formulation for the liposomal packaging of vitamin C. Using freeze etching electron microscopy, we show the formed liposomes. With a novel approach of post-processing procedures of real-time sonography that combines enhancement effects by contrast-like ultrasound with a transducer, we wanted to demonstrate the elevated intestinal vitamin C resorption on four participants. With the method presented in this study, it is possible to make use of the liposomal packaging of vitamin C with simple household materials and equipment for intake elevation. For the first time, we show the enhanced resorption of ingested liposomes using microbubble enhanced ultrasound imaging. KW - ASCORBIC-ACID KW - CEUS KW - CONTRAST AGENT KW - CULTURES KW - DEFICIENCY KW - enhanced resorption KW - GULO KW - immune system KW - liposomal packing KW - MITOCHONDRIAL DYSFUNCTION KW - OXIDATIVE STRESS KW - PHOSPHATIDYLCHOLINE KW - sonography KW - vitamin C Y1 - 2020 U6 - https://doi.org/10.3390/jcm9061616 VL - 9 IS - 6 SP - 1 EP - 12 PB - MDPI CY - Basel ER - TY - JOUR A1 - Prantl, Lukas A1 - Eigenberger, Andreas A1 - Klein, Silvan A1 - Limm, Katharina A1 - Oefner, Peter J. A1 - Schratzenstaller, Thomas A1 - Felthaus, Oliver T1 - Shear Force Processing of Lipoaspirates for Stem Cell Enrichment Does Not Affect Secretome of Human Cells Detected by Mass Spectrometry In Vitro JF - Plastic and Reconstructive Surgery N2 - Background: Lipofilling is one of the most often performed surgical procedures in plastic and reconstructive surgery. Lipoaspirates provide a ready source of stem cells and secreted factors that contribute to neoangiogenesis and fat graft survival. However, the regulations about the enrichment of these beneficial cells and factors are ambiguous. In this study, the authors tested whether a combination of centrifugation and homogenization allowed the enrichment of viable stem cells in lipoaspirates through the selective removal of tumescent solution, blood, and released lipids without significantly affecting the cell secretome. Methods: Human lipoaspirate was harvested from six different patients using water jet–assisted liposuction. Lipoaspirate was homogenized by first centrifugation (3584 rpm for 2 minutes), shear strain (10 times intersyringe processing), and second centrifugation (3584 rpm for 2 minutes). Stem cell enrichment was shown by cell counting after stem cell isolation. Lipoaspirate from different processing steps (unprocessed, after first centrifugation, after homogenization, after second centrifugation) was incubated in serum-free cell culture medium for mass spectrometric analysis of secreted proteins. Results: Lipoaspirate homogenization leads to a significant 2.6 ± 1.75-fold enrichment attributable to volume reduction without reducing the viability of the stem cells. Protein composition of the secretome did not change significantly after tissue homogenization. Considering the enrichment effects, there were no significant differences in the protein concentration of the 83 proteins found in all processing steps. Conclusions: Stem cells can be enriched mechanically without significantly affecting the composition of secreted proteins. Shear-assisted enrichment of lipoaspirate constitutes no substantial manipulation of the cells’ secretome. Y1 - 2020 U6 - https://doi.org/10.1097/PRS.0000000000007343 VL - 146 IS - 6 SP - 749e EP - 758e PB - American Society of Plastic Surgeons ER - TY - JOUR A1 - Rogge, Alize A. A1 - Baur, Isabel A1 - Blettner, Gabriele A1 - Holtkamp, Ulrike A1 - Horneber, Markus A1 - Jahn, Patrick A1 - Joos, Stefanie A1 - Keberle, Silva A1 - Kettelgerdes, Anita A1 - Klemperer, David A1 - Laengler, Alfred A1 - Voiss, Petra A1 - Weis, Joachim A1 - Witt, Claudia M. T1 - Defining Criteria for Guiding Cancer Patients to Find a Reputable Complementary Medicine Provider BT - Results of a Literature Review and a Consensus Procedure JF - Patient Preference and Adherence N2 - Purpose: Even in cases of positive evidence for complementary medicine (CM) therapies, it is still difficult for cancer patients to identify reputable providers. The aim of this study was to develop and evaluate a criteria list to provide guidance to cancer patients seeking a reputable CM provider. Methods: The design combined a literature review, an expert consensus procedure (n=15) and an assessment from three stakeholder perspectives (patients (n=18), CM providers (n=26) and oncology physicians (n=20)). Results: A total of 30 existing CM criteria were extracted from the literature, and 12 more were added by the experts. The main challenge was to define criteria that could easily be applied by the patients. A final comprehensive list of 8 criteria guiding cancer patients to find a reputable CM provider was developed. Conclusion: Health professionals and cancer information services might find the criteria list helpful when aiming to strengthen patients' awareness of quality-related factors associated with CM providers. The criteria developed might be helpful when standards are established for quality assurance in CM in oncology. KW - complementary medicine KW - healthcare quality assurance KW - neoplasms KW - patient-centered care KW - standards Y1 - 2020 U6 - https://doi.org/10.2147/PPA.S230705 VL - 14 SP - 747 EP - 755 PB - DOVE MEDICAL PRESS ER - TY - JOUR A1 - Rolfes, Vasilija A1 - Bittner, Uta A1 - Fangerau, Heiner A1 - Weber, Karsten T1 - Is it all about revising, correcting, and transferring genes? JF - The American Journal of Bioethics Y1 - 2020 U6 - https://doi.org/10.1080/15265161.2020.1782526 VL - 20 IS - 8 SP - 30 EP - 32 PB - Taylor & Francis ER - TY - JOUR A1 - Schecklmann, Martin A1 - Schmausser, Maximilian A1 - Klinger, Felix A1 - Kreuzer, Peter M. A1 - Krenkel, Lars A1 - Langguth, Berthold T1 - Resting motor threshold and magnetic field output of the figure-of-8 and the double-cone coil JF - scientific reports N2 - The use of the double-cone (DC) coil in transcranial magnetic stimulation (TMS) is promoted with the notion that the DC coil enables stimulation of deeper brain areas in contrast to conventional figure-of-8 (Fo8) coils. However, systematic comparisons of these two coil types with respect to the spatial distribution of the magnetic field output and also to the induced activity in superficial and deeper brain areas are limited. Resting motor thresholds of the left and right first dorsal interosseous (FDI) and tibialis anterior (TA) were determined with the DC and the Fo8 coil in 17 healthy subjects. Coils were orientated over the corresponding motor area in an angle of 45 degrees for the hand area with the handle pointing in posterior direction and in medio-lateral direction for the leg area. Physical measurements were done with an automatic gantry table using a Gaussmeter. Resting motor threshold was higher for the leg area in contrast to the hand area and for the Fo8 in contrast to the DC coil. Muscle by coil interaction was also significant providing higher differences between leg and hand area for the Fo8 (about 27%) in contrast to the DC coil (about 15%). Magnetic field strength was higher for the DC coil in contrast to the Fo8 coil. The DC coil produces a higher magnetic field with higher depth of penetration than the figure of eight coil. KW - ANTERIOR CINGULATE CORTEX KW - CONNECTIVITY KW - Depression KW - FRONTAL-CORTEX KW - PREDICTOR KW - RTMS KW - STIMULATION KW - TMS Y1 - 2020 U6 - https://doi.org/10.1038/s41598-020-58034-2 VL - 10 IS - 1 PB - Nature ER - TY - CHAP A1 - Seebauer, Stefan A1 - Jahn, Sabrina A1 - Mottok, Jürgen T1 - Learning from Escape Rooms? A Study Design Concept Measuring the Effect of a Cryptography Educational Escape Room T2 - 2020 IEEE Global Engineering Education Conference (EDUCON): 27-30 April 2020, Porto, Portugal N2 - Experts predict that more IT-Security specialists will be needed in the coming years, but in current higher education in engineering disciplines, this topic is hardly addressed. Newer learning methods such as game-based learning (GBL) are enjoying an increasing popularity as their improvement in the education of subject specific topics can be proven by a variety of studies. We chose Educational Escape Rooms (EduER) as a GBL-tool to impart IT-Security in higher education of engineers. In our Escape Room (ER), the students try to solve puzzles and riddles with learned knowledge on the emphasis of cryptography. This paper first deals with a brief introduction to GBL and EduERs, followed by the design of our ER concept, containing different tasks with focus on the topic of cryptography. The tasks cover different cryptographic methods and hash algorithms, e.g. AES, RSA, SHA3. Afterwards the experimental study is presented. The study of the EduER was carried out with students from the bachelor's program in Electrical Engineering and Information Technology at the OTH Regensburg. The participants were divided into three groups of 5 to 8 persons each. They received a briefing with important information, followed by the ER execution, a debriefing afterwards and an exam-like evaluation sheet to test their learned knowledge. Finally, first basic results are presented. Y1 - 2020 U6 - https://doi.org/10.1109/EDUCON45650.2020.9125333 SP - 1684 EP - 1685 ER - TY - JOUR A1 - Treutwein, Marius A1 - Löschel, Rainer A1 - Hipp, Matthias A1 - Kölbl, Oliver A1 - Dobler, Barbara T1 - Secondary malignancy risk for patients with localized prostate cancer after intensity-modulated radiotherapy with and without flattening filter JF - The Journal of Applied Clinical Medical Physics (JACMP) N2 - Men treated for localized prostate cancer by radiotherapy have often a remaining life span of 10 yr or more. Therefore, the risk for secondary malignancies should be taken into account. Plans for ten patients were evaluated which had been performed on an Oncentra (R) treatment planning system for a treatment with an Elekta Synergy (TM) linac with Agility (TM) head. The investigated techniques involved IMRT and VMTA with and without flattening filter. Different dose response models were applied for secondary carcinoma and sarcoma risk in the treated region and also in the periphery. As organs at risk we regarded for carcinoma risk urinary bladder, rectum, colon, esophagus, thyroid, and for sarcoma risk bone and soft tissue. The excess absolute risk (EAR) was found very similar in the treated region for both techniques (IMRT and VMAT) and also for both with and without flattening filter. The secondary sarcoma risk resulted about one magnitude smaller than the secondary carcinoma risk. The EAR to the peripheral organs was statistically significant reduced by application of the flattening filter free mode concerning the flattening filter as main source of scattered dose. Application of flattening filter free mode can thus support to reduce second malignancy risk for patients with localized prostate cancer. KW - 2ND PRIMARY CANCERS KW - ARC THERAPY VMAT KW - BEAM KW - CARCINOMA KW - flattening filter free KW - IMPACT KW - IMRT KW - localized prostate cancer KW - PHOTON KW - RADIATION-THERAPY KW - RECTAL-CANCER KW - secondary malignancy risk KW - SOFT-TISSUE SARCOMA KW - VMAT Y1 - 2020 U6 - https://doi.org/10.1002/acm2.13088 VL - 21 IS - 12 SP - 197 EP - 205 PB - Wiley ER - TY - JOUR A1 - Treutwein, Marius A1 - Steger, Felix A1 - Löschel, Rainer A1 - Kölbl, Oliver A1 - Dobler, Barbara T1 - The influence of radiotherapy techniques on the plan quality and on the risk of secondary tumors in patients with pituitary adenoma JF - BMC cancer N2 - BACKGROUND: This planning study compares different radiotherapy techniques for patients with pituitary adenoma, including flatness filter free mode (FFF), concerning plan quality and secondary malignancies for potentially young patients. The flatness filter has been described as main source of photon scatter. MATERIAL AND METHODS: Eleven patients with pituitary adenoma were included. An Elekta Synergy™ linac was used in the treatment planning system Oncentra® and for the measurements. 3D plans, IMRT, and VMAT plans and non-coplanar varieties were considered. The plan quality was evaluated regarding homogeneity, conformity, delivery time and dose to the organs at risk. The secondary malignancy risk was calculated from dose volume data and from measured dose to the periphery using different models for carcinoma and sarcoma risk. RESULTS: The homogeneity and conformity were nearly unchanged with and without flattening filter, neither was the delivery time found substantively different. VMAT plans were more homogenous, conformal and faster in delivery than IMRT plans. The secondary cancer risk was reduced with FFF both in the treated region and in the periphery. VMAT plans resulted in a higher secondary brain cancer risk than IMRT plans, but the risk for secondary peripheral cancer was reduced. Secondary sarcoma risk plays a minor role. No advantage was found for non-coplanar techniques. The FFF delivery times were not shortened due to additional monitor units needed and technical limitations. The risk for secondary brain cancer seems to depend on the irradiated volume. Secondary sarcoma risk is much smaller than carcinoma risk in accordance to the results of the atomic bomb survivors. The reduction of the peripheral dose and resulting secondary malignancy risk for FFF is statistically significant. However, it is negligible in comparison to the risk in the treated region. CONCLUSION: Treatments with FFF can reduce secondary malignancy risk while retaining similar quality as with flattening filter and should be preferred. VMAT plans show the best plan quality combined with lowest peripheral secondary malignancy risk, but highest level of second brain cancer risk. Taking this into account VMAT FFF seems the most advantageous technique for the treatment of pituitary adenomas with the given equipment. KW - Adenoma/radiotherapy KW - Age Factors KW - Female KW - Humans KW - Male KW - Pituitary Neoplasms/radiotherapy KW - Radiotherapy Dosage KW - risk factors Y1 - 2020 U6 - https://doi.org/10.1186/s12885-020-6535-y VL - 20 SP - 1 EP - 13 PB - Springer ER - TY - JOUR A1 - Visscher, Rosa A1 - Wyss, C. A1 - Singh, Navrag B. A1 - Taylor, William R. A1 - Dendorfer, Sebastian A1 - Rutz, E. A1 - Brunner, Reinald T1 - Influence of TAL-TATS surgery on energy production of Tricepts Surae - A musculoskeletal modeling evaluation JF - Gait & Posture Y1 - 2020 U6 - https://doi.org/10.1016/j.gaitpost.2020.08.090 VL - 81 IS - Suppl. 1 SP - 381 EP - 382 PB - Elsevier ER - TY - JOUR A1 - Weber, Markus A1 - Merle, Christian A1 - Nawabi, Danyal H. A1 - Dendorfer, Sebastian A1 - Grifka, Joachim A1 - Renkawitz, Tobias T1 - Inaccurate offset restoration in total hip arthroplasty results in reduced range of motion JF - Scientific Reports N2 - Offset restoration in total hip arthroplasty (THA) is associated with postoperative range of motion (ROM) and gait kinematics. We aimed to research into the impact of high offset (HO) and standard stems on postoperative ROM. 121 patients received cementless THA through a minimally-invasive anterolateral approach. A 360° hip ROM analysis software calculated impingement-free hip movement based on postoperative 3D-CTs compared to ROM values necessary for activities of daily living (ADL). The same model was then run a second time after changing the stem geometry between standard and HO configuration with the implants in the same position. HO stems showed higher ROM for all directions between 4.6 and 8.9° (p < 0.001) compared with standard stems but with high interindividual variability. In the subgroup with HO stems for intraoperative offset restoration, the increase in ROM was even higher for all ROM directions with values between 6.1 and 14.4° (p < 0.001) compared to offset underrestoration with standard stems. Avoiding offset underrestoration resulted in a higher amount of patients of over 20% for each ROM direction that fulfilled the criteria for ADL (p < 0.001). In contrast, in patients with standard stems for offset restoration ROM did increase but not clinically relevant by offset overcorrection for all directions between 3.1 and 6.1° (p < 0.001). Offset overcorrection by replacing standard with HO stems improved ROM for ADL in a low number of patients below 10% (p > 0.03). Patient-individual restoration of offset is crucial for free ROM in THA. Both over and underrestoration of offset should be avoided. KW - Adaptive clinical trial KW - Bone imaging Y1 - 2020 U6 - https://doi.org/10.1038/s41598-020-70059-1 VL - 10 IS - 13208 SP - 9 PB - Nature ER - TY - CHAP A1 - Weiherer, Maximilian A1 - Zorn, Martin A1 - Wittenberg, Thomas A1 - Palm, Christoph ED - Tolxdorff, Thomas ED - Deserno, Thomas M. ED - Handels, Heinz ED - Maier, Andreas ED - Maier-Hein, Klaus H. ED - Palm, Christoph T1 - Retrospective Color Shading Correction for Endoscopic Images T2 - Bildverarbeitung für die Medizin 2020. Algorithmen - Systeme - Anwendungen. Proceedings des Workshops vom 15. bis 17. März 2020 in Berlin N2 - In this paper, we address the problem of retrospective color shading correction. An extension of the established gray-level shading correction algorithm based on signal envelope (SE) estimation to color images is developed using principal color components. Compared to the probably most general shading correction algorithm based on entropy minimization, SE estimation does not need any computationally expensive optimization and thus can be implemented more effciently. We tested our new shading correction scheme on artificial as well as real endoscopic images and observed promising results. Additionally, an indepth analysis of the stop criterion used in the SE estimation algorithm is provided leading to the conclusion that a fixed, user-defined threshold is generally not feasible. Thus, we present new ideas how to develop a non-parametric version of the SE estimation algorithm using entropy. KW - Endoskopie KW - Bildgebendes Verfahren KW - Farbenraum KW - Graustufe Y1 - 2020 SN - 978-3-658-29266-9 U6 - https://doi.org/10.1007/978-3-658-29267-6 SP - 14 EP - 19 PB - Springer Vieweg CY - Wiesbaden ER - TY - JOUR A1 - Wiesent, Lisa A1 - Schultheiß, Ulrich A1 - Lulla, Philipp A1 - Noster, Ulf A1 - Schratzenstaller, Thomas A1 - Schmid, Christof A1 - Nonn, Aida A1 - Spear, Ashley T1 - Computational analysis of the effects of geometric irregularities and post-processing steps on the mechanical behavior of additively manufactured 316L stainless steel stents JF - PLoS ONE N2 - Advances in additive manufacturing enable the production of tailored lattice structures and thus, in principle, coronary stents. This study investigates the effects of process-related irregularities, heat and surface treatment on the morphology, mechanical response, and expansion behavior of 316L stainless steel stents produced by laser powder bed fusion and provides a methodological approach for their numerical evaluation. A combined experimental and computational framework is used, based on both actual and computationally reconstructed laser powder bed fused stents. Process-related morphological deviations between the as-designed and actual laser powder bed fused stents were observed, resulting in a diameter increase by a factor of 2-2.6 for the stents without surface treatment and 1.3-2 for the electropolished stent compared to the as-designed stent. Thus, due to the increased geometrically induced stiffness, the laser powder bed fused stents in the as-built (7.11 ± 0.63 N) or the heat treated condition (5.87 ± 0.49 N) showed increased radial forces when compressed between two plates. After electropolishing, the heat treated stents exhibited radial forces (2.38 ± 0.23 N) comparable to conventional metallic stents. The laser powder bed fused stents were further affected by the size effect, resulting in a reduced yield strength by 41% in the as-built and by 59% in the heat treated condition compared to the bulk material obtained from tensile tests. The presented numerical approach was successful in predicting the macroscopic mechanical response of the stents under compression. During deformation, increased stiffness and local stress concentration were observed within the laser powder bed fused stents. Subsequent numerical expansion analysis of the derived stent models within a previously verified numerical model of stent expansion showed that electropolished and heat treated laser powder bed fused stents can exhibit comparable expansion behavior to conventional stents. The findings from this work motivate future experimental/numerical studies to quantify threshold values of critical geometric irregularities, which could be used to establish design guidelines for laser powder bed fused stents/lattice structures. KW - Heat treatment KW - Lasers KW - Surface treatments KW - Specimen preparation and treatment KW - Material properties KW - Stiffness KW - Deformation KW - Powders KW - Koronarendoprothese KW - Rapid prototyping KW - Numerische Methode Y1 - 2020 U6 - https://doi.org/10.1371/journal.pone.0244463 N1 - Corresponding author: Lisa Wiesent VL - 15 IS - 12 SP - 1 EP - 30 PB - PLOS ER - TY - JOUR A1 - Zucchi, Jose William A1 - Franco, Estefania Aparecida Thome A1 - Schreck, Thomas A1 - Castro Silva, Maria Helena A1 - Migliorini, Sandro Rogério dos Santos A1 - Garcia, T. A1 - Mota, G. A. F. A1 - de Morais, Bruna Evelyn Bueno A1 - Machado, L. H. S. A1 - Batista, A. N. R. A1 - de Pavia, Sergio A1 - de Godoy, I. A1 - Tanni, Suzana T1 - Different Clusters in Patients with Chronic Obstructive Pulmonary Disease (COPD) BT - A Two-Center Study in Brazil JF - International Journal of chronic obstructive pulmonary disease N2 - Background: Chronic obstructive pulmonary disease (COPD) has a functional definition. However, differences in clinical characteristics and systemic manifestations make COPD a heterogeneous disease and some manifestations have been associated with different risks of acute exacerbations, hospitalizations, and death. Objective: Therefore, the objective of the study was to evaluate possible clinical clusters in COPD at two study centers in Brazil and identify the associated exacerbation and mortality rate during 1 year of follow-up. Methods: We included patients with COPD and all underwent an evaluation composed of the Charlson Index, body mass index (BMI), current pharmacological treatment, smoking history (packs-year), history of exacerbations/hospitalizations in the last year, spirometry, six-minute walking test (6MWT), quality of life questionnaires, dyspnea, and hospital anxiety and depression scale. Blood samples were also collected for measurements of C-reactive protein (CRP), blood gases, laboratory analysis, and blood count. For the construction of the clusters, 13 continuous variables of clinical importance were considered: hematocrit, CRP, triglycerides, low density lipoprotein, absolute number of peripheral eosinophils, age, pulse oximetry, BMI, forced expiratory volume in the first second, dyspnea, 6MWD, total score of the Saint George Respiratory Questionnaire and packs-year of smoking. We used the Ward and K-means methods and determined the best silhouette value to identify similarities of individuals within the cluster (cohesion) in relation to the other clusters (separation). The number of clusters was determined by the heterogeneity values of the cluster, which in this case was determined as four clusters. Results: We evaluated 301 COPD patients and identified four different groups of COPD patients. The first cluster (203 patients) was characterized by fewer symptoms and lower functional severity of the disease, the second cluster by higher values of peripheral eosinophils, the third cluster by more systemic inflammation and the fourth cluster by greater obstructive severity and worse gas exchange. Cluster 2 had an average of 959 3 peripheral eosinophils, cluster 3 had a higher prevalence of nutritional depletion (46.1%), and cluster 4 had a higher BODE index. Regarding the associated comorbidities, we found that only obstructive sleep apnea syndrome and pulmonary thromboembolism were more prevalent in cluster 4. Almost 50% of all patients presented an exacerbation during 1 year of follow-up. However, it was higher in cluster 4, with 65% of all patients having at least one exacerbation. The mortality rate was statistically higher in cluster 4, with 26.9%, vs 9.6% in cluster 1. Conclusion: We could identify four clinical different clusters in these COPD populations, that were related to different clinical manifestations, comorbidities, exacerbation, and mortality rate. We also identified a specific cluster with higher values of peripheral eosinophils. KW - AIRWAY DISEASE KW - BIOMARKERS KW - BLOOD EOSINOPHILS KW - cluster analysis KW - COMORBIDITIES KW - COPD KW - COPD phenotype KW - Dyspnea KW - eosinophils KW - Identification KW - Impact KW - inflammation KW - lung function KW - Overlap syndrome KW - Prevention Y1 - 2020 U6 - https://doi.org/10.2147/COPD.S268332 VL - 15 SP - 2847 EP - 2856 PB - Dove Medical Press ER -