Lebenswissenschaften und Ethik
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In 2015 we began a sub-challenge at the EndoVis workshop at MICCAI in Munich using endoscope images of exvivo tissue with automatically generated annotations from robot forward kinematics and instrument CAD models. However, the limited background variation and simple motion rendered the dataset uninformative in learning about which techniques would be suitable for segmentation in real surgery. In 2017, at the same workshop in Quebec we introduced the robotic instrument segmentation dataset with 10 teams participating in the challenge to perform binary, articulating parts and type segmentation of da Vinci instruments. This challenge included realistic instrument motion and more complex porcine tissue as background and was widely addressed with modfications on U-Nets and other popular CNN architectures [1].
In 2018 we added to the complexity by introducing a set of anatomical objects and medical devices to the segmented classes. To avoid over-complicating the challenge, we continued with porcine data which is dramatically simpler than human tissue due to the lack of fatty tissue occluding many organs.
In dem vorliegenden Papier versuchen wir den Bestand der Euro-Banknoten zu ermitteln, der sich von der deutschen Banknotenemission im Ausland befindet. Dabei unterscheiden wir nach Beständen, die außerhalb des Euro-Währungsraumes gehalten werden, und solchen, die in anderen Ländern der EWU zirkulieren. Die Analyse basiert auf Ansätzen, die den Auslandsumlauf auf indirektem Wege abschätzen. Der Untersuchungszeitraum reicht von 2002 bis 2009. Wir finden heraus, dass Ende 2009 insgesamt rund zwei Drittel der deutschen kumulierten Nettoemissionen im Ausland umliefen. Der größte Teil, etwa 160 Mrd. €, befand sich außerhalb des Euro-Raums, der Rest - 80 Mrd. € - lief in anderen EWU-Ländern um. Somit entsprach der Inlandsumlauf deutscher Euro-Banknoten nur rund einem Drittel aller von der Bundesbank in Höhe von 350 Mrd. € in Umlauf gegebenen Banknoten. Damit werden die Ergebnisse direkter Ansätze bestätigt.
In this paper, we endeavour to determine the volume of euro banknotes issued by Germany that is in circulation outside Germany. In so doing, we draw a distinction between banknotes outstanding in non-euro-area countries and those that are in circulation in other euro-area countries. The analysis is based on approaches that estimate the volume of banknotes in circulation outside Germany indirectly. The observation period runs from 2002 to 2009. We discover that, at the end of 2009, a total of roughly two-thirds of Germany's cumulated net issuance of euro banknotes was in circulation outside Germany. The lion's share of roughly €160 billion was in non-euro-area countries, with the remaining €80 billion in other euro-area countries. Thus, the volume of German euro banknotes in circulation in Germany accounted for only roughly one-third of all banknotes issued by the Deutsche Bundesbank (€350 billion). This confirms the results of direct approaches.
Der Beitrag untersucht die Nutzung altersgerechter Assistenz-systeme und insbesondere Roboter. Die Studie basiert auf einem Scoping Review, das einen Überblick über aktuelle Forschungsergebnisse zum Einsatz von Robotern in der Pflege gibt, sowie auf Ergebnissen einer qualitativen und quantitativen Studie. In die-ser Untersuchung zeigen sich einige Diffusionshemmnisse, aber auch Chancen für den Einsatz, die anhand eines Fallbeispiels zum Einsatz von Telepräsenzrobotern zu Pflege und Therapie diskutiert werden.
Abstract Background Most medical students are in contact with the pharmaceutical or medical device industry during their studies. Medical schools play an important role in protecting students from undue commercial influence and educating them about pharmaceutical marketing practices. Such influence has been shown to affect later prescribing behaviour with potential adverse effects for patient care. While in North America, many medical schools formulated and implemented conflicts of interest (COI) policies, only few such institutional policies have been reported in Germany. We aimed to analyze the quantity and quality of policies and curricula on COI at medical schools across Germany. Methods We collected relevant COI policies and teaching activities by conducting a search of the websites of all 38 German medical schools using standardized keywords for COI policies and teaching. Further, we surveyed all medical schools’ dean’s offices and adapted a scoring system for obtained results with 13 categories based on prior similar studies. 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. Conclusion 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 their respective school. 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.
In this article, we address the challenge of solving the ill-posed reconstruction problem in computed tomography using a translation invariant diagonal frame decomposition (TIDFD). First, we review the concept of a TI-DFD for general linear operators and the corresponding filter-based regularization concept. We then introduce the TI-DFD for the Radon transform on L 2 (R 2) and provide an exemplary construction using the TI wavelet transform. Presented numerical results clearly demonstrate the benefits of our approach over non-translation invariant counterparts.
Hintergrund /Zielsetzung
Der Beitrag befasst sich mit Wissenstand und Einstellung der Bevölkerung. Betrachtet werden die Übermittlung und Verfügbarkeit von Gesundheitsdaten, Gesundheitsregister, die elektronische Patientenakte, Einwilligungsverfahren für die Übermittlung von Daten und der Zugriff auf Gesundheitsdaten zu Forschungszwecken.
Methoden
Die Studie basiert auf einer computergestützten Telefonbefragung (Dual-Frame) bei einer Zufallsstichprobe der Bevölkerung in Deutschland im Zeitraum 01.-27.06.2022 (n=1.308).
Ergebnisse
Der Wissensstand zur Übermittlung von Gesundheitsdaten an Krankenkassen ist hoch, wohingegen das Vorhandensein zentraler Sterbe-, Impf-, und Gesundheitsregister und der Zugriff auf Gesundheitsdaten durch behandelnde Ärztinnen und Ärzte überschätzt werden. Die Akzeptanz medizinischer Register ist sehr hoch. Die elektronische Patientenakte ist bei der Hälfte der Bevölkerung unbekannt, die Nutzungsbereitschaft ist eher gering ausgeprägt, bei der Übertragung von Daten wird eine Zustimmungsoption bevorzugt und über achtzig Prozent würden die Daten der elektronischen Patientenakte zur Forschung freigeben. Drei Viertel würden ihre Gesundheitsdaten allgemein zur Forschung freigeben, insbesondere an Universitäten in Deutschland, wobei meist Anonymität Bedingung ist. Die Bereitschaft zur Datenfreigabe steigt mit Höhe des Vertrauens in Presse sowie in Universitäten und Hochschulen und sinkt, wenn ein Datenleck als schwerwiegend betrachtet wird.
Diskussion und Schlussfolgerung
In Deutschland besteht, wie in anderen europäischen Ländern, eine große Bereitschaft zur Freigabe von Gesundheitsdaten zu Forschungszwecken. Dagegen ist der Wunsch zur Nutzung der elektronischen Patientenakte eher gering. Ebenso niedrig ist die Akzeptanz einer Widerspruchsoption, die jedoch als Voraussetzung für eine erfolgreiche Einführung einer elektronischen Patientenakte gilt. Vertrauen in die Forschung und staatliche Stellen, die Gesundheitsdaten verarbeiten, sind zentrale Faktoren.
Hintergrund
In Deutschland liegen unterschiedliche Befunde zur Akzeptanz von Schutzimpfungen gegen COVID-19 vor. Die Impfbereitschaft schwankt je nach Stichprobe, Messung und Erhebungszeitraum.
Ziel der Arbeit (Fragestellung)
Ziel der Studie ist die Untersuchung der Impfbereitschaft mit einem COVID-19-Vakzin an einer Zufallsstichprobe der Gesamtbevölkerung. Der Schwerpunkt der Studie liegt in der Beschreibung des Zusammenhangs zwischen Impfbereitschaft, wahrgenommenen Risiken einer Erkrankung, den subjektiven Überzeugungen zu Nebenwirkungen und dem Vertrauen in Institutionen sowie dem Einfluss sozialer Bezugsgruppen.
Material und Methoden
Die Studie basiert auf einer telefonischen Ein-Themen-Bevölkerungsbefragung zur Impfbereitschaft (n=2.014) vor der Zulassung eines COVID-19-Vakzins in Deutschland im November/Dezember 2020.
Ergebnisse
Die Impfbereitschaft liegt bei etwa 67 % und steigt mit dem Anteil der impfbereiten Freunde und Bekannten und dem Vertrauen gegenüber dem Robert-Koch-Institut, bei Zugehörigkeit zu einer Risikogruppe und der Erwartung gefährlicher Konsequenzen bei einer Erkrankung oder Unklarheit darüber. Erfahrungen mit einer Infektion bei den Befragten oder in ihrer sozialen Bezugsgruppe erhöhen die Impfbereitschaft. Eine Überschätzung der Wahrscheinlichkeit ernsthafter Nebenwirkungen bei Grippeimpfungen senkt die Impfbereitschaft gegen COVID-19. Auffällig ist der Befund einer erheblichen Überschätzung der Häufigkeit von ernsthaften Impfnebenwirkungen.
Diskussion
Die Überschätzung der Häufigkeit ernsthafter Nebenwirkungen bei Impfungen weist erstens auf ein Informationsdefizit, zweitens auf weit verbreitete Fehlinformationen und drittens auf kognitive Probleme bei der Interpretation relativer Häufigkeiten hin. Es werden Implikationen für eine Informationskampagne abgeleitet.
Background:
People with aphasia (PWA) often have a reduced quality of life. Nevertheless, there are currently only a few specific services that respond to this problem. Hence, there is a pressing need for action to improve participation and well-being of people with aphasia. An adapted social network could be a solution. Well-being could be increased by exchanging experiences with peers in a similar situation. Moreover, comprehensive digital coverage would also be possible in rural and underserved areas. This digital social network should be adapted to the specific needs of PWA. Therefore, a participatory, agile process with the involvement of the target group should be adopted.
Aim:
The aim is to develop and evaluate a social media platform as a smartphone app to support the social integration of PWA and to improve their quality of life. In addition to the digital exchange, face-to-face meetings between PWA should be stimulated.
Design:
The study will be conducted in a randomised pretest-posttest control group design with follow-up testing. The participants will be randomly assigned to the experimental intervention (36 participants) or the control intervention (36 participants). The primary outcome is quality of life, measured with the SAQOL-39. At all measurement times, psychological well-being is recorded with the help of two measuring instruments (GHQ-12 & DISCs). The secondary outcome is the recording of social contacts and activities as well as associated emotions, registered in a structured diary. In addition, communication skills (measured with the CPIB) and social support (recorded with the F-SozU) will be examined.
Method:
During the first project phase, a user-centred, agile development process will be adopted to design the app. The target group will be involved in the app development in a participatory manner. A workshop is planned for the users of the app. In the second phase, the usability and user-friendliness of the app will first be evaluated in a feasibility study. Subsequently, in the main study, the app will then be tested by the target group for 4 months.
Discussion:
The app developed in the research project is the first social network that is tailored to the needs and capabilities of PWA. It aims to enable better exchange between PWA to improve social participation and quality of life.
Real-time computational speed and a high degree of precision are requirements for computer-assisted interventions. Applying a segmentation network to a medical video processing task can introduce significant inter-frame prediction noise. Existing approaches can reduce inconsistencies by including temporal information but often impose requirements on the architecture or dataset. This paper proposes a method to include temporal information in any segmentation model and, thus, a technique to improve video segmentation performance without alterations during training or additional labeling. With Motion-Corrected Moving Average, we refine the exponential moving average between the current and previous predictions. Using optical flow to estimate the movement between consecutive frames, we can shift the prior term in the moving-average calculation to align with the geometry of the current frame. The optical flow calculation does not require the output of the model and can therefore be performed in parallel, leading to no significant runtime penalty for our approach. We evaluate our approach on two publicly available segmentation datasets and two proprietary endoscopic datasets and show improvements over a baseline approach.
In the field of computer- and robot-assisted minimally invasive surgery, enormous progress has been made in recent years based on the recognition of surgical instruments in endoscopic images. Especially the determination of the position and type of the instruments is of great interest here. Current work involves both spatial and temporal information with the idea, that the prediction of movement of surgical tools over time may improve the quality of final segmentations. The provision of publicly available datasets has recently encouraged the development of new methods, mainly based on deep learning. In this review, we identify datasets used for method development and evaluation, as well as quantify their frequency of use in the literature. We further present an overview of the current state of research regarding the segmentation and tracking of minimally invasive surgical instruments in endoscopic images. The paper focuses on methods that work purely visually without attached markers of any kind on the instruments, taking into account both single-frame segmentation approaches as well as those involving temporal information. A discussion of the reviewed literature is provided, highlighting existing shortcomings and emphasizing available potential for future developments. The publications considered were identified through the platforms Google Scholar, Web of Science, and PubMed. The search terms used were "instrument segmentation", "instrument tracking", "surgical tool segmentation", and "surgical tool tracking" and result in 408 articles published between 2015 and 2022 from which 109 were included using systematic selection criteria.
In this paper, we focus on the stabilizing role of cash from a society-wide perspective. Starting with conceptual remarks on the importance of money for the economy in general, special attention is paid to the unique characteristics of cash. As these become apparent especially during crisis periods, a comparison of the Great Depression (1929 – 1933) and the Great Recession 2008/09 shows the devastating effects of a severe monetary contraction and how a fully elastic provision of cash can help to avoid such a situation. We find interesting similarities to both crises in two separate case studies, one on the demonetization in India 2016 and the other on cash supply during various crises in Greece since 2008. The paper concludes that supply-driven cash withdrawals from circulation (either by demonetization or by capital controls) destabilize the economy if electronic payment substitutes are not instantly available. However, as there is no perfect substitute for cash due to its unique properties, from the viewpoint of the society as a whole an efficient payment mix necessarily includes cash: It helps to stabilize the economy not only in times of crises in general, no matter which government is in place. Consequently, it should be the undisputed task of central banks to ensure that cash remains in circulation in normal times and is provided in a fully elastic way in times of crisis.
Which influence had the sudden appearance of sound recording, film, and typewriters at the end of the 19th century on the human perception of and our thinking about what we consider “reality”? How did our society change with these technological innovations? After millennia of speech and the culture of writing, a fundamental disruption occurred when Thomas Alva Edison introduced his “phonograph” in 1877. In his book “Grammophon, Film, Typewriter” (Brinkmann & Bose, Berlin 1986), Friedrich Kittler (1943-2011) discusses this question from his perspective as literary scholar and media theorist, reviewing contemporary authors to let them bear witness to their experiences and impressions of the then-new media. This essay intends to be a short extract of Kittler’s book, meandering between additional sources of historians, writers, commentators, yet always coming back to Kittler’s fascinating panopticon.
Psychiatry" by Ligthart et al. (2021) Ligthart et al. (2021) introduce the idea that "Extended Reality (XR) systems, such as Virtual Reality (VR) and Augmented Reality (AR)," could be used for forensic psychiatry, and then go into detail about considerations that advocate for and against the use of XR systems in forensic psychiatry. Yet, in doing so, they implicitly make presuppositions about the functionality and performance of such systems, which first already seem to be questionable from a technical point of view, understood in a broad sense, but moreover, subsequently have far-reaching significance for a normative assessment of the use of such systems. The following remarks will therefore first describe what Ligthart et al. do not explicitly say about the required technology but must presuppose, and then outline the normative consequences of this omission. In the following, the focus will be placed on virtual reality since the use cases initially mentioned by Ligthart et al. suggest that the authors have also such systems in mind. Presumably, however, the remarks made here can also be applied to Augmented and Extended Reality systems.
We present the Regensburg Breast Shape Model (RBSM) – a 3D statistical shape model of the female breast built from 110 breast scans, and the first ever publicly available. Together with the model, a fully automated, pairwise surface registration pipeline used to establish correspondence among 3D breast scans is introduced. Our method is computationally efficient and requires only four landmarks to guide the registration process. In order to weaken the strong coupling between breast and thorax, we propose to minimize the variance outside the breast region as much as possible. To achieve this goal, a novel concept called breast probability masks (BPMs) is introduced. A BPM assigns probabilities to each point of a 3D breast scan, telling how likely it is that a particular point belongs to the breast area. During registration, we use BPMs to align the template to the target as accurately as possible inside the breast region and only roughly outside. This simple yet effective strategy significantly reduces the unwanted variance outside the breast region, leading to better statistical shape models in which breast shapes are quite well decoupled from the thorax. The RBSM is thus able to produce a variety of different breast shapes as independently as possible from the shape of the thorax. Our systematic experimental evaluation reveals a generalization ability of 0.17 mm and a specificity of 2.8 mm for the RBSM. Ultimately, our model is seen as a first step towards combining physically motivated deformable models of the breast and statistical approaches in order to enable more realistic surgical outcome simulation.