Lebenswissenschaften und Ethik
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Following a ban on many materials containing bisphenol-A, new bisphenol-free Boron silicates have been found as substitutes. The purpose of this study is to describe the mechanical properties of these bisphenol-free magnetoactive borosilicate polymers containing hard magnetic particles. Samples of 0%, 33% and 66% by wt. were loaded for compression using a universal testing machine. The maximum forces occurring for different travel speeds were compared before and after post-magnetization treatments. The post-magnetization included 2 stages. In addition, the change in mechanical properties within 24 hours after the post-magnetization process was investigated. Furthermore, the influence of speed and particle content were investigated. In general, there is a correlation between the required compressive force and, the level of post-magnetization stress, the increase in travel speed and particle content in the boron silicate. Comparison of the non-post-magnetized and post-magnetized samples using two-tailed t-tests shows that the p-values for all weight fraction changes in NdPrFeB particles and travel speeds are less than 0.001. Also, a comparison between tests in which the traverse speed was varied also showed significant changes in the resulting compression forces. The same is valid for changes in the weight ratio of the NdPrFeB particles in the samples. For post-magnetized samples, no significant difference can be observed in the first 24 hours following magnetization. In summary, the material presents viscoelastic, plastic force-displacement behavior, which can be well recognized by its bi-linear curve shape.
The investigation shows that borosilicate polymers based on NdPrFeB can have their mechanical behavior modified and controlled by post-magnetization processes. This opens new possibilities for many future applications.
The study is based on a German single-topic population survey on vaccination willingness against COVID-19 (VWC) by the authors (2020, n = 2014). The single-topic survey allowed us to test several competing explanations for VWC, as discussed in the literature. The VWC in the sample was 67.3%. Logistic regression was used to identify factors affecting VWC. Being at high risk from COVID-19 and having received flu vaccination have a positive impact on VWC. Perceived VWC of friends has a strong positive effect on respondents’ VWC. Bivariate relationships of gender, age, and level of education with VWC were no longer significant in a multivariate analysis. Trust in alternative medicine and belief in conspiracy theories have a negative effect on VWC.
It is generally known that project-based learning is a very important part of engineering education to connect theoretical knowledge with practical work. Students learn to apply their knowledge to real-world challenges as it is the case in their later professional life. If students are not used to project work or the scientific topic is new and relatively complex, they may be overwhelmed. The consequence is that students achieve poor results, are frustrated, and therefore learning success is low. Semi-structured projects are introduced that combine the advantages of structured experiments with projects. The project work is structured into several parts with detailed descriptions of the tasks. In the end, students get similar results to doing a free project, but the success rate is higher due to higher guidance. Therefore, these semi-structured projects are seen to be an appropriate method to guide students to learn how to do project work. The feedback from most students is very positive. Some students with no previous lab experience complained about the project work and wished for more guidance to become familiar with lab work. In sum, the student feedback is encouraging to develop semi-structured projects further.
To avoid dislocation of the shoulder joint after reverse total shoulder arthroplasty, it is important to achieve sufficient shoulder stability when placing the implant components during surgery. One parameter for assessing shoulder stability can be shoulder stiffness. The aim of this research was to develop a temporary reverse shoulder implant prototype that would allow intraoperative measurement of shoulder stiffness while varying the position of the implant components. Joint angle and torque measurement techniques were developed to determine shoulder stiffness. Hall sensors were used to measure the joint angles by converting the magnetic flux densities into angles. The accuracy of the joint angle measurements was tested using a test bench. Torques were determined by using thin-film pressure sensors. Various mechanical mechanisms for variable positioning of the implant components were integrated into the prototype. The results of the joint angle measurements showed measurement errors of less than 5° in a deflection range of ±15° adduction/abduction combined with ±45° flexion/extension. The proposed design provides a first approach for intra-operative assessment of shoulder stiffness. The findings can be used as a technological basis for further developments.
Older adults in long-term care homes are at high risk of experiencing
reduced quality of life (QoL) and depression. Technology-assisted biography work can have a positive impact on QoL and mood, but there is little research on its use with this target group. The purpose of this paper is to examine the effect of tablet-based biography work conducted by volunteers on the QoL of residents and volunteers. A pretest-posttest control group design with an intervention period of 3 months and a 3-month follow-up was used. Results show a significant increase in participation for volunteers and residents after
the intervention, which is stable for residents until follow-up. Volunteers also show significant improvement in mental QoL immediately after the intervention. There were no significant effects for life satisfaction, self-esteem, or depression. No significant changes were found for the control group. Digitally conducted tablet-based biography work appears to have effects on QoL-associated outcomes.
The utilization of virtual reality (VR) technology has shown promise in various therapeutic applications, particularly in exposure therapy
for reducing fear of certain situations objects or activities, e.g. fear of height, or negative evaluation of others in social situations. VR has been shown to yield positive outcomes in follow-up studies, and provides a safe and ecological therapeutic environment for therapists and their patients. This paper presents a collaborative
effort to develop a VR speech therapy system which simulates a virtual audience for users to practice their public speaking skills. We describe a novel web-based graphica user interface that enables
therapists to manage the therapy session using a simple timeline. Lastly, we present the results from a qualitative study with therapists and teachers with functional dysphonia, which highlight the potential of such an application to support and augment the therapists’ work and the remaining challenges regarding the design of natural interactions, agent behaviours and scenario customisation for patients.
Hintergrund/Zielsetzung
Der Beitrag befasst sich mit dem Wissenstand und der 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 sowie 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 der Höhe des Vertrauens in die Presse sowie in Universitäten und Hochschulen, und sie sinkt, wenn ein Datenleck als schwerwiegend erachtet 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.
This study investigates the impact of eye movement modeling examples in Software Engineering education. Software Engineering is a highly visual domain. The daily tasks of a software engineer (e.g., formulating requirements, creating UML diagrams, or conducting a code review) require in many cases the use of certain visual strategies. Although these strategies can be found for experts, it has been observed in different eye tracking studies that students have difficulties in learning and applying them. To familiarize students with these visual strategies and to provide them with a better understanding for the cognitive processes involved, a total of seven eye movement modeling examples was created. The seven eye movement modeling examples cover relevant parts of an introductory Software Engineering lecture; they are focused on typical situations in which visual strategies are applied. The results of a questionnaire-based evaluation shows that students consider the eye movement modeling examples as useful, feel supported in their learning process, and would like to see more use of them in the Software Engineering lecture. Furthermore, the students suggested that eye movement modeling examples should also be used in other lectures.
Three-dimensional Medical Printing and Associated Legal Issues in Plastic Surgery: A Scoping Review
(2023)
Three-dimensional printing (3DP) represents an emerging field of surgery. 3DP can facilitate the plastic surgeon’s workflow, including preoperative planning, intraoperative assistance, and postoperative follow-up. The broad clinical application spectrum stands in contrast to the paucity of research on the legal framework of 3DP. This imbalance poses a potential risk for medical malpractice lawsuits. To address this knowledge gap, we aimed to summarize the current body of legal literature on medical 3DP in the US legal system. By combining the promising clinical use of 3DP with its current legal regulations, plastic surgeons can enhance patient safety and outcomes.
BACKGROUND
Surgeons have historically used age as a preoperative predictor of postoperative outcomes. Sarcopenia, the loss of skeletal muscle mass due to disease or biological age, has been proposed as a more accurate risk predictor. The prognostic value of sarcopenia assessment in surgical patients remains poorly understood. Therefore, we aimed to synthesize the available literature and investigate the impact of sarcopenia on peri- and postoperative outcomes across all surgical specialties.
METHODS
We systematically assessed the prognostic value of sarcopenia on postoperative outcomes by conducting a systematic review and meta-analysis according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, searching the PubMed/MEDLINE and EMBASE databases from inception to 1st October 2022. Our primary outcomes were complication occurrence, mortality, length of operation and hospital stay, discharge to home, and postdischarge survival rate at one, three, and five years. Subgroup analysis was performed by stratifying complications according to the Clavien-Dindo classification system. Sensitivity analysis was performed by focusing on studies with an oncological, cardiovascular, emergency, or transplant surgery population, and on those of higher quality or prospective study design.
RESULTS
A total of 294 studies comprising 97,643 patients, of which 33,070 had sarcopenia, were included in our analysis. Sarcopenia was associated with significantly poorer postoperative outcomes including greater mortality, complication occurrence, length of hospital stay, and lower rates of discharge to home (all P<0.00001). A significantly lower survival rate in patients with sarcopenia was noted at one, three, and five years (all P<0.00001) after surgery. Subgroup analysis confirmed higher rates of complications and mortality in oncological (both P<0.00001), cardiovascular (both P<0.00001), and emergency (P=0.03 and P=0.04, respectively) patients with sarcopenia. In the transplant surgery cohort, mortality was significantly higher in patients with sarcopenia (P<0.00001). Among all patients undergoing surgery for inflammatory bowel disease, the frequency of complications was significantly increased among sarcopenic patients (P=0.007). Sensitivity analysis based on higher-quality studies and prospective studies showed that sarcopenia remained a significant predictor of mortality and complication occurrence (all P<0.00001).
CONCLUSION
Sarcopenia is a significant predictor of poorer outcomes in surgical patients. Preoperative assessment of sarcopenia can help surgeons to identify patients at risk, critically balance eligibility, and refine perioperative management. Large-scale studies are required to further validate the importance of sarcopenia as a prognostic indicator of perioperative risk, especially in surgical sub-specialties.
Background:
People with aphasia (PWA) often suffer from reduced participation and quality of life. Nevertheless, there are currently only a few specific interventions that respond to this problem. Participation and quality of life could be increased by interacting with peers who have similar experiences. Digital social networks could stimulate an autonomous interaction. However, digital social networks need to be adapted to the specific needs of PWA. Therefore, a participatory, agile process involving the target group should be chosen to develop such a olution, i.e., an app. The research project consists of a total of three phases. In the first phase—app development—the app was developed and programmed including the target group. In the second phase—app testing—the usability and user-friendliness of the app were evaluated with four PWA. In the third phase—feasibility and preliminary effcacy—that will be described in the article, the impact of the app on PWA will be evaluated.
Aims:
The overarching aim of our study is to provide preliminary effcacy of the intervention. Digital social interaction with other PWA can lead to increased social integration. In addition to digital interaction, personal encounters between PWA should be encouraged. As a result, we expect an improvement in quality of life of PWA. Additionally, we focus on identification of the most appropriate measurements to discover changes associated with the intervention.
Methods:
The evaluation, which is described in this paper, takes place in a pre-test - post-test design with a total of n = 48 PWA. Participants will be recruited in regional clusters to facilitate face-to-face meetings. Half of the participants will be assigned to the delayed intervention group and the other half to the immediate intervention group. Participants in the delayed intervention group will go through a 3-month waiting period before using the app, while the participants of the immediate intervention group will start using the app for 3 months right away. Inclusion criteria are the presence of chronic aphasia (at least 6 months) and possession of a smartphone with internet access. Questionnaires on quality of life (SAQOL-39, GHQ-12), depression (GDS, DISCs), communicative participation (CPIB), and social support (F-SozU) will be conducted at inclusion (t0), after 3 months of app use (t1), and after another 3 months for follow-up (t2). Participants in the delayed intervention group will be assessed twice before the intervention, before the 3-month waiting period (t0a) and after the waiting period (t0b). In addition to the quantitative measures, interviews will take place with 6 to 8 selected participants after 3 months of app use. Responses will be analysed using Thematic Analysis.
Discussion:
The app will be the first social network tool that is systematically developed with PWA. Initial indications from the first phases are that the app can be used by PWA, so that the evaluation of this app version can take place in the third phase. Results of this study can provide an initial indication of whether social network support is a suitable intervention. Findings will help provide information on the feasibility of digital connectivity for PWA. Preliminary findings on its impact on the participation and quality of life of PWA could be made available.
Although adopting Low Code Development Platforms (LCDPs) promises significant efficiency and effectiveness improvements for application development, its adoption still needs further empirical research. This paper uses a combinatorial approach to research LCDP adoption and presents the results of a multiple mini case study with 36 cases on LCDP adoption. A combination of the Socio-Technical Systems theory and the Technology-Organisational-Environment model is used as a theoretical lens. In this paper, we show that LCDP adoption is a multifaceted phenomenon and identify three archetypes for LCDP adoption (i.e., IT Resource Shortage Mitigators, Application Development Democratisers, and Synergy Realisers) and one archetype for LCDP non-adoption (i.e., Intricacy Adversaries). Each archetype can be interpreted as an individual path towards LCDP (non-)adoption. Based on these archetypes, we derive seven starting points for practitioners to adopt LCDPs in work systems. Moreover, by using the theoretical lenses, the paper shows that for an LCDP adoption to occur, an optimisation of the social and technical sub-systems is required.
In Vitro Analysis of Human Cartilage Infiltrated by Hydrogels and Hydrogel-Encapsulated Chondrocytes
(2023)
Osteoarthritis (OA) is a degenerative joint disease causing loss of articular cartilage and structural damage in all joint tissues. Given the limited regenerative capacity of articular cartilage, methods to support the native structural properties of articular cartilage are highly anticipated. The aim of this study was to infiltrate zwitterionic monomer solutions into human OA-cartilage explants to replace lost proteoglycans. The study included polymerization and deposition of methacryloyloxyethyl-phosphorylcholine- and a novel sulfobetaine-methacrylate-based monomer solution within ex vivo human OA-cartilage explants and the encapsulation of isolated chondrocytes within hydrogels and the corresponding effects on chondrocyte viability. The results demonstrated that zwitterionic cartilage–hydrogel networks are formed by infiltration. In general, cytotoxic effects of the monomer solutions were observed, as was a time-dependent infiltration behavior into the tissue accompanied by increasing cell death and penetration depth. The successful deposition of zwitterionic hydrogels within OA cartilage identifies the infiltration method as a potential future therapeutic option for the repair/replacement of OA-cartilage extracellular suprastructure. Due to the toxic effects of the monomer solutions, the focus should be on sealing the OA-cartilage surface, instead of complete infiltration. An alternative treatment option for focal cartilage defects could be the usage of monomer solutions, especially the novel generated sulfobetaine-methacrylate-based monomer solution, as bionic for cell-based 3D bioprintable hydrogels.
BACKGROUND: Thrombosis remains a critical complication during venovenous extracorporeal membrane oxygenation (VV ECMO). The involvement of neutrophil extracellular traps (NETs) in thrombogenesis has to be discussed. The aim was to verify NETs in the form of cell-free DNA (cfDNA) in the plasma of patients during ECMO.
METHODS: A fluorescent DNA-binding dye (QuantifFluor®, Promega) was used to detect cell-free DNA in plasma samples. cfDNA concentrations from volunteers (n = 21) and patients (n = 9) were compared and correlated with clinical/technical data before/during support, ECMO end and time of a system exchange.
RESULTS: Before ECMO, patients with a median (IQR) age of 59 (51/63) years, SOFA score of 11 (10/15), and ECMO run time of 9.0 (7.0/19.5) days presented significantly higher levels of cfDNA compared to volunteers (6.4 (5.8/7.9) ng/μL vs. 5.9 (5.4/6.3) ng/μL; p = 0.044). Within 2 days after ECMO start, cfDNA, inflammatory, and hemolysis parameters remained unchanged, while platelets decreased (p = 0.005). After ECMO removal at the end of therapy, cfDNA, inflammation, and coagulation data (except antithrombin III) remained unchanged. The renewal of a system resulted in known alterations in fibrinogen, d-dimers, and platelets, while cfDNA remained unchanged.
CONCLUSION: Detection of cfDNA in plasma of ECMO patients was not an indicator of acute and circuit-induced thrombogenesis.
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.
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.
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.
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.
Im Rahmen des Projektes AUT-1A wurden 123 Arbeitgeber*innen mittels Fragebogen zu ihren Erfahrungen mit der Beschäftigung von autistischen Mitarbeiter*innen befragt. Ziel war es, die beschäftigungsfördernden und -hindernden Faktoren herauszuarbeiten. Die Studie deutet darauf hin, dass sich die berufliche Qualifizierung in den Berufsbildungswerken positiv auf die nachhaltige Beschäftigung von Menschen mit Autismus-Spektrum-Diagnose (ASD) auswirkt, die Unterstützungsleistungen für Betriebe aber noch nicht hinreichend sind. Auch konnte eine mangelnde Aufklärung in Bezug auf eine autismusfreundliche Umgebungsgestaltung sowie eine mangelnde Aufklärung über die Diagnose Autismus der direkten Kolleg*innen herausgearbeitet werden.