Lebenswissenschaften und Ethik
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Purpose
We present a systematic Bayesian formulation of the stochastic localization/triangulation problem close to constraining interfaces.
Methods
For this purpose, the terminology of Bayesian estimation is summarized suitably for applied researchers including the presentation of Maximum Likelihood (ML), Maximum A Posteriori (MAP), and Minimum Mean Square Error (MMSE) estimation. Explicit estimators for triangulation are presented for the linear 2D parallel beam and the nonlinear 3D cone beam model. The priors in MAP and MMSE optionally incorporate (A) the hard constraints about the interface and (B) knowledge about the probability of the object with respect to the interface. All presented estimators are compared in several simulation studies for live acquisition scenarios with 10,000 samples each.
Results
First, the presented application shows that MAP and MMSE perform considerably better, leading to lower Root Mean Square Errors (RMSEs) in the simulation studies compared to the ML approach by typically introducing a bias. Second, utilizing priors including (A) and (B) is very beneficial compared to just including (A). Third, typically MMSE leads to better results than MAP, by the cost of significantly higher computational effort.
Conclusion
Depending on the specific application and prior knowledge, MAP and MMSE estimators strongly increase the estimation accuracy for localization close to interfaces.
One of the main goals in reconstructing rotator cuff tears is the restoration of glenohumeral joint stability, which is subsequently of utmost importance in order to prevent degenerative damage such as superior labral anterior posterior (SLAP) lesion, arthrosis, and malfunction. The goal of the current study was to facilitate musculoskeletal models in order to estimate glenohumeral instability introduced by muscle weakness due to cuff lesions. Inverse dynamics simulations were used to compute joint reaction forces for several static abduction tasks with different muscle weakness. Results were compared with the existing literature in order to ensure the model validity. Further arm positions taken from activities of daily living, requiring the rotator cuff muscles were modeled and their contribution to joint kinetics computed. Weakness of the superior rotator cuff muscles (supraspinatus; infraspinatus) leads to a deviation of the joint reaction force to the cranial dorsal rim of the glenoid. Massive rotator cuff defects showed higher potential for glenohumeral instability in contrast to single muscle ruptures. The teres minor muscle seems to substitute lost joint torque during several simulated muscle tears to maintain joint stability. Joint instability increases with cuff tear size. Weakness of the upper part of the rotator cuff leads to a joint reaction force closer to the upper glenoid rim. This indicates the comorbidity of cuff tears with SLAP lesions. The teres minor is crucial for maintaining joint stability in case of massive cuff defects and should be uprated in clinical decision-making.
Thoracolumbar spine model with articulated ribcage for the prediction of dynamic spinal loading
(2016)
Musculoskeletal modeling offers an invaluable insight into the spine biomechanics. A better understanding of thoracic spine kinetics is essential for understanding disease processes and developing new prevention and treatment methods. Current models of the thoracic region are not designed for segmental load estimation, or do not include the complex construct of the ribcage, despite its potentially important role in load transmission. In this paper, we describe a numerical musculoskeletal model of the thoracolumbar spine with articulated ribcage, modeled as a system of individual vertebral segments, elastic elements and thoracic muscles, based on a previously established lumbar spine model and data from the literature. The inverse dynamics simulations of the model allow the prediction of spinal loading as well as costal joints kinetics and kinematics. The intradiscal pressure predicted by the model correlated well (R2=0.89) with reported intradiscal pressure measurements, providing a first validation of the model. The inclusion of the ribcage did not affect segmental force predictions when the thoracic spine did not perform motion. During thoracic motion tasks, the ribcage had an important influence on the predicted compressive forces and muscle activation patterns. The compressive forces were reduced by up to 32%, or distributed more evenly between thoracic vertebrae, when compared to the predictions of the model without ribcage, for mild thoracic flexion and hyperextension tasks, respectively. The presented musculoskeletal model provides a tool for investigating thoracic spine loading and load sharing between vertebral column and ribcage during dynamic activities. Further validation for specific applications is still necessary.
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.
In recent years, our society faced a massive interconnection of computer-based everyday objects, which opens these items for cyber-attacks. Dependent on the physical capabilities, successful attacks can vary from data exposure or a loss of functionality to a threat to life and limb. Connected- and autonomous vehicles are extremely safety-critical systems with a huge damage potential. This global trend, together with existing and upcoming regulations (ISO 270xx, ISO 21434, UNECE WP.29, UNECE R155), and the lack of qualified professionals create a tension field for the entire automotive industry.
Hence, new education concepts for engineers of safety-critical and connected systems are necessary to secure our daily and future systems against cyber-attacks and raise awareness and knowledge of the topic of IT-Security. Existing automotive security education systems have one common problem: All systems are hardware-based and therefore have very steep learning curves for beginners. Hardware-based systems, in general, are expensive in their initial costs, require regular maintenance, and add diverse operational difficulties independent of the aspired education goal. Additionally, the global pandemic increased the necessity of virtual education concepts for security training in cyber-physical systems.
Therefore, we present a novel concept for the education of cyber-security professionals for automotive systems based on discovery and problem-based learning in a virtual learning environment (VLE). Our concept contains individual exercises focusing on the topics of vulnerabilities and attacks in automotive networks and systems. Each exercise relates those topics to the corresponding security goals and countermeasures for mitigation. The learners work collaboratively in a self-contained manner within the VLE to acquire the necessary information to answer questions or find a solution to the given problem. To consider the heterogeneous background (e.g. knowledge, experience, preconceptions) of the learners, the topics can be presented in different difficulties, enabling an adaptable learning environment and different learning trajectories within the exercises.
The concept is based on a VLE, consisting of automotive networks and components, which simulate the behavior of a vehicle. This environment provides a hands-on, "real-life" scenario, which allows discovery and problem-based learning in a realistic, but cheap and scalable education environment. Furthermore, virtualization removes common difficulties, always present in training on real hardware. This aims to decrease complexity, prevent learning obstacles related to hardware handling, and enables a location-independent learning environment.
The target group of our education concept is Bachelor and Master students of computer science, engineering (e.g. electrical engineering, mechatronics), or similar studies, and (experienced) engineers from the industry.
In summary, our publication contains two contributions. We present an adaptable virtual learning environment for automotive security education, combined with an educational concept based on discovery and problem-based learning techniques. The goals of our concept are the education of cyber-security professionals for safety-critical, connected automotive systems and the support of life-long learning reaching from academic education to training in the industry.
The professional requirements in Software Engineering have become highly volatile due to the complexities of project development and rapid and innovative changes occurring in the field. Therefore, the development of inter-personal and social competences has gained central importance in the training of software developers. This paper will present a concept allowing to acquire competences by using Case Method and Role Play as instruments in several lectures of Software Engineering. By approaching the issue of competence acquisition on a technical as well as on an educational and social level, life-long learning is facilitated and supported.
Purpose
This paper aims to investigate the foreclosure discount for the German residential market in the years from 2008 to 2011.
Design/methodology/approach
The determinants of the foreclosure discount are estimated in a hedonic price model. The analysis is based on a unique data set compiled from three different data sources with 135,000 foreclosed properties.
Findings
The findings reveal that residential units in foreclosures are sold at a discount of 19 per cent compared to residential units with similar characteristics that are not in foreclosure. Second, a regional pattern can be observed, with discounts being negatively correlated to unemployment risk and liquidity. Third, the model with interaction terms shows that foreclosure discounts are linked to specific property characteristics. Fourth, these object-related risks are typically smaller than regional risks or locational risks.
Research limitations/implications
Given the highly fragmented system of Gutachterausschusse in Germany, who are responsible for collecting transaction data, we were not able to directly analyze transaction data, but only a proxy for this price information.
Practical implications
The results can be important for financial institutions that are trying to assess the risk of lending for a specific object in a specific location. So far, banks primarily try to assess the default risk of private lenders by analyzing the debtor's financial position and the quality of the property. The analysis provides insights into which characteristics of a property might imply additional risk, and in which region these risks are biggest.
Originality/value
To the best of the authors' knowledge, this is the first attempt to analyze the foreclosure discount for the German housing market.
As a result of increasing globalisation, universities are being confronted by the challenge of adapting their teaching standards to meet the demands of a more dynamic labour market. Entrepreneurship education provides an important contribution to improving students ́ entrepreneurial competencies and stimulating innovative work behaviour. Based on the current state of research, as well as on the results of an empirical comparative study at partner institutions of applied sciences, this article describes how the internationalisation of curricula with regards to the academic teaching of entrepreneurship and the promotion of entrepreneurial competence can be structured. An online survey of students carried out within the framework of an EU project, as well as joint class observations, revealed some important differences in study-related matters, which emphasises the need for stronger cooperation in terms of cross-border employability. With regards to the promotion of entrepreneurial thinking and behaviour, it appears appropriate to intensify the use of case-based instructional designs within teaching standards, to extend the supportive offers to students and to enable engagement with entrepreneurship in various courses of studies.
Writing, with no doubt, is besides reading a core competency which allows us to "exploit" knowledge in general. It also makes possible the exploration of software engineering's core issues. Especially within this context it is necessary to master the reading of complex texts as well as to be able to write in an appropriate academic expression. With regard to studies in software engineering this seems to be obvious, but in fact the opposite is the reality. Therefore measures to improve these skills seemed to be necessarily applied. At the Ostbayerische Technische Hochschule (OTH, University of Applied Sciences, Regensburg) a new format, the so called c*lab, was installed during the winter semester 2017. This was a course which followed the principle of "Writing Across the Curriculum" (WAC). Organized parallel to a lecture of learning how to program the language C, and addressing students of the first semester, the course was a complete voluntary offer in addition to the general standard courses and lectures of the faculty. Students who participated not only reflected on C and its principles, nor only on writing as a self purpose, but they also learned to express technical thoughts and ideas by the use of didactic methods. The idea to transfer also basic LTeX concepts to write a paper based on the IEEE bare_conf.tex-template were also planned. The course followed the idea of student's-centred learning. This paper presents the main structure, goals, and means of the c*lab, and the theory behind. It also embeds the course within the horizon of experiences of teaching writing skills at the Laboratory for Safe and Secure Systems (LaS 3 ) at the faculty of electronic and information engineering at the OTH Regensburg. First experiences have shown that participants increase writing skills and their idea of the importance of writing.
Purpose
The complexity of the treatment techniques IMRT (Intensity Modulated Radiation Therapy) and VMAT (Volumetric Modulated Arc Therapy) introduced the requirement of an individual plan verification. The latest development is 3D verification which allows evaluation in terms of 3D gamma values but also a judgment based on differences in dose distributions on individual patient CT data and in dose volume histograms. For a verification tool the error detection sensitivity is important. The purpose of this work is to evaluate the accuracy and the sensitivity of the gamma evaluation of the 3D verification software MobiusFx when a systematic error in one parameter is applied. The results are compared to an established 2D-measurement based method.
Methods
11 IMRT and 11 VMAT plans were selected as reference plans. For every reference plan a systematic offset of 1 mm, 2 mm and 3 mm in the same direction was applied to the Multi-Leaf-Collimator (MLC) positions. All plans were irradiated and verified simultaneously with MobiusFx and MatriXX Evolution 2D array measurement. For both verification systems the applied dose distributions were evaluated using the gamma method based on the reference plans. In MobiusFx additionally the MLC position errors were evaluated.
Results
Regarding the gamma evaluation results, MobiusFx and MatriXX Evolution 2D measurements have almost the same sensitivity: The gamma evaluation of both systems detected shifts of 1 mm in VMAT plans and shifts of 2 mm and larger in IMRT plans. The information of the MLC position error provided by MobiusFx allows further to detect errors down to a shift of 1 mm in IMRT plans, giving an advantage over the MatriXX measurement.
Conclusions
MobiusFx shows a high error detection sensitivity, comparable to MatriXX Evolution. Through the gamma calculation and the MLC position error it is possible to detect errors down to a shift in MLC positions of 1 mm. It is recommended to inspect all the above parameters during plan verification.
Results of WICOVIR Gargle Pool PCR Testing in German Schools Based on the First 100,000 Tests
(2021)
Background:
Opening schools and keeping children safe from SARS-CoV-2 infections at the same time is urgently needed to protect children from direct and indirect consequences of the COVID-19 pandemic. To achieve this goal, a safe, efficient, and cost-effective SARS-CoV-2 testing system for schools in addition to standard hygiene measures is necessary.
Methods:
We implemented the screening WICOVIR concept for schools in the southeast of Germany, which is based on gargling at home, pooling of samples in schools, and assessment of SARS-CoV-2 by pool rRT-PCR, performed decentralized in numerous participating laboratories. Depooling was performed if pools were positive, and results were transmitted with software specifically developed for the project within a day. Here, we report the results after the first 13 weeks in the project.
Findings:
We developed and implemented the proof-of-concept test system within a pilot phase of 7 weeks based on almost 17,000 participants. After 6 weeks in the main phase of the project, we performed >100,000 tests in total, analyzed in 7,896 pools, identifying 19 cases in >100 participating schools. On average, positive children showed an individual CT value of 31 when identified in the pools. Up to 30 samples were pooled (mean 13) in general, based on school classes and attached school staff. All three participating laboratories detected positive samples reliably with their previously established rRT-PCR standard protocols. When self-administered antigen tests were performed concomitantly in positive cases, only one of these eight tests was positive, and when antigen tests performed after positive pool rRT-PCR results were already known were included, 3 out of 11 truly positive tests were also identified by antigen testing. After 3 weeks of repetitive WICOVIR testing twice weekly, the detection rate of positive children in that cohort decreased significantly from 0.042 to 0.012 (p = 0.008).
Interpretation:
Repeated gargle pool rRT-PCR testing can be implemented quickly in schools. It is an effective, valid, and well-received test system for schools, superior to antigen tests in sensitivity, acceptance, and costs.
Survey practitioners regularly face the task to draw a sample from a (sub-) population for which no sampling frame exists. Indirect sampling might be a way out in such situations, given that connections exist between the target population and another population for which probability sampling is feasible. While the theory of indirect sampling originated in the context of household panel studies, a wider area of applications emerged during the last decade. We first give a short review of the theory of indirect sampling, show that estimators from indirect samples might have smaller variance than the corresponding direct estimators (contrary to some claims in the literature), summarize recent applications and discuss some issues that are relevant for applying indirect sampling in practice. We also present some theory for unbiased estimation after an additional subsampling stage that was necessary for sampling kindergarten children in the German National Educational Panel Study (NEPS).
Choosing wisely in Germany - adapting an international initiative to a national healthcare agenda
(2016)
Overuse and underuse in healthcare is a chronic problem in most healthcare systems. Inspired by the North American Choosing Wisely Initiative, the Association of Scientific Medical Societies in Germany (AWMF), which actually counts 173 member organisations, decided to address the problem. The aim of the German “Gemeinsam klug entscheiden” (deciding together wisely)-initiative is to reduce overuse, underuse and misuse of health interventions in areas where recommendations of clinical practice guidelines (CPG) are not adequately implemented or missing. Starting point are the positive and negative recommendations of the CPGs, which the AWMF-member societies have developed for more than 20 years, following the manual and rules set up by AWMF. To identify and select recommendations methodological criteria have been developed by a working group in a consensus-based process. The development of AWMF-CPGs follows a methodology that aims to ensure the full integration of evidence, an interdisciplinary and interprofessional perspective, the prevention of bias as a consequence of conflicts of interest and full transparency of the development process.
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.
Background:
Reliable, time- and cost-effective, and clinician-friendly diagnostic tools are cornerstones in facial palsy (FP) patient management. Different automated FP grading systems have been developed but revealed persisting downsides such as insufficient accuracy and cost-intensive hardware. We aimed to overcome these barriers and programmed an automated grading system for FP patients utilizing the House and Brackmann scale (HBS).
Methods:
Image datasets of 86 patients seen at the Department of Plastic, Hand, and Reconstructive Surgery at the University Hospital Regensburg, Germany, between June 2017 and May 2021, were used to train the neural network and evaluate its accuracy. Nine facial poses per patient were analyzed by the algorithm.
Results:
The algorithm showed an accuracy of 100%. Oversampling did not result in altered outcomes, while the direct form displayed superior accuracy levels when compared to the modular classification form (n = 86; 100% vs. 99%). The Early Fusion technique was linked to improved accuracy outcomes in comparison to the Late Fusion and sequential method (n = 86; 100% vs. 96% vs. 97%).
Conclusions:
Our automated FP grading system combines high-level accuracy with cost- and time-effectiveness. Our algorithm may accelerate the grading process in FP patients and facilitate the FP surgeon’s workflow.
Background:
With the prevalence of burnout among surgeons posing a significant threat to healthcare outcomes, the mental toughness of medical professionals has come to the fore. Mental toughness is pivotal for surgical performance and patient safety, yet research into its dynamics within a global and multi-specialty context remains scarce. This study aims to elucidate the factors contributing to mental toughness among surgeons and to understand how it correlates with surgical outcomes and personal well-being.
Methods:
Utilizing a cross-sectional design, this study surveyed 104 surgeons from English and German-speaking countries using the Mental Toughness Questionnaire (MTQ-18) along with additional queries about their surgical practice and general life satisfaction. Descriptive and inferential statistical analyses were applied to investigate the variations in mental toughness across different surgical domains and its correlation with professional and personal factors.
Results:
The study found a statistically significant higher level of mental toughness in micro-surgeons compared to macro-surgeons and a positive correlation between mental toughness and surgeons' intent to continue their careers. A strong association was also observed between general life satisfaction and mental toughness. No significant correlations were found between the application of psychological skills and mental toughness.
Conclusion:
Mental toughness varies significantly among surgeons from different specialties and is influenced by professional dedication and personal life satisfaction. These findings suggest the need for targeted interventions to foster mental toughness in the surgical community, potentially enhancing surgical performance and reducing burnout. Future research should continue to explore these correlations, with an emphasis on longitudinal data and the development of resilience-building programs.
Thinking like a Lawyer - Human Rights and Their Association with the Plastic Surgeon of Today
(2022)
Plastic surgeons are trained to perform a wide repertoire of surgeries-ranging from standard local procedures to highly specialized operations. Therefore, plastic surgeons treat a plethora of clinical presentations and address multiple patient needs. Their daily workflow is increasingly entwined with legal topics. The concrete legal
interpretation falls within the remit of legal experts.
However, by understanding the legal basics of selected surgical procedures, plastic surgeons may generate synergies in patient care and clinical practice. The legal situation is to be elucidated based on the German Basic Law (GBL) and the European Convention on Human Rights
(ECHR).
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.
Academic self-regulation is a key factor for motivation and learning achievement. Yet with the large range of individual factors, this is not a one-size-fits-all proposition. This study of L2 Technical English students at two German universities explored learners’ expectations and motivations, in particular regarding self-regulation and self-efficacy via the individual’s time investment in self-led study. In an initial survey, learners (N=1646) reported on their English skill levels and anticipated learning habits. Complementarily, the retrospective survey investigated learners’ (N=796) actual behavior during the course, their perceptions of language skill improvement, and their satisfaction. The initial survey indicates a clear understanding that time investment in self-regulated study will lead to greater improvement, an outcome confirmed in the retrospective survey. Additionally, students who invested more time in their coursework were more satisfied with their achievement, although most learners acknowledge they should have studied more. The results verify that learners recognize the nexus between self-regulation and language skill improvement, yet university students are not satisfied with their capacity to self-regulate their language learning strategies. While differences in students’ skill levels and academic self-efficacy result in divergent degrees of progress, students of all types report benefits to their language skills when motivated to self-regulated study.
Academic self-regulation is a key factor for motivation and learning achievement. Yet with the large range of individual factors, this is not a one-size-fits-all proposition. This study of L2 Technical English students at two German universities explored learners’ expectations and motivations, in particular regarding self-regulation and self-efficacy via the individual’s time investment in self-led study. In an initial survey, learners (N=1646) reported on their English skill levels and anticipated learning habits. Complementarily, the retrospective survey investigated learners’ (N=796) actual behavior during the course, their perceptions of language skill improvement, and their satisfaction. The initial survey indicates a clear understanding that time investment in self-regulated study will lead to greater improvement, an outcome confirmed in the retrospective survey. Additionally, students who invested more time in their coursework were more satisfied with their achievement, although most learners acknowledge they should have studied more. The results verify that learners recognize the nexus between self-regulation and language skill improvement, yet university students are not satisfied with their capacity to self-regulate their language learning strategies. While differences in students’ skill levels and academic self-efficacy result in divergent degrees of progress, students of all types report benefits to their language skills when motivated to self-regulated study.
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.
Biological applications like vesicle membrane analysis involve the precise segmentation of 3D structures in noisy volumetric data, obtained by techniques like magnetic resonance imaging (MRI) or laser scanning microscopy (LSM). Dealing with such data is a challenging task and requires robust and accurate segmentation methods. In this article, we propose a novel energy model for 3D segmentation fusing various cues like regional intensity subdivision, edge alignment and orientation information. The uniqueness of the approach consists in the definition of a new anisotropic regularizer, which accounts for the unbalanced slicing of the measured volume data, and the generalization of an efficient numerical scheme for solving the arising minimization problem, based on linearization and fixed-point iteration. We show how the proposed energy model can be optimized globally by making use of recent continuous convex relaxation techniques. The accuracy and robustness of the presented approach are demonstrated by evaluating it on multiple real data sets and comparing it to alternative segmentation methods based on level sets. Although the proposed model is designed with focus on the particular application at hand, it is general enough to be applied to a variety of different segmentation tasks.
Small and medium-sized enterprises (SMEs) increasingly need to manage nformation technology (IT) effectively in order to remain competitive. However, compared to larger organizations, SMEs often face challenges in terms of resources and employer attractiveness, and regularly do not have the need to employ a Chief Information Officer (CIO) on a full-time basis. To address this issue, a growing number of global experts have begun to provide CIO services on a part-time basis for multiple clients simultaneously. This approach allows SMEs to tap into the expertise of experienced IT leaders at a fraction of the cost and without committing to long-term arrangements. While these professionals, known as “Fractional CIOs”, have proven their value in the field, there has been a lack of academic research on this emerging trend. Therefore, we carried out a comprehensive research project between 2020 and 2023, involving 62 Fractional CIOs from 10 countries. The research produced a definition, different types of engagements, and success factors for Fractional CIOs and their engagements. This paper summarizes these findings for a wider audience of academics and practitioners.
Accurate and reliable information about three-dimensional (3D) knee joint laxity can prevent misdiagnosis and avoid incorrect treatments. Nevertheless, knee laxity assessments presented in the literature suffer from significant drawbacks such as soft tissue artifacts, restricting the knee within the measurement, and the absence of quantitative knee ligament property information. In this study, we demonstrated the applicability of a novel methodology for measuring 3D knee laxity, combining robotics- and image-based technology. As such technology has never been applied to healthy living subjects, the aims of this study were to develop novel technology to measure 3D knee laxity in vivo and to provide proof-of-concept 3D knee laxity measurements. To measure tibiofemoral movements, four healthy subjects were placed on a custom-built arthrometer located inside a low dose biplanar X-ray system with an approximately 60 deg knee flexion angle. Anteroposterior and mediolateral translation as well as internal and external rotation loads were subsequently applied to the unconstrained leg, which was placed inside a pneumatic cast boot. Bone contours were segmented in the obtained X-rays, to which subject-specific bone geometries from magnetic resonance imaging (MRI) scans were registered. Afterward, tibiofemoral poses were computed. Measurements of primary and secondary laxity revealed considerable interpersonal differences. The method differs from those available by the ability to accurately track secondary laxity of the unrestricted knee and to apply coupled forces in multiple planes. Our methodology can provide reliable information for academic knee ligament research as well as for clinical diagnostics in the future.
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.
This paper presents experiences with a digitalized concept for teaching control theory as minor subject with an integrated approach for lectures, exercises and practical sessions in the department of electrical engineering at the OTH Regensburg. The concept uses activating methods like blended learning and possibilities of digitalization of teaching implementing Just in Time Teaching and Peer Instruction. The basis for the new concept is the idea of constructive alignment. Furthermore this paper presents feedback from the students along with an accompanying scientific research over several semesters focusing on the development over past semesters.
The progress of medical genetics leads to a significant increase in genetic knowledge and a vast expansion of genetic diagnostics. However, it is still unknown how these changes will be integrated into medical practice and how they will change patients' and healthy persons' perception and evaluation of genetic diagnoses and genetic knowledge. Therefore, we carried out a comprehensive questionnaire survey with more than 500 patients, clients seeking genetic counseling, health care staff, and healthy persons (N = 523). The questionnaire survey covered detailed questions on the value of genetic diagnoses for the different groups of study participants, the right to know or not to know genetic diagnoses, possible differences between genetic and other medical diagnoses, and the practical use and implications of genetic knowledge with a special focus on hereditary neuropsychiatric diseases. A huge majority of the participants (90.7%) stated to have a right to learn every aspect of her or his genetic make-up. Similarly, study participants showed high interest (81.8%) in incidental health care findings-independent of whether the diseases are treatable or not. One can derive from the data outcome that study participants did not follow the implications of a "genetic exceptionalism" and often considered genetic findings as equivalent in relation to other medical diagnoses.
We propose a new permanent magnet system for Kibble balance experiments, which combines advantages of the magnet designs invented by the National Physical Laboratory (NPL) and by the Bureau International des Poids et Mesures (BIPM). The goal of the proposed magnet system is to minimize the coil-current effect and to optimize the shielding at the same time. In the proposed design, a permanent magnet system with two gaps, each housing a coil, is employed to minimize the coil current effect, by reducing the linear coil-current dependence reported for the single air gap design by at least one order of magnitude. Both air gaps of the magnet are completely surrounded by high-permeability material, and hence the coils are shielded from outside magnetic fields and no magnetic field leaks outside of the magnet system. An example of the new magnet system is given and the analysis shows that the magnetic field in the air gap can be optimized to meet the requirement to be used in Kibble balances.
Hintergrund
Inhalte von Public Health werden in Deutschland in gesundheitsbezogenen Studiengängen an Hochschulen und Universitäten gelehrt. Ziel dieser Studie war es, Daten zur Lehre und zur Kooperation von Lehrenden von Public Health in gesundheitsbezogenen Studiengängen in Deutschland zur Verfügung zu stellen.
Methode
Eine Querschnittsuntersuchung wurde online-basiert vom 01.06. bis 15.09.2015 an 93 Hochschulen/Universitäten in Deutschland mit 351 Studiengangsverantwortlichen aus gesundheitsbezogenen Studiengängen durchgeführt. Einbezogen wurden Public Health Studiengänge und gesundheitsbezogene Studiengänge, deren Hochschulen bzw. Universitäten entweder Mitglied in der "Deutschen Gesellschaft für Sozialmedizin und Prävention" (DGSMP) oder in der Gesellschaft "Hochschulen für Gesundheit" (HOGE) sind. Teilgenommen an dieser Studie haben N=104 Studiengangsverantwortliche (43% Männer, 57% Frauen). In Public Health Studiengängen wurden „Global Health" und "Umwelt und Gesundheit" als Studieninhalte häufiger als in gesundheitsbezogenen Studiengängen benannt; in gesundheitsbezogenen Studiengängen wurden häufiger "Ethik" und "Gesundheitspsychologie" als Lehrinhalte benannt. Finanzielle Unterstützungen durch die Hochschulen/ Universitäten sowie strukturierte Partnerschaften zwischen Hochschulen und/ oder Universitäten werden von Lehrenden an Hochschulen (36%) und an Universitäten (40%) gewünscht. Lehrende an Hochschulen wünschen darüber hinaus Promotionspartnerschaften.
Schlussfolgerung
Bisher gibt es in Deutschland keine einheitlichen fachlichen Qualitätskriterien für Absolvierende von Public Health bzw. gesundheitsbezogenen Studiengängen. Zudem gibt es nach Aussage der Studiengangsverantwortlichen dieser Studiengänge wenig Kooperation zwischen Lehrenden der Public Health bzw. der gesundheitsbezogenen Studiengänge.
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.
"Topographic Shift": a new digital approach to evaluating topographic changes of the female breast
(2021)
Purpose
To assess precise topographic changes of the breast, objective documentation and evaluation of pre- and postoperative results are crucial. New technologies for mapping the body using digital, three-dimensional surface measurements have offered novel ways to numerically assess the female breast. Due to the lack of clear demarcation points of the breast contour, the selection of landmarks on the breast is highly dependent on the examiner, and, therefore, is prone to error when conducting before-after comparisons of the same breast. This study describes an alternative to volumetric measurements, focusing on topographic changes of the female breast, based on three-dimensional scans.
Method
The study was designed as an interventional prospective study of 10 female volunteers who had planned on having aesthetic breast augmentation with anatomical, textured implants. Three dimensional scans of the breasts were performed intraoperatively, first without and then with breast implants. The topographic change was determined as the mean distance between two three-dimensional layers before and after augmentation. This mean distance is defined as the Topographic Shift. Results The mean implant volume was 283 cc (SD = 68.6 cc, range = 210-395 cc). The mean Topographic Shift was 7.4 mm (SD = 1.9 mm, range = 4.8-10.7 mm). The mean Topographic Shifts per quadrant were: I: 8.0 mm (SD = 3.3 mm); II: 9.2 mm (SD = 3.1 mm); III: 6.9 mm (SD = 3.5 mm); IV: 1.9 mm (SD = 4.3 mm).
Conclusion
The Topographic Shift, describing the mean distance between two three-dimensional layers (for example before and after a volume changing therapy), is a new approach that can be used for assessing topographic changes of a body area. It was found that anatomical, textured breast implants cause a topographic change, particularly on the upper breast, in quadrant II, the decollete.
In order to fix a fracture using minimally invasive surgery approaches, surgeons are drilling complex and tiny bones with a 2 dimensional X-ray as single imaging modality in the operating room. Our novel haptic force-feedback and visual assisted training system will potentially help hand surgeons to learn the drilling procedure in a realistic visual environment. Within the simulation, the collision detection as well as the interaction between virtual drill, bone voxels and surfaces are important. In this work, the chai3d collision detection and force calculation algorithms are combined with a physics engine to simulate the bone drilling process. The chosen Bullet-Physics-Engine provides a stable simulation of rigid bodies, if the collision model of the drill and the tool holder is generated as a compound shape. Three haptic points are added to the K-wire tip for removing single voxels from the bone. For the drilling process three modes are proposed to emulate the different phases of drilling in restricting the movement of a haptic device.
Background:
The aim of the study was to compare the two irradiation modes with (FF) and without flattening filter (FFF) for three different treatment techniques for simultaneous integrated boost radiation therapy of patients with right sided breast cancer.
Methods:
An Elekta Synergy linac with Agility collimating device is used to simulate the treatment of 10 patients. Six plans were generated in Monaco 5.0 for each patient treating the whole breast and a simultaneous integrated boost (SIB) volume: intensity modulated radiation therapy (IMRT), volumetric modulated arc therapy (VMAT) and a tangential arc VMAT (tVMAT), each with and without flattening filter. Plan quality was assessed considering target coverage, sparing of the contralateral breast, the lungs, the heart and the normal tissue. All plans were verified by a 2D-ionisation-chamber-array and delivery times were measured and compared. The Wilcoxon test was used for statistical analysis with a significance level of 0.05.
Results:
Significantly best target coverage and homogeneity was achieved using VMAT FFF with V95% = (98.7 +/- 0.8) % and HI = (8.2 +/- 0.9) % for the SIB and V95% = (98.3 +/- 0.7) % for the PTV, whereas tVMAT showed significantly lowest doses to the contralateral organs at risk with a D-mean of (0.7 +/- 0.1) Gy for the contralateral lung, (1.0 +/- 0.2) Gy for the contralateral breast and (1.4 +/- 0.2) Gy for the heart. All plans passed the gamma evaluation with a mean passing rate of (99.2 +/- 0.8) %. Delivery times were significantly reduced for VMAT and tVMAT but increased for IMRT, when FFF was used. Lowest delivery times were observed for tVMAT FFF with (1:20 +/- 0:07) min.
Conclusion:
Balancing target coverage, OAR sparing and delivery time, VMAT FFF and tVMAT FFF are considered the preferable of the investigated treatment options in simultaneous integrated boost irradiation of right sided breast cancer for the combination of an Elekta Synergy linac with Agility and the treatment planning system Monaco 5.0.
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.
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.
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.
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.
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.
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.
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.
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.
Musculoskeletal lower back load of accoucheurs during childbirth – A pilot and feasibility study
(2021)
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.
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.
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.
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.
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.
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.
This study presents a new measure of value systems, the Motivational Value Systems Questionnaire (MVSQ), which is based on a theory of value systems by psychologist Clare W. Graves. The purpose of the instrument is to help people identify their personal hierarchies of value systems and thus become more aware of what motivates and demotivates them in work-related contexts. The MVSQ is a forced-choice (FC) measure, making it quicker to complete and more difficult to intentionally distort, but also more difficult to assess its psychometric properties due to ipsativity of FC data compared to rating scales. To overcome limitations of ipsative data, a Thurstonian IRT (TIRT) model was fitted to the questionnaire data, based on a broad sample of <i>N</i> = 1,217 professionals and students. Comparison of normative (IRT) scale scores and ipsative scores suggested that MVSQ IRT scores are largely freed from restrictions due to ipsativity and thus allow interindividual comparison of scale scores. Empirical reliability was estimated using a sample-based simulation approach which showed acceptable and good estimates and, on average, slightly higher test-retest reliabilities. Further, validation studies provided evidence on both construct validity and criterion-related validity. Scale score correlations and associations of scores with both age and gender were largely in line with theoretically - and empirically-based expectations, and results of a multitrait-multimethod analysis supports convergent and discriminant construct validity. Criterion validity was assessed by examining the relation of value system preferences to departmental affiliation which revealed significant relations in line with prior hypothesizing. These findings demonstrate the good psychometric properties of the MVSQ and support its application in the assessment of value systems in work-related contexts.
The success of artificial intelligence in medicine is based on the need for large amounts of high quality training data. Sharing of medical image data, however, is often restricted by laws such as doctor-patient confidentiality. Although there are publicly available medical datasets, their quality and quantity are often low. Moreover, datasets are often imbalanced and only represent a fraction of the images generated in hospitals or clinics and can thus usually only be used as training data for specific problems. The introduction of generative adversarial networks (GANs) provides a mean to generate artificial images by training two convolutional networks. This paper proposes a method which uses GANs trained on medical images in order to generate a large number of artificial images that could be used to train other artificial intelligence algorithms. This work is a first step towards alleviating data privacy concerns and being able to publicly share data that still contains a substantial amount of the information in the original private data. The method has been evaluated on several public datasets and quantitative and qualitative tests showing promising results.
At risk of reproductive disadvantage? Exploring fertility awareness among migrant women in Germany
(2022)
This study examined awareness about fertility among immigrant women and non-migrants in Germany. The social relevance of infertility and fertility treatment is increasing in Western countries due to continually low overall birth rates, a high rate of childlessness, and a gap between the desired and actual numbers of children. While there is growing interest in infertility and reproductive medicine in general, previous studies have rarely included immigrant or ethnic minorities in Europe. This study investigated whether knowledge on the age-related fertility decline (ARFD) varies between migrant groups and the majority group, and the role of education. Working hypotheses were drawn from theoretical considerations on frameworks of migrant assimilation. The analysis was based on data collected in a social science pilot study on reproductive medicine, representative of the general population (‘NeWiRe’ 2014–2015). The sample included 962 women aged 18–50 years living in Germany. Approximately 81% of the sample were immigrants who originated from Turkey, Poland, the Balkan countries or countries of the (post-Soviet) Commonwealth of Independent States. While rather poor overall, knowledge on ARFD was found to be significantly lower in the migrant groups compared with the majority group. This minority-group disadvantage cannot be explained by sociodemographic or cultural variables. Future research should include minority groups in empirical studies on awareness about fertility in order to better understand the causes of this disadvantage, and the potential reproductive needs of migrants.
Physical inactivity is a problem in Europe, contributing to various non-communicable diseases (NCDs). While health sciences offer data and models for preventing the development of NCDs through health promotion, they do not explain the dynamics between the different institutions and actors in the health field. Neofunctionalism refers to these different actors and suggests that their interaction leads to the construction of a supranational authority, allowing the actors to cooperate on common policies, rules and institutions, resulting in integration and Europeanization. Indeed, there are a variety of European Union (EU) institutions and policies concerned with physical activity (PA), however, the purpose of this paper is to analyze if Europeanization and integration are happening in PA promotion, through the lens of neofunctionalism. Analysis uses process tracing for investigating the emergence of PA on the EU agenda, the legal background, existing policies and institutions. Findings indicate that Europeanization and integration of PA promotion are happening, although the opportunity for actions of the EU are restricted to voluntary actions of the EU Member States due to the agreements in the Treaty of Lisbon. This only allows the EU institutions to apply soft law approaches on PA promotion, which seems to be implemented in some Member States despite its non-binding character. The findings are discussed and further implications for public health professionals and policies outlined.
An amateur radio lecture was developed and is conducted within the general education program of the Ostbayerische Technische Hochschule Regensburg. This course enables the students to participate in a variety of activities within the university. Different learning formats for communication engineering are carried out in combination with an amateur radio station of the university. Additionally, some of the projects serve as anchor points for increased visibility of the university in local society, e.g. by carrying out public events in connection with the local amateur radio community. It is seen that this course together with the amateur radio station have several positive effects for technical education and university visibility.
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.
Purpose
Congenital breast asymmetry is a serious gynecological malformation for affected patients. The condition hits young women in puberty and is associated with socio-esthetic handicap, depression, and psychosexual problems. Surgical treatment is usually early in the patient's lifetime, so a long-term sustainable solution is important. Although postoperative outcome has been evaluated in several studies before, this study is the first to analyze which objective parameters have the greatest influence on subjective satisfaction with long-term results.
Methods
Thirty-four patients diagnosed with congenital breast asymmetry that underwent either lipofilling or implant therapy between the years of 2008 to 2019 were examined. On average, our collective comprised patients seven years after surgery. Data were mainly gathered through manual measurements, patient-reported outcome measures (Breast Q™), and breast volumetry based on 3D scans (Vectra® H2, Canfield Scientific).
Results
Among all analyzed parameters, only areolar diameter correlated significantly negatively with the subjective outcome satisfaction of the patient. Regarding the subjective assessment of postoperative satisfaction with similarity of the breasts, again the mean areolar diameter, but also the difference in areolar diameter and breast volume between the right and left breasts correlated significantly negatively.
Conclusion
Areolar diameter was revealed as being a significant factor influencing subjective long-term satisfaction in breast asymmetry patients. Moreover, 3D volumetry proves to be an effective tool to substantiate subjective patient assessments. Our findings may lead to further improvements to surgical planning and will be expanded in further studies.
Gemeinsam Klug Entscheiden – Initiative der AWMF und ihrer
Fachgesellschaften – ein Werkstattberich
(2017)
Gemeinsam Klug Entscheiden ist eine Initiative der AWMF und ihrer
Fachgesellschaften, mit dem Ziel, Empfehlungen zu Versorgungsaspek-
ten in die Versorgung zu bringen, für die ein großes Verbesserungspoten-
tial besteht. Der Impuls dafür wurde durch die TOP-5-Listen der Choosing
Wisely Kampagne gegeben. Ziel des Posters ist es das Vorgehen und die
Methodik für eine evidenzbasierte Entwicklung bekannt zu machen und
zu diskutieren im Hinblick auf Machbarkeit und Verbesserungspotential.
Introduction:
Neointimal hyperplasia after percutaneous coronary intervention remains a major determinant of in-stent restenosis (ISR). The extent of mechanical vessel injury correlates with ISR. A new ex vivo porcine stent model was introduced and evaluated comparing different stent designs.
Methods:
Coronary arteries were prepared from pig hearts from the slaughterhouse and used for ex vivo implantations of coronary stents. One basic stent design in two configurations (dogbone, DB; non-dogbone, NDB) was used. Vascular injury was determined according to a modified injury score (IS).
Results:
Standardized experimental conditions ensured comparable vessel dimensions and overstretch data. DB stents caused more severe IS compared to NDB stents. The mean IS and the IS at the distal end of all stents were significantly reduced for NDB stents (ISMean, DB, 1.16 ±0.12; NDB, 1.02 ±0.12; p=0.018; ISDist, DB, 1.39 ±0.28; NDB, 1.13 ±0.24; p=0.03).
Discussion/Conclusion:
The introduced ex-vivo model allowed the evaluation of different stent designs exclude unfavorable stent designs.
Metals are involved in many processes of life. They are needed for enzymatic reactions, are involved in healthy processes but also yield diseases if the metal homeostasis is disordered. Therefore, the interest to assess the spatial distribution of metals is rising in biomedical science. Imaging metal (and non-metal) isotopes by laser ablation mass spectrometry with inductively coupled plasma (LA-ICP-MS) requires a special software solution to process raw data obtained by scanning a sample line-by-line. As no software ready to use was available we developed an interactive software tool for Image Generation and Analysis (IMAGENA). Unless optimised for LA-ICP-MS, IMAGENA can handle other raw data as well. The general purpose was to reconstruct images from a continuous list of raw data points, to visualise these images, and to convert them into a commonly readable image file format that can be further analysed by standard image analysis software. The generation of the image starts with loading a text file that holds a data column of every measured isotope. Specifying general spatial domain settings like the data offset and the image dimensions is done by the user getting a direct feedback by means of a preview image. IMAGENA provides tools for calibration and to correct for a signal drift in the y-direction. Images are visualised in greyscale as well a pseudo-colours with possibilities for contrast enhancement. Image analysis is performed in terms of smoothed line plots in row and column direction.
Brain lesions in language-related cortical areas remain a challenge in the clinical routine. In recent years, the resting-state fMRI (RS-fMRI) was shown to be a feasible method for preoperative language assessment. The aim of this study was to examine whether language-related resting-state components, which have been obtained using a data-driven independent-component-based identification algorithm, can be supportive in determining language dominance in the left or right hemisphere. Twenty patients suffering from brain lesions close to supposed language-relevant cortical areas were included. RS-fMRI and task-based (TB-fMRI) were performed for the purpose of preoperative language assessment. TB-fMRI included a verb generation task with an appropriate control condition (a syllable switching task) to decompose language-critical and language-supportive processes. Subsequently, the best fitting ICA component for the resting-state language network (RSLN) referential to general linear models (GLMs) of the TB-fMRI (including models with and without linguistic control conditions) was identified using an algorithm based on the Dice index. Thereby, the RSLNs associated with GLMs using a linguistic control condition led to significantly higher laterality indices than GLM baseline contrasts. LIs derived from GLM contrasts with and without control conditions alone did not differ significantly. In general, the results suggest that determining language dominance in the human brain is feasible both with TB-fMRI and RS-fMRI, and in particular, the combination of both approaches yields a higher specificity in preoperative language assessment. Moreover, we can conclude that the choice of the language mapping paradigm is crucial for the mentioned benefits.
GinJinn: An object-detection pipeline for automated feature extraction from herbarium specimens
(2020)
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.
Polarised light imaging (PLI) utilises the birefringence of the myelin sheaths in order to visualise the orientation of nerve fibres in microtome sections of adult human post-mortem brains at ultra-high spatial resolution. The preparation of post-mortem brains for PLI involves fixation, freezing and cutting into 100-μm-thick sections. Hence, geometrical distortions of histological sections are inevitable and have to be removed for 3D reconstruction and subsequent fibre tracking. We here present a processing pipeline for 3D reconstruction of these sections using PLI derived multimodal images of post-mortem brains. Blockface images of the brains were obtained during cutting; they serve as reference data for alignment and elimination of distortion artefacts. In addition to the spatial image transformation, fibre orientation vectors were reoriented using the transformation fields, which consider both affine and subsequent non-linear registration. The application of this registration and reorientation approach results in a smooth fibre vector field, which reflects brain morphology. PLI combined with 3D reconstruction and fibre tracking is a powerful tool for human brain mapping. It can also serve as an independent method for evaluating in vivo fibre tractography.
The number of patients with Barret’s esophagus (BE) has increased in the last decades. Considering the dangerousness of the disease and its evolution to adenocarcinoma, an early diagnosis of BE may provide a high probability of cancer remission. However, limitations regarding traditional methods of detection and management of BE demand alternative solutions. As such, computer-aided tools have been recently used to assist in this problem, but the challenge still persists. To manage the problem, we introduce the infinity Restricted Boltzmann Machines (iRBMs) to the task of automatic identification of Barrett’s esophagus from endoscopic images of the lower esophagus. Moreover, since iRBM requires a proper selection of its meta-parameters, we also present a discriminative iRBM fine-tuning using six meta-heuristic optimization techniques. We showed that iRBMs are suitable for the context since it provides competitive results, as well as the meta-heuristic techniques showed to be appropriate for such task.
Background and objective:
In this work, we present a systematic review concerning the recent enabling technologies as a tool to the diagnosis, treatment and better quality of life of patients diagnosed with Parkinson's Disease (PD), as well as an analysis of future trends on new approaches to this end.
Methods:
In this review, we compile a number of works published at some well-established databases, such as Science Direct, IEEEXplore, PubMed, Plos One, Multidisciplinary Digital Publishing Institute (MDPI), Association for Computing Machinery (ACM), Springer and Hindawi Publishing Corporation. Each selected work has been carefully analyzed in order to identify its objective, methodology and results.
Results:
The review showed the majority of works make use of signal-based data, which are often acquired by means of sensors. Also, we have observed the increasing number of works that employ virtual reality and e-health monitoring systems to increase the life quality of PD patients. Despite the different approaches found in the literature, almost all of them make use of some sort of machine learning mechanism to aid the automatic PD diagnosis.
Conclusions:
The main focus of this survey is to consider computer-assisted diagnosis, and how effective they can be when handling the problem of PD identification. Also, the main contribution of this review is to consider very recent works only, mainly from 2015 and 2016.
Over the past decade, veno-venous extracorporeal membrane oxygenation (vvECMO) has been increasingly utilized in respiratory failure in patients. This study presents our institution´s experience focusing on the life span of ECMO systems reflecting the performance of a particular system. A retrospective review of our ECMO database identified 461 adult patients undergoing vvECMO (2010-2017). Patients that required more than one system and survived the first exchange >24 hours (n = 139) were included. Life span until the first exchange and exchange criteria were analyzed for all systems (PLS, Cardiohelp HLS-set, both Maquet Cardiopulmonary, Rastatt, Germany; Deltastream/Hilite7000LT, iLA-activve, Xenios/NovaLung, Heilbronn, Germany; ECC.O5, LivaNova, Mirandola, Italy). At our ECMO center, the frequency of a system exchange was 30%. The median (IQR) life span was 9 (6-12) days. There was no difference regarding the different systems (p = 0.145 and p = 0.108, respectively). However, the Deltastream systems were exchanged more frequently due to elective technical complications (e. g. worsened gas transfer, development of coagulation disorder, increased bleedings complications) compared to the other exchanged systems (p = 0.013). In summary, the used ECMO systems are safe and effective for acute respiratory failure. There is no evidence for the usage of a specific system. Only the increased predictability of an imminent exchange preferred the usage of a Deltastream system. However, the decision to use a particular system should not depend solely on the possible criteria for an exchange.
Patients with age-related macular degeneration (AMD) or hereditary macular dystrophies (JMD) rely on an efficient use of their peripheral visual field. We trained eight AMD and five JMD patients to perform a texture-discrimination task (TDT) at their preferred retinal locus (PRL) used for fixation. Six training sessions of approximately one hour duration were conducted over a period of approximately 3 weeks. Before, during and after training twelve patients and twelve age-matched controls (the data from two controls had to be discarded later) took part in three functional magnetic resonance imaging (fMRI) sessions to assess training-related changes in the BOLD response in early visual cortex. Patients benefited from the training measurements as indexed by significant decrease (p = 0.001) in the stimulus onset asynchrony (SOA) between the presentation of the texture target on background and the visual mask, and in a significant location specific effect of the PRL with respect to hit rate (p = 0.014). The following trends were observed: (i) improvement in Vernier acuity for an eccentric line-bisection task; (ii) positive correlation between the development of BOLD signals in early visual cortex and initial fixation stability (r = 0.531); (iii) positive correlation between the increase in task performance and initial fixation stability (r = 0.730). The first two trends were non-significant, whereas the third trend was significant at p = 0.014, Bonferroni corrected. Consequently, our exploratory study suggests that training on the TDT can enhance eccentric vision in patients with central vision loss. This enhancement is accompanied by a modest alteration in the BOLD response in early visual cortex.
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.
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.
The good availability and the large content of adult stem cells in adipose tissue has made it one of the most interesting tissues in regenerative medicine. Although lipofilling is one of the most frequent procedures in plastic surgery, the method still struggles with high absorption rates and volume losses of up to 70%. Therefore, many efforts have been made to optimize liposuction and to process the harvested tissue in order to increase fat graft retention. Because of their immunomodulatory properties, their cytokine secretory activity, and their differentiation potential, enrichment with adipose tissue-derived stem cells was identified as a promising tool to promote transplant survival. Here, we review the important parameters for lipofilling optimization. Finally, we present a new method for the enrichment of lipoaspirate with adipose tissue-derived stem cells and discuss the parameters that contribute to fat graft survival.
Background
There is a wide range of mechanical properties of spinal ligaments documented in literature. Due to the fact that ligaments contribute in stabilizing the spine by limiting excessive intersegmental motion, those properties are of particular interest for the implementation in musculoskeletal models. The aim of this study was to investigate the effect of varying ligament stiffness on the kinematic behaviour of the lumbar spine.
Methods
A musculoskeletal model with a detailed lumbar spine was modified according to fluoroscopic recordings and corresponding data files of three different subjects. For flexion, inverse dynamics analysis with a variation of the ligament stiffness matrix were conducted. The influence of several degrees of ligament stiffness on the lumbar spine model were investigated by tracking ligament forces, disc forces and resulting moments generated by the ligaments. Additionally, the kinematics of the motion segments were evaluated.
Results
An increase of ligament stiffness resulted in an increase of ligament and disc forces, whereas the relative change of disc force increased at a higher rate at the L4/L5 level (19 %) than at the L3/L4 (10 %) level in a fully flexed posture. The same behaviour applied to measured moments with 67 % and 45 %. As a consequence, the motion deflected to the lower levels of the lumbar spine and the lower discs had to resist an increase in loading.
Conclusions
Higher values of ligament stiffness over all lumbar levels could lead to a shift of the loading and the motion between segments to the lower lumbar levels. This could lead to an increased risk for the lower lumbar parts.
Musculoskeletal simulations of lumbar spine loading rely on a geometrical representation of the anatomy. However, this data has an inherent inaccuracy. This study evaluates the influence of defined geometrical parameters on lumbar spine loading utilising five parametrised musculoskeletal lumbar spine models for four different postures. The influence of the dimensions of vertebral body, disc, posterior parts of the vertebrae as well as the curvature of the lumbar spine was studied. Additionally, simulations with combinations of selected parameters were conducted. Changes in L4/L5 resultant joint force were used as outcome variable. Variations of the vertebral body height, disc height, transverse process width and the curvature of the lumbar spine were the most influential.
These parameters can be easily acquired from X-rays and should be used to morph a musculoskeletal lumbar spine model for subject-specific approaches with respect to bone geometry. Furthermore, the model was very sensitive to uncommon configurations and therefore, it is advised that stiffness properties of discs and ligaments should be individualised.
Celiac disease is an autoimmune disorder caused by gluten that results in an inflammatory response of the small intestine.We investigated whether celiac disease can be detected using endoscopic images through a deep learning approach. The results show that additional clinical parameters can improve the classification accuracy. In this work, we distinguished between healthy tissue and Marsh III, according to the Marsh score system. We first trained a baseline network to classify endoscopic images of the small bowel into these two classes and then augmented the approach with a multimodality component that took the antibody status into account.
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.
Osteoporosis is a common disease of old age. However, in many cases, it can be very well prevented and counteracted with physical activity, especially high-impact exercises. Wearables have the potential to provide data that can help with continuous monitoring of patients during therapy phases or preventive exercise programs in everyday life. This study aimed to determine the accuracy and reliability of measured acceleration data at different body positions compared to accelerations at the pelvis during different jumping exercises. Accelerations at the hips have been investigated in previous studies with regard to osteoporosis prevention. Data were collected using an IMU-based motion capture system (Xsens) consisting of 17 sensors. Forty-nine subjects were included in this study. The analysis shows the correlation between impacts and the corresponding drop height, which are dependent on the respective exercise. Very high correlations (0.83–0.94) were found between accelerations at the pelvis and the other measured segments at the upper body. The foot sensors provided very weak correlations (0.20–0.27). Accelerations measured at the pelvis during jumping exercises can be tracked very well on the upper body and upper extremities, including locations where smart devices are typically worn, which gives possibilities for remote and continuous monitoring of programs.
We aimed to investigate the relationship between postoperative leg length/offset (LL/OS) reconstruction and gait performance after total hip arthroplasty (THA). In the course of a prospective randomized controlled trial, 60 patients with unilateral hip arthrosis received cementless THA through a minimally-invasive anterolateral surgical approach. One year post-operatively, LL and global OS restoration were analyzed and compared to the contralateral hip on AP pelvic radiographs. The combined postoperative limb length/OS reconstruction of the operated hip was categorized as restored (within 5 mm) or non-restored (more than 5 mm reduction or more than 5 mm increment). The acetabular component inclination, anteversion and femoral component anteversion were evaluated using CT scans of the pelvis and the femur. 3D gait analysis of the lower extremity and patient related outcome measures (HHS, HOOS, EQ-5D) were obtained pre-operatively, six months and twelve months post-operatively by an observer blinded to radiographic results. Component position of cup and stem was comparable between the restored and non-restored group. Combined LL and OS restoration within 5 mm resulted in higher Froude number (p < 0.001), normalized walking speed (p < 0.001) and hip range-of-motion (ROM) (p = 0.004) during gait twelve months postoperatively, whereas gait symmetry was comparable regardless of LL and OS reconstruction at both examinations. Clinical scores did not show any relevant association between the accuracy of LL or OS reconstruction and gait six/twelve months after THA. In summary, postoperative LL/OS discrepancies larger than 5 mm relate to unphysiological gait kinematics within the first year after THA. DRKS00000739, German Clinical Trials Register.
This article presents results of the social-scientific evaluation of an established care model for people with dementia developed by the professionals as a result of acute problems in care in north-east Germany. In addition to the central elements of the model, the conditions of intersectoral and interprofessional cooperation as well as the qualification profile requirements of the professional groups involved are presented in detail. The results can give suggestions for the organization of integrated care for people with dementia in other countries. Further, the author would hereby like to highlight the gain from the scientific examination of solutions to problems in the field.
Defining Criteria for Guiding Cancer Patients to Find a Reputable Complementary Medicine Provider
(2020)
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.
By many accounts, the Newtonian constant of gravitation G is the fundamental constant that is most difficult to measure accurately. Over the past three decades, more than a dozen precision measurements of this constant have been performed. However, the scatter of the data points is much larger than the uncertainties assigned to each individual measurement, yielding a Birge ratio of about five. Today, G is known with a relative standard uncertainty of 4.7 x 10(-5), which is several orders of magnitudes greater than the relative uncertainties of other fundamental constants. In this article, various methods to measure G are discussed. Alarge array of different instruments ranging from the simple torsion balance to the sophisticated atom interferometer can be used to determine G. Some instruments, such as the torsion balance can be used in several different ways. In this article, the advantages and disadvantages of different instruments as well as different methods are discussed. A narrative arc from the historical beginnings of the different methods to their modern implementation is given. Finally, the article ends with a brief overview of the current state of the art and an outlook.
Old wine in new wineskins?
(2013)
In the mid 2000s, a fundamental labour market reform has been carried out in Germany. The so-called Hartz-reforms were supposed to implement the paradigms of “activation” and “individual responsibility”. It was also discussed, whether in this context the “adult worker model” and more gender equality in the labour market should and could be achieved. This article clarifies the reforms ambivalent impact on women: there is a stronger but only partial labour market inclusion predominantly into the low-wage sector. Women´s responsibility in private care remains unchanged. Besides, in both fields, gender equality is not only a matter of quantity but also of quality. In other words, it is not about work inclusion at any cost, but rather the circumstances for female employment must be critically analyzed. The labour market reforms have so far done little to oppose the gender specific structures of the labour market.
Digital nerve lesions result in a loss of tactile sensation reflected by an anesthetic area (AA) at the radial or ulnar aspect of the respective digit. Yet, available tools to monitor the recovery of tactile sense have been criticized for their lack of validity. However, the precise quantification of AA dynamics by three-dimensional (3-D) imaging could serve as an accurate surrogate to monitor recovery following digital nerve repair.
For validation, AAs were marked on digits of healthy volunteers to simulate the AA of an impaired cutaneous innervation. Three dimensional models were composed from raw images that had been acquired with a 3-D camera (Vectra H2) to precisely quantify relative AA for each digit (3-D models, n= 80). Operator properties varied regarding individual experience in 3-D imaging and image processing. Additionally, the concept was applied in a clinical case study.
Images taken by experienced photographers were rated better quality (p< 0.001) and needed less processing time (p= 0.020). Quantification of the relative AA was neither altered significantly by experience levels of the photographer (p= 0.425) nor the image assembler (p= 0.749).
The proposed concept allows precise and reliable surface quantification of digits and can be performed consistently without relevant distortion by lack of examiner experience. Routine 3-D imaging of the AA has the great potential to provide visual evidence of various returning states of sensation and to convert sensory nerve recovery into a metric variable with high responsiveness to temporal progress.
The endoscopic features associated with eosinophilic esophagitis (EoE) may be missed during routine endoscopy. We aimed to develop and evaluate an Artificial Intelligence (AI) algorithm for detecting and quantifying the endoscopic features of EoE in white light images, supplemented by the EoE Endoscopic Reference Score (EREFS). An AI algorithm (AI-EoE) was constructed and trained to differentiate between EoE and normal esophagus using endoscopic white light images extracted from the database of the University Hospital Augsburg. In addition to binary classification, a second algorithm was trained with specific auxiliary branches for each EREFS feature (AI-EoE-EREFS). The AI algorithms were evaluated on an external data set from the University of North Carolina, Chapel Hill (UNC), and compared with the performance of human endoscopists with varying levels of experience. The overall sensitivity, specificity, and accuracy of AI-EoE were 0.93 for all measures, while the AUC was 0.986. With additional auxiliary branches for the EREFS categories, the AI algorithm (AI-EoEEREFS) performance improved to 0.96, 0.94, 0.95, and 0.992 for sensitivity, specificity, accuracy, and AUC, respectively. AI-EoE and AI-EoE-EREFS performed significantly better than endoscopy beginners and senior fellows on the same set of images. An AI algorithm can be trained to detect and quantify endoscopic features of EoE with excellent performance scores. The addition of the EREFS criteria improved the performance of the AI algorithm, which performed significantly better than endoscopists with a lower or medium experience level.
Aims
Eosinophilic esophagitis (EoE) is easily missed during endoscopy, either because physicians are not familiar with its endoscopic features or the morphologic changes are too subtle. In this preliminary paper, we present the first attempt to detect EoE in endoscopic white light (WL) images using a deep learning network (EoE-AI).
Methods
401 WL images of eosinophilic esophagitis and 871 WL images of normal esophageal mucosa were evaluated. All images were assessed for the Endoscopic Reference score (EREFS) (edema, rings, exudates, furrows, strictures). Images with strictures were excluded. EoE was defined as the presence of at least 15 eosinophils per high power field on biopsy. A convolutional neural network based on the ResNet architecture with several five-fold cross-validation runs was used. Adding auxiliary EREFS-classification branches to the neural network allowed the inclusion of the scores as optimization criteria during training. EoE-AI was evaluated for sensitivity, specificity, and F1-score. In addition, two human endoscopists evaluated the images.
Results
EoE-AI showed a mean sensitivity, specificity, and F1 of 0.759, 0.976, and 0.834 respectively, averaged over the five distinct cross-validation runs. With the EREFS-augmented architecture, a mean sensitivity, specificity, and F1-score of 0.848, 0.945, and 0.861 could be demonstrated respectively. In comparison, the two human endoscopists had an average sensitivity, specificity, and F1-score of 0.718, 0.958, and 0.793.
Conclusions
To the best of our knowledge, this is the first application of deep learning to endoscopic images of EoE which were also assessed after augmentation with the EREFS-score. The next step is the evaluation of EoE-AI using an external dataset. We then plan to assess the EoE-AI tool on endoscopic videos, and also in real-time. This preliminary work is encouraging regarding the ability for AI to enhance physician detection of EoE, and potentially to do a true “optical biopsy” but more work is needed.
This paper focuses on the role of specific types of crisis (technological crisis, financial market crisis, natural disaster) and their effects on the demand for cash in an international context. As evidence from the last 30 years shows, demand for cash increases during periods of crisis, regardless of the nature of the crisis. The nature of the crisis does, however, determine whether small or large banknote denominations are affected more. This study finds that times of payment uncertainties are associated with increased demand for small denominations, probably reflecting an elevated demand for transaction balances. By contrast, in times of financial crisis or general economic uncertainty, the increased demand for cash is largely the result of consumers taking precautionary actions and building up non-transaction balances; for this reason, there is greater demand for large banknote denominations. This study finds that cash continues to play an important role in crisis management. Whether this function can also be fulfilled by a future central bank digital currency, however, remains to be seen.
The present paper provides an overview on current developments of cash usage and issue of central bank digital currency (CBDC) in the euro area and proposes a possible design of a digital euro that allows for instant offline payments. Cash usage at the point-of-sale decreased perceptibly in the past years mainly due to the ongoing trend towards digitalization. However, we show that there are also indications that consumers were somewhat pushed into cashless payments by government regulations and supply-side restrictions by commercial banks. Nonetheless, overall demand for euro cash remained strong and even increased relative to GDP since the financial crisis in 2008. In this process, however, we observe a supply-driven shift towards lower banknote denominations. Central banks all over the world are intensively thinking about the potential issue of CBDC as a substitute or complement to cash. Based on some of its preferred characteristics, we propose a double pre-paid scheme combining central elements of TARGET Instant Payment Settlement and electronic money features enabling offline and online instant payments. Since anonymity is categorically discarded by the ECB and as cash has some special advantages from a consumer perspective, the digital euro will rather co-circulate with cash than replace it in transactions.
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 and videos. In particular, the determination of the position and type of instruments is of great interest. Current work involves both spatial and temporal information, with the idea that predicting the movement of surgical tools over time may improve the quality of the 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 and characterize datasets used for method development and evaluation and 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 and videos. The paper focuses on methods that work purely visually, without markers of any kind attached to the instruments, considering both single-frame semantic and instance segmentation approaches, as well as those that incorporate temporal information. The publications analyzed 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”, resulting in a total of 741 articles published between 01/2015 and 07/2023, of which 123 were included using systematic selection criteria. A discussion of the reviewed literature is provided, highlighting existing shortcomings and emphasizing the available potential for future developments.
Biomechanical Analysis of the Right Elevated Glenohumeral Joint in Violinists during Legato-Playing
(2021)
BACKGROUND:
Many statistics reveal that violin players suffer most often from musculoskeletal disorders compared to musicians of other instrument groups. A common phenomenon, especially observed in violin beginners, is the tendency to elevate the right shoulder during playing the violin. This can probably lead to serious disorders in long-term practice with repetitive movements.
OBJECTIVE:
For this reason, this study investigated the relationship between the right shoulder elevation and the force in the right glenohumeral joint during violin playing. It was hypothesized that the forces in the right glenohumeral joint are higher during playing with the right shoulder raised compared to playing in normal posture.
METHODS:
Motion capture data from four experienced violinists was recorded and processed by means of musculoskeletal simulation to get the force and elevation angle while playing with raised shoulder and in normal position.
RESULTS:
The results indicate that the absolute values of the resulting force, as well as the forces in the mediolateral, inferosuperior, and anteroposterior directions, are higher in playing the violin with the shoulder raised than in a normal posture.
CONCLUSIONS: Elevating the right shoulder while playing the violin may pose a potential problem.
Biomechanical analysis of the right elevated glenohumeral joint in violinists during legato-playing
(2022)
BACKGROUND:
Many statistics reveal that violin players suffer most often from musculoskeletal disorders compared to musicians of other instrument groups. A common phenomenon, especially observed in violin beginners, is the tendency to elevate the right shoulder during playing the violin. This can probably lead to serious disorders in long-term practice with repetitive movements.
OBJECTIVE:
For this reason, this study investigated the relationship between the right shoulder elevation and the force in the right glenohumeral joint during violin playing. It was hypothesized that the forces in the right glenohumeral joint are higher during playing with the right shoulder raised compared to playing in normal posture.
METHODS:
Motion capture data from four experienced violinists was recorded and processed by means of musculoskeletal simulation to get the force and elevation angle while playing with raised shoulder and in normal position.
RESULTS:
The results indicate that the absolute values of the resulting force, as well as the forces in the mediolateral, inferosuperior, and anteroposterior directions, are higher in playing the violin with the shoulder raised than in a normal posture.
CONCLUSIONS:
Elevating the right shoulder while playing the violin may pose a potential problem.
This paper provides an overview of the state of art of research on social entrepreneurship and the establishment of this topic in the academic world, It uses scientometric methods in measuring the maturity of social entrepreneurship research. The empirical part reveals the exponentially growing number of papers, the institutionalization of social entrepreneurship in seven dimensions the emergence of thematic clusters, and methodological issues. The paper makes concrete suggestions on how to overcome methodological challenges. Furthermore, we provide a ranking of the 22 most cited academic contributions in social entrepreneurship. Surprisingly, almost half of the most cited papers have not been published in journals but in books, raising doubts about the current (over-)rating of journal publications.
In the treatment of hand injuries in the context of orthopedic care, movable wrist hand orthoses are used in numerous instances. Early motion therapy is in most cases advantageous for adequate, rapid and successful long-term healing of the hand. Conventional dynamic wrist hand orthoses can only be used for movement therapy to a limited extent since they represent the wrist as a simple rotating joint and neglect the complexity of the hand movement possibilities. In this paper, a preliminary concept for dynamic wrist hand orthoses based on prestressed compliant structures is presented. The distinctive feature of this concept lies in the enabling of multiaxial motion capabilities of the human hand without applying conventional joints. According to the concept the wrist region is surrounded by a prestressed compliant structure. Besides the derivation and description of the concept, a first three-dimensional computer-aided design is shown. Additionally, the necessary steps in the development of such a novel dynamic wrist orthosis are discussed.
In the treatment of hand injuries in the context of orthopedic care, movable hand orthoses are used in many cases. Early motion therapy is in most cases advantageous for adequate, rapid, and successful long-term healing of the hand. Conventional mobile hand orthoses can only be used for movement therapy to a limited extent since they represent the wrist as a simple rotating joint and neglect the complexity of the movement possibilities of the hand. In this paper, a novel concept for movable hand orthoses based on prestressed compliant structures is presented. The advantage with this concept is that it replicates the multiaxial motion capabilities without the need for conventional joints. Besides the derivation and description of the concept, a first three-dimensional CAD design is shown. Additionally, the next planned steps in the development of such a novel dynamic hand orthosis are described.