TY - JOUR A1 - Maier, Johannes A1 - Perret, Jerome A1 - Simon, Martina A1 - Schmitt-Rüth, Stephanie A1 - Wittenberg, Thomas A1 - Palm, Christoph T1 - Force-feedback assisted and virtual fixtures based K-wire drilling simulation JF - Computers in Biology and Medicine N2 - One common method to fix fractures of the human hand after an accident is an osteosynthesis with Kirschner wires (K-wires) to stabilize the bone fragments. The insertion of K-wires is a delicate minimally invasive surgery, because surgeons operate almost without a sight. Since realistic training methods are time consuming, costly and insufficient, a virtual-reality (VR) based training system for the placement of K-wires was developed. As part of this, the current work deals with the real-time bone drilling simulation using a haptic force-feedback device. To simulate the drilling, we introduce a virtual fixture based force-feedback drilling approach. By decomposition of the drilling task into individual phases, each phase can be handled individually to perfectly control the drilling procedure. We report about the related finite state machine (FSM), describe the haptic feedback of each state and explain, how to avoid jerking of the haptic force-feedback during state transition. The usage of the virtual fixture approach results in a good haptic performance and a stable drilling behavior. This was confirmed by 26 expert surgeons, who evaluated the virtual drilling on the simulator and rated it as very realistic. To make the system even more convincing, we determined real drilling feed rates through experimental pig bone drilling and transferred them to our system. Due to a constant simulation thread we can guarantee a precise drilling motion. Virtual fixtures based force-feedback calculation is able to simulate force-feedback assisted bone drilling with high quality and, thus, will have a great potential in developing medical applications. KW - Handchirurgie KW - Osteosynthese KW - Operationstechnik KW - Lernprogramm KW - Virtuelle Realität KW - Medical training system KW - Virtual fixtures KW - Virtual reality KW - Force-feedback haptic KW - Minimally invasive hand surgery KW - K-wire drilling Y1 - 2019 U6 - https://doi.org/10.1016/j.compbiomed.2019.103473 N1 - Corresponding author: Christoph Palm VL - 114 SP - 1 EP - 10 PB - Elsevier ER - TY - JOUR A1 - Maier, Johannes A1 - Weiherer, Maximilian A1 - Huber, Michaela A1 - Palm, Christoph T1 - Imitating human soft tissue on basis of a dual-material 3D print using a support-filled metamaterial to provide bimanual haptic for a hand surgery training system JF - Quantitative Imaging in Medicine and Surgery N2 - Background: Currently, it is common practice to use three-dimensional (3D) printers not only for rapid prototyping in the industry, but also in the medical area to create medical applications for training inexperienced surgeons. In a clinical training simulator for minimally invasive bone drilling to fix hand fractures with Kirschner-wires (K-wires), a 3D-printed hand phantom must not only be geometrically but also haptically correct. Due to a limited view during an operation, surgeons need to perfectly localize underlying risk structures only by feeling of specific bony protrusions of the human hand. Methods: The goal of this experiment is to imitate human soft tissue with its haptic and elasticity for a realistic hand phantom fabrication, using only a dual-material 3D printer and support-material-filled metamaterial between skin and bone. We present our workflow to generate lattice structures between hard bone and soft skin with iterative cube edge (CE) or cube face (CF) unit cells. Cuboid and finger shaped sample prints with and without inner hard bone in different lattice thickness are constructed and 3D printed. Results: The most elastic available rubber-like material is too firm to imitate soft tissue. By reducing the amount of rubber in the inner volume through support material (SUP), objects become significantly softer. Without metamaterial, after disintegration, the SUP can be shifted through the volume and thus the body loses its original shape. Although the CE design increases the elasticity, it cannot restore the fabric form. In contrast to CE, the CF design increases not only the elasticity but also guarantees a local limitation of the SUP. Therefore, the body retains its shape and internal bones remain in its intended place. Various unit cell sizes, lattice thickening and skin thickness regulate the rubber material and SUP ratio. Test prints with higher SUP and lower rubber material percentage appear softer and vice versa. This was confirmed by an expert surgeon evaluation. Subjects adjudged pure rubber-like material as too firm and samples only filled with SUP or lattice structure in CE design as not suitable for imitating tissue. 3D-printed finger samples in CF design were rated as realistic compared to the haptic of human tissue with a good palpable bone structure. Conclusions: We developed a new dual-material 3D print technique to imitate soft tissue of the human hand with its haptic properties. Blowy SUP is trapped within a lattice structure to soften rubber-like 3D print material, which makes it possible to reproduce a realistic replica of human hand soft tissue. KW - Dual-material 3D printing KW - Hand surgery training KW - Metamaterial KW - Support material KW - Tissue-imitating hand phantom KW - Handchirurgie KW - 3D-Druck KW - Biomaterial KW - Lernprogramm Y1 - 2019 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:898-opus4-979 N1 - Corresponding author: Christoph Palm VL - 9 IS - 1 SP - 30 EP - 42 PB - AME Publishing Company 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 - Markov-Glazer, Alon A1 - Elbe, Anne-Marie A1 - Schliermann, Rainer T1 - Sport psychology consultants’ views on mental training with elite Deaf sport athletes JF - International Journal of Sport and Exercise Psychology N2 - The elite sport movement for athletes with hearing impairments, namely Deaflympics, differs from the Paralympic and Olympic sport movements because it exhibits a variety of distinct sociocultural and organisational characteristics. Yet, mental training with Deaflympic athletes receives little to no attention from the scientific community. Little is known about sport psychology consultants’ (SPCs) work with Deaflympic athletes. In this study, we explored SPCs’ exposure to so called Deaf sport as well as their experiences, attitudes, and assumptions regarding the utility of psychological skills training (PST) with Deaflympic athletes. A self-constructed questionnaire with closed and semi-open questions was completed by 93 (58.8% female) SPCs in European German-speaking countries. Analyses revealed SPCs had limited exposure to Deaflympic sport but indicated readiness to work with Deaflympic athletes. SPCs shared no reasons as to why PST skills and techniques would not be effective with Deaflympic athletes. However, SPCs regarded communication challenges as a major obstacle. We conclude that the integration of elite Deaf sport in SPCs’ training programmes is vital, considering SPCs’ lack of exposure and experience with Deaflympic athletes as well as their communication insecurities. In addition, further empirical research on PST effectiveness in Deaflympics athletes should provide the foundation for evidence-based utility of applied sport psychology in Deaflympic sport. KW - Deaf culture KW - Deaflympics KW - psychological skills training Y1 - 2023 U6 - https://doi.org/10.1080/1612197X.2023.2245422 SN - 1557-251X N1 - This work was supported by the German Federal Institute of Sport Science (BISp) under Grant number [ZMVI4-070401/19-20]. AMG received a doctoral scholarship from the Bundesministerium für Bildung und Forschung (BMBF). SP - 1 EP - 16 PB - Taylor & Francis ER - TY - JOUR A1 - Markov-Glazer, Alon A1 - Elbe, Anne-Marie A1 - Schliermann, Rainer T1 - From their eyes: Deaflympic athletes' and coaches' perspectives on mental training JF - Frontiers in sports and active living N2 - INTRODUCTION Sport psychology research has largely overlooked athletes with hearing impairments competing in Deaflympic sports, the designated elite sporting movement for this population. This study therefore explored Deaflympic athletes' and coaches' perspectives on mental training in the elite Deaf sports. METHODS A qualitative approach was used, involving six focus group interviews with 23 athletes (Mage = 33.09; 26.1% female) and four coaches from individual and team Deaf sports. Data were analyzed using reflexive thematic analysis. RESULTS Three themes emerged: sport psychology consultation, the influence of visual orientation on psychological skills and demands, and Deaf sport culture and communication. While participants expressed strong interest in sport psychology, engagement with professionals was limited by accessibility issues, lack of sign language-fluent consultants, and structural barriers. Deaf athletes reported adapting some techniques to match their visual-spatial orientation and both advantages and challenges of visual reliance in sports. Distinct communication dynamics between native signers and spoken-language users within Deaf teams were also revealed. DISCUSSION These findings highlight the importance of culturally sensitive sport psychology frameworks that support the needs and preferences of Deaflympic athletes and promote equitable access to effective mental training resources. Y1 - 2025 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:898-opus4-84183 N1 - Corresponding author der OTH Regensburg: Alon Markov-Glazer VL - 7 PB - Frontiers ER - TY - JOUR A1 - Markov-Glazer, Alon A1 - Elbe, Anne-Marie A1 - Schliermann, Rainer T1 - The use of psychological skills in deaflympic sport JF - European Journal of Adapted Physical Activity N2 - This study explores the use of psychological skills among Deaflympic athletes and aims to provide initial insights into sport psychology practices in this overlooked population. To this end, the frequency of psychological skills’ usage, usage patterns, and differences between subgroups were examined within this population. The Test of Performance Strategies (TOPS) was administered to 84 German Deaflympic athletes (mean age = 28; 27% female) along with biographical questions (e.g., hearing status). The findings indicate that Deaflympic athletes regularly utilize psychological skills in training and competition, displaying similar usage to that of Olympic athletes. However, only a minority of Deaflympic athletes train their skills with professional consultants. Additionally, relaxation techniques were employed rarely in comparison to the other investigated skills. This study’s findings contribute to the foundation of sport psychology research with Deaflympic athletes and underscore the need for a differentiated approach in tailoring interventions for this population. KW - Deaf culture KW - Deaflympian KW - psychological skills training KW - TOPS Y1 - 2024 U6 - https://doi.org/10.5507/euj.2024.012 VL - 17 IS - 15 PB - European Federation of Adapted Physical Activity CY - Olomouc ER - TY - GEN A1 - Markov-Glazer, Alon A1 - Schliermann, Rainer ED - Ng, K. ED - Rintala, P. ED - Kandzia, A. ED - Lindeman, A. T1 - Sport psychological Skills Training (PST) in Elite Deaf Sport BT - Diagnostic and other Intervention-related Challenges T2 - The 23rd International Symposium of Adapted Physical Activity (Online ISAPA 2021) and the Nordic Congress of Adapted Physical Activity: 15th-18th June 2021, Jyväskylä, Finland Y1 - 2021 SP - 57 PB - University of Jyväskylä CY - Jyväskylä ER - TY - CHAP A1 - Markov-Glazer, Alon A1 - Schliermann, Rainer ED - Schinke, Robert ED - Chang, Yu-Kai T1 - Psychological skills and techniques utility patterns in elite deaf sport T2 - International Society of Sport Psychology (ISSP), 15th World Congress, Proceedings, 30th September – 4th October 2021, Taipeh, China KW - Deaf sport KW - Deaflympics KW - Hearing impairments KW - Psychological skills Training (PST) Y1 - 2021 SP - 236 EP - 237 PB - Routledge ER - TY - JOUR A1 - Maurer, Julia A1 - Saibold, Anna A1 - Gerl, Katharina A1 - Koller, Michael A1 - Kölbl, Oliver A1 - Pukrop, Tobias A1 - Windschuettl, Sandra A1 - Einhell, Sabine A1 - Herrmann-Johns, Anne A1 - Raptis, Georgios A1 - Mueller, Karolina T1 - Systematic development of a patient-reported ONCOlogical-ROUTinE-Screening (ONCO-ROUTES) procedure at the University Cancer Center Regensburg JF - Journal of Cancer Research and Clinical Oncology N2 - Purpose The evaluation of treatment success and progression in oncology patient-reported outcomes (PROs) is playing an increasingly important role. Meanwhile, PROs are a component of the certification requirements of the German Cancer Society for oncology centers. PROs are used to provide supportive therapy. There is currently no instrument that fully covers the requirements. At the University Hospital Regensburg (UKR), a digital ONCOlogical-ROUTinE-Screening (ONCO-ROUTES) procedure was developed in order to assess the need for supportive therapy in a standardized way and to provide patients with supportive interventions tailored to their needs. Methods On the basis of current requirements and guidelines, the development of ONCO-ROUTES was supported by experts in focus groups and interviews, and digitalization was carried out in connection with the IT infrastructure. Results A Needs-based, Quality-of-life (QoL) and Symptoms Screening (NQS2) tool already established in the routine at the UKR was further developed into ONCO-ROUTES, which is made up of the domains therapy phase, nutrition, tobacco use, alcohol use, quality of life, general condition/functional status, physical activity, psychooncology, social services, and further support needs. By linking the digitized questionnaire to the hospital information system, the results are available for immediate use in routine operations and thus for the referral of patients for further supportive therapy. Conclusion The digital PRO application ONCO-ROUTES is designed to involve patients in monitoring additional supportive needs and thus, improves supportive interdisciplinary treatment. Y1 - 2024 U6 - https://doi.org/10.1007/s00432-024-05955-4 SN - 1432-1335 VL - 150 IS - 9 PB - Springer Science and Business Media LLC ER - TY - JOUR A1 - Meinikheim, Michael A1 - Mendel, Robert A1 - Palm, Christoph A1 - Probst, Andreas A1 - Muzalyova, Anna A1 - Scheppach, Markus W. A1 - Nagl, Sandra A1 - Schnoy, Elisabeth A1 - Römmele, Christoph A1 - Schulz, Dominik Andreas Helmut Otto A1 - Schlottmann, Jakob A1 - Prinz, Friederike A1 - Rauber, David A1 - Rückert, Tobias A1 - Matsumura, Tomoaki A1 - Fernández-Esparrach, Glòria A1 - Parsa, Nasim A1 - Byrne, Michael F. A1 - Messmann, Helmut A1 - Ebigbo, Alanna T1 - Influence of artificial intelligence on the diagnostic performance of endoscopists in the assessment of Barrett’s esophagus: a tandem randomized and video trial JF - Endoscopy N2 - Background This study evaluated the effect of an artificial intelligence (AI)-based clinical decision support system on the performance and diagnostic confidence of endoscopists in their assessment of Barrett’s esophagus (BE). Methods 96 standardized endoscopy videos were assessed by 22 endoscopists with varying degrees of BE experience from 12 centers. Assessment was randomized into two video sets: group A (review first without AI and second with AI) and group B (review first with AI and second without AI). Endoscopists were required to evaluate each video for the presence of Barrett’s esophagus-related neoplasia (BERN) and then decide on a spot for a targeted biopsy. After the second assessment, they were allowed to change their clinical decision and confidence level. Results AI had a stand-alone sensitivity, specificity, and accuracy of 92.2%, 68.9%, and 81.3%, respectively. Without AI, BE experts had an overall sensitivity, specificity, and accuracy of 83.3%, 58.1%, and 71.5%, respectively. With AI, BE nonexperts showed a significant improvement in sensitivity and specificity when videos were assessed a second time with AI (sensitivity 69.8% [95%CI 65.2%–74.2%] to 78.0% [95%CI 74.0%–82.0%]; specificity 67.3% [95%CI 62.5%–72.2%] to 72.7% [95%CI 68.2%–77.3%]). In addition, the diagnostic confidence of BE nonexperts improved significantly with AI. Conclusion BE nonexperts benefitted significantly from additional AI. BE experts and nonexperts remained significantly below the stand-alone performance of AI, suggesting that there may be other factors influencing endoscopists’ decisions to follow or discard AI advice. KW - Artificial Intelligence KW - Endoscopy KW - Medical Image Computing Y1 - 2024 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:898-opus4-72818 VL - 56 SP - 641 EP - 649 PB - Georg Thieme Verlag CY - Stuttgart ER - TY - GEN A1 - Meinikheim, Michael A1 - Mendel, Robert A1 - Probst, Andreas A1 - Scheppach, Markus W. A1 - Schnoy, Elisabeth A1 - Nagl, Sandra A1 - Römmele, Christoph A1 - Prinz, Friederike A1 - Schlottmann, Jakob A1 - Golger, Daniela A1 - Palm, Christoph A1 - Messmann, Helmut A1 - Ebigbo, Alanna T1 - AI-assisted detection and characterization of early Barrett's neoplasia: Results of an Interim analysis T2 - Endoscopy N2 - Aims  Evaluation of the add-on effect an artificial intelligence (AI) based clinical decision support system has on the performance of endoscopists with different degrees of expertise in the field of Barrett's esophagus (BE) and Barrett's esophagus-related neoplasia (BERN). Methods  The support system is based on a multi-task deep learning model trained to solve a segmentation and several classification tasks. The training approach represents an extension of the ECMT semi-supervised learning algorithm. The complete system evaluates a decision tree between estimated motion, classification, segmentation, and temporal constraints, to decide when and how the prediction is highlighted to the observer. In our current study, ninety-six video cases of patients with BE and BERN were prospectively collected and assessed by Barrett's specialists and non-specialists. All video cases were evaluated twice – with and without AI assistance. The order of appearance, either with or without AI support, was assigned randomly. Participants were asked to detect and characterize regions of dysplasia or early neoplasia within the video sequences. Results  Standalone sensitivity, specificity, and accuracy of the AI system were 92.16%, 68.89%, and 81.25%, respectively. Mean sensitivity, specificity, and accuracy of expert endoscopists without AI support were 83,33%, 58,20%, and 71,48 %, respectively. Gastroenterologists without Barrett's expertise but with AI support had a comparable performance with a mean sensitivity, specificity, and accuracy of 76,63%, 65,35%, and 71,36%, respectively. Conclusions  Non-Barrett's experts with AI support had a similar performance as experts in a video-based study. Y1 - 2023 U6 - https://doi.org/10.1055/s-0043-1765437 VL - 55 IS - S02 PB - Thieme ER - TY - GEN A1 - Meinikheim, Michael A1 - Mendel, Robert A1 - Scheppach, Markus W. A1 - Probst, Andreas A1 - Prinz, Friederike A1 - Schwamberger, Tanja A1 - Schlottmann, Jakob A1 - Gölder, Stefan Karl A1 - Walter, Benjamin A1 - Steinbrück, Ingo A1 - Palm, Christoph A1 - Messmann, Helmut A1 - Ebigbo, Alanna T1 - INFLUENCE OF AN ARTIFICIAL INTELLIGENCE (AI) BASED DECISION SUPPORT SYSTEM (DSS) ON THE DIAGNOSTIC PERFORMANCE OF NON-EXPERTS IN BARRETT´S ESOPHAGUS RELATED NEOPLASIA (BERN) T2 - Endoscopy N2 - Aims Barrett´s esophagus related neoplasia (BERN) is difficult to detect and characterize during endoscopy, even for expert endoscopists. We aimed to assess the add-on effect of an Artificial Intelligence (AI) algorithm (Barrett-Ampel) as a decision support system (DSS) for non-expert endoscopists in the evaluation of Barrett’s esophagus (BE) and BERN. Methods Twelve videos with multimodal imaging white light (WL), narrow-band imaging (NBI), texture and color enhanced imaging (TXI) of histologically confirmed BE and BERN were assessed by expert and non-expert endoscopists. For each video, endoscopists were asked to identify the area of BERN and decide on the biopsy spot. Videos were assessed by the AI algorithm and regions of BERN were highlighted in real-time by a transparent overlay. Finally, endoscopists were shown the AI videos and asked to either confirm or change their initial decision based on the AI support. Results Barrett-Ampel correctly identified all areas of BERN, irrespective of the imaging modality (WL, NBI, TXI), but misinterpreted two inflammatory lesions (Accuracy=75%). Expert endoscopists had a similar performance (Accuracy=70,8%), while non-experts had an accuracy of 58.3%. When AI was implemented as a DSS, non-expert endoscopists improved their diagnostic accuracy to 75%. Conclusions AI may have the potential to support non-expert endoscopists in the assessment of videos of BE and BERN. Limitations of this study include the low number of videos used. Randomized clinical trials in a real-life setting should be performed to confirm these results. KW - Artificial Intelligence KW - Barrett's Esophagus KW - Speiseröhrenkrankheit KW - Künstliche Intelligenz KW - Diagnose Y1 - 2022 U6 - https://doi.org/10.1055/s-00000012 VL - 54 IS - S 01 SP - S39 PB - Thieme ER - TY - JOUR A1 - Melzner, Maximilian A1 - Engelhardt, Lucas A1 - Simon, Ulrich A1 - Dendorfer, Sebastian T1 - Electromyography-Based Validation of a Musculoskeletal Hand Model JF - Journal of Biomechanical Engineering N2 - Regarding the prevention of injuries and rehabilitation of the human hand, musculoskeletal simulations using an inverse dynamics approach allow for insights of the muscle recruitment and thus acting forces on the hand. Currently, several hand models from various research groups are in use, which are mainly validated by the comparison of numerical and anatomical moment arms. In contrast to this validation and model-building technique by cadaver studies, the aim of this study is to further validate a recently published hand model [1] by analyzing numerically calculated muscle activities in comparison to experimentally measured electromyographical signals of the muscles. Therefore, the electromyographical signals of 10 hand muscles of five test subjects performing seven different hand movements were measured. The kinematics of these tasks were used as input for the hand model, and the numerical muscle activities were computed. To analyze the relationship between simulated and measured activities, the time difference of the muscle on- and off-set points was calculated, which resulted in a mean on- and off-set time difference of 0.58 s between the experimental data and the model. The largest differences were detected for movements that mainly addressed the wrist. One major issue comparing simulated and measured muscle activities of the hand is cross-talk. Nevertheless, the results show that the hand model fits the experiment quite accurately despite some limitations and is a further step toward patient-specific modeling of the upper extremity. KW - Elektromyographie KW - Biomechanik KW - Simulation KW - Electromyography KW - Muscle KW - Musculoskeletal system KW - Signals KW - Simulation Y1 - 2021 U6 - https://doi.org/10.1115/1.4052115 VL - 144 IS - 2 PB - American Society of Mechanical Engineers, ASME ER - TY - JOUR A1 - Melzner, Maximilian A1 - Ismail, Khaled M. A1 - Rušavy, Zdenek A1 - Kališ, Vladimír A1 - Süß, Franz A1 - Dendorfer, Sebastian T1 - Musculoskeletal lower back load of accoucheurs during childbirth – A pilot and feasibility study JF - European Journal of Obstetrics & Gynecology and Reproductive Biology N2 - Introduction: Back problems represent one of the leading causes of accouchers' work-related musculoskeletal morbidities. The correct execution of birth-related maneuvers including manual perineal protection is crucial not only for the mother and child but also for obstetricians and midwives to reduce any strain on their musculoskeletal system. Therefore, the overall aim of this study was to test the feasibility of determining the effect of different accouchers' postures (standing and kneeling) on their musculoskeletal system. Methods: The biomechanical analysis is based on musculoskeletal simulations that included motion recordings of real deliveries as well as deliveries conducted on a birthing simulator. These simulations were then used to determine individual joints' loads. Results: In the kneeling posture, both a low intra-operator variability and a lower average maximum load of the lower back was observed. For the standing position the spine load was reduced by pivoting the elbow on the accouchers' thigh, which in turn was associated with a significantly greater load on the shoulder joint. Conclusion: The study demonstrated the feasibility of our technique to assess joints loads. It also provided initial data indicating that a posture that reduces spinal flexion and tilt, achieved in this study by the kneeling, can significantly reduce the strain on the practitioner's musculoskeletal system. KW - lower back load KW - Accoucheur KW - Musculoskeletal simulation Y1 - 2021 U6 - https://doi.org/10.1016/j.ejogrb.2021.07.042 IS - 264 SP - 306 EP - 313 PB - Elsevier ER - TY - JOUR A1 - Melzner, Maximilian A1 - Pfeiffer, Christian A1 - Suess, Franz A1 - Dendorfer, Sebastian T1 - Musculoskeletal simulation of elbow stability for common injury patterns JF - Journal of Orthopaedic Research N2 - Elbow stability is derived from a combination of muscular, ligamentous, and bony structures. After an elbow trauma the stability of the joint is an important decision criterion for the subsequent treatment. The decision regarding non-operative/operative care depends mostly on subjective assessments of medical experts. Therefore, the aim of this study is to use musculoskeletal simulations as an objective assessment tool to investigate the extent to which failure of different stabilizers affects the elbow stability and how these observations correspond to the assessment from clinical practice. A musculoskeletal elbow simulation model was developed for this aim. To investigate the stability of the elbow, varus/valgus moments were applied under 0°, 45°and 90° flexion while the respective cubital angle was analyzed. This was performed for nine different injury scenarios, which were also evaluated for stability by clinical experts. With the results, it can be determined by which injury pattern and under which flexion angle the elbow stability is impaired regarding varus/valgus moments. The scenario with a complete failure of the medial and lateral ligaments and a fracture of the radial head was identified as having the greatest instability. The study presented a numerical determination of elbow stability against varus/valgus moments regarding clinical injury patterns, as well as a comparison of the numerical outcome with experience gained in clinical practice. The numerical predictions agree well with the assessments of the clinical specialists. Thus, the results from musculoskeletal simulation can make an important contribution to a more objective assessment of the elbow stability. KW - AnyBody KW - musculoskeletal simulation KW - elbow stability Y1 - 2022 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:898-opus4-54819 SN - 1554-527X N1 - Corresponding author: Maximilian Melzner VL - 41 IS - 6 SP - 1356 EP - 1364 PB - Wiley ER - TY - JOUR A1 - Melzner, Maximilian A1 - Suess, Franz A1 - Dendorfer, Sebastian T1 - The impact of anatomical uncertainties on the predictions of a musculoskeletal hand model – a sensitivity study JF - Computer Methods in Biomechanics and Biomedical Engineering N2 - Outputs of musculoskeletal models should be considered probabilistic rather than deterministic as they are affected by inaccuracies and estimations associated with the development of the model. One of these uncertainties being critical for modeling arises from the determination of the muscles' line of action and the physiological cross-sectional area. Therefore, the aim of this study was to evaluate the outcome sensitivity of model predictions from a musculoskeletal hand model in comparison to the uncertainty of these input parameters. For this purpose, the kinematics and muscle activities of different hand movements (abduction of the fingers, abduction of the thumb, and flexion of the thumb) were recorded. One thousand simulations were calculated for each movement using the Latin hypercube sampling method with a corresponding variation of the muscle origin/insertion points and the cross-sectional area. Comparing the standard hand to simulations incorporating uncertainties of input parameters shows no major deviations in on- and off-set time point of muscle activities. About 60% of simulations are located within a ± 30% interval around the standard model concerning joint reaction forces. The comparison with the variation of the input data leads to the conclusion that the standard hand model is able to provide not over-scattered outcomes and, therefore, can be considered relatively stable. These results are of practical importance to the personalization of a musculoskeletal model with subject-specific bone geometries and hence changed muscle line of action. KW - Biomechanik KW - Simulation Y1 - 2021 U6 - https://doi.org/10.1080/10255842.2021.1940974 SN - 1476-8259 N1 - Corresponding author: Maximilian Melzner VL - 25 IS - 2 SP - 156 EP - 164 PB - Taylor & Francis ER - TY - CHAP A1 - Mendel, Robert A1 - Ebigbo, Alanna A1 - Probst, Andreas A1 - Messmann, Helmut A1 - Palm, Christoph T1 - Barrett’s Esophagus Analysis Using Convolutional Neural Networks T2 - Bildverarbeitung für die Medizin 2017; Algorithmen - Systeme - Anwendungen. Proceedings des Workshops vom 12. bis 14. März 2017 in Heidelberg N2 - We propose an automatic approach for early detection of adenocarcinoma in the esophagus. High-definition endoscopic images (50 cancer, 50 Barrett) are partitioned into a dataset containing approximately equal amounts of patches showing cancerous and non-cancerous regions. A deep convolutional neural network is adapted to the data using a transfer learning approach. The final classification of an image is determined by at least one patch, for which the probability being a cancer patch exceeds a given threshold. The model was evaluated with leave one patient out cross-validation. With sensitivity and specificity of 0.94 and 0.88, respectively, our findings improve recently published results on the same image data base considerably. Furthermore, the visualization of the class probabilities of each individual patch indicates, that our approach might be extensible to the segmentation domain. KW - Speiseröhrenkrebs KW - Diagnose KW - Maschinelles Lernen KW - Bilderkennung KW - Automatische Klassifikation Y1 - 2017 U6 - https://doi.org/10.1007/978-3-662-54345-0_23 SP - 80 EP - 85 PB - Springer CY - Berlin ER - TY - CHAP A1 - Mendel, Robert A1 - Rauber, David A1 - Palm, Christoph T1 - Exploring the Effects of Contrastive Learning on Homogeneous Medical Image Data T2 - Bildverarbeitung für die Medizin 2023: Proceedings, German Workshop on Medical Image Computing, July 2– 4, 2023, Braunschweig N2 - We investigate contrastive learning in a multi-task learning setting classifying and segmenting early Barrett’s cancer. How can contrastive learning be applied in a domain with few classes and low inter-class and inter-sample variance, potentially enabling image retrieval or image attribution? We introduce a data sampling strategy that mines per-lesion data for positive samples and keeps a queue of the recent projections as negative samples. We propose a masking strategy for the NT-Xent loss that keeps the negative set pure and removes samples from the same lesion. We show cohesion and uniqueness improvements of the proposed method in feature space. The introduction of the auxiliary objective does not affect the performance but adds the ability to indicate similarity between lesions. Therefore, the approach could enable downstream auto-documentation tasks on homogeneous medical image data. Y1 - 2023 U6 - https://doi.org/10.1007/978-3-658-41657-7 SP - 128 EP - 13 PB - Springer Vieweg CY - Wiesbaden ER - TY - JOUR A1 - Mendel, Robert A1 - Rauber, David A1 - Souza Jr., Luis Antonio de A1 - Papa, João Paulo A1 - Palm, Christoph T1 - Error-Correcting Mean-Teacher: Corrections instead of consistency-targets applied to semi-supervised medical image segmentation JF - Computers in Biology and Medicine N2 - Semantic segmentation is an essential task in medical imaging research. Many powerful deep-learning-based approaches can be employed for this problem, but they are dependent on the availability of an expansive labeled dataset. In this work, we augment such supervised segmentation models to be suitable for learning from unlabeled data. Our semi-supervised approach, termed Error-Correcting Mean-Teacher, uses an exponential moving average model like the original Mean Teacher but introduces our new paradigm of error correction. The original segmentation network is augmented to handle this secondary correction task. Both tasks build upon the core feature extraction layers of the model. For the correction task, features detected in the input image are fused with features detected in the predicted segmentation and further processed with task-specific decoder layers. The combination of image and segmentation features allows the model to correct present mistakes in the given input pair. The correction task is trained jointly on the labeled data. On unlabeled data, the exponential moving average of the original network corrects the student’s prediction. The combined outputs of the students’ prediction with the teachers’ correction form the basis for the semi-supervised update. We evaluate our method with the 2017 and 2018 Robotic Scene Segmentation data, the ISIC 2017 and the BraTS 2020 Challenges, a proprietary Endoscopic Submucosal Dissection dataset, Cityscapes, and Pascal VOC 2012. Additionally, we analyze the impact of the individual components and examine the behavior when the amount of labeled data varies, with experiments performed on two distinct segmentation architectures. Our method shows improvements in terms of the mean Intersection over Union over the supervised baseline and competing methods. Code is available at https://github.com/CloneRob/ECMT. KW - Semi-supervised Segmentation KW - Mean-Teacher KW - Pseudo-labels KW - Medical Imaging Y1 - 2023 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:898-opus4-57790 SN - 0010-4825 N1 - Corresponding author der OTH Regensburg: Robert Mendel VL - 154 IS - March PB - Elsevier ER - TY - JOUR A1 - Menn, Lara A1 - Corsten, Sabine A1 - Lauer, Norina A1 - Wallace, Sarah J. T1 - The effectiveness of biographical approaches in long-term care: a systematic review JF - Gerontologist N2 - Background and Objectives Older adults in long-term residential aged care experience loneliness and reduced quality of life (QoL). Biographical approaches use the recall of the past events to increase self-efficacy, promote acceptance, and improve QoL. The aim of the systematic review was to examine the effectiveness of biographical approaches in improving the QoL of older adults in long-term residential aged care. Research Design and Methods This systematic review was conducted in accordance with PRISMA guidelines, using databases Medline, CINAHL, and the Cochrane Library. A 2-phase search strategy was used to identify research literature relating to the use of biographical interventions. Narrative analysis was used to synthesize results. Results Twenty-one studies met inclusion criteria for this review, comprising both group and individual interventions. The findings were inconsistent. Subjective elements of QoL of older adults improved in a narrow majority of the studies. Of a total of 21 outcomes investigated in group interventions, 11 resulted in significant improvements in QoL. The 16 outcomes of the individual interventions resulted in 10 significant improvements. The most significant influence was observed in life satisfaction. Group reminiscence also had a particularly strong influence on self-esteem. Discussion and Implications Although benefits were observed, it remains unclear why some interventions led to improvements in subjective elements of QoL and others did not. Exploration of the participant perspective through qualitative data collection and more detailed description of interventions in future studies could lead to a better understanding of the treatment components that are related to improved outcomes for older adults. KW - Biographical approaches KW - Quality of life KW - Long-term care KW - Reminiscence KW - Life review Y1 - 2019 U6 - https://doi.org/10.1093/geront/gnz074 VL - 60 IS - 4 SP - 309 EP - 328 ER -