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Nowadays, the importance of early active patient mobilization in the recovery and rehabilitation phase has increased significantly. One way to involve patients in the treatment is a gamification-like approach, which is one of the methods of motivation in various life processes. This article shows a system prototype for patients who require physical activity because of active early mobilization after medical interventions or during illness. Bedridden patients and people with a sedentary lifestyle (predominantly lying in bed) are also potential users. The main idea for the concept was non-contact system implementation for the patients making them feel effortless during its usage. The system consists of three related parts: hardware, software, and game application. To test the relevance and coherence of the system, it was used by 35 people. The participants were asked to play a video game requiring them to make body movements while lying down. Then they were asked to take part in a small survey to evaluate the system's usability. As a result, we offer a prototype consisting of hardware and software parts that can increase and diversify physical activity during active early mobilization of patients and prevent the occurrence of possible health problems due to predominantly low activity. The proposed design can be possibly implemented in hospitals, rehabilitation centers, and even at home.
With the progress of technology in modern hospitals, an intelligent perioperative situation recognition will gain more relevance due to its potential to substantially improve surgical workflows by providing situation knowledge in real-time. Such knowledge can be extracted from image data by machine learning techniques but poses a privacy threat to the staff’s and patients’ personal data. De-identification is a possible solution for removing visual sensitive information. In this work, we developed a YOLO v3 based prototype to detect sensitive areas in the image in real-time. These are then deidentified using common image obfuscation techniques. Our approach shows that it is principle suitable for de-identifying sensitive data in OR images and contributes to a privacyrespectful way of processing in the context of situation recognition in the OR.
In our initial DaMoN paper, we set out the goal to revisit the results of “Starring into the Abyss [...] of Concurrency Control with [1000] Cores” (Yu in Proc. VLDB Endow 8: 209-220, 2014). Against their assumption, today we do not see single-socket CPUs with 1000 cores. Instead, multi-socket hardware is prevalent today and in fact offers over 1000 cores. Hence, we evaluated concurrency control (CC) schemes on a real (Intel-based) multi-socket platform. To our surprise, we made interesting findings opposing results of the original analysis that we discussed in our initial DaMoN paper. In this paper, we further broaden our analysis, detailing the effect of hardware and workload characteristics via additional real hardware platforms (IBM Power8 and 9) and the full TPC-C transaction mix. Among others, we identified clear connections between the performance of the CC schemes and hardware characteristics, especially concerning NUMA and CPU cache. Overall, we conclude that no CC scheme can efficiently make use of large multi-socket hardware in a robust manner and suggest several directions on how CC schemes and overall OLTP DBMS should evolve in future.
Literature reviews are essential for any scientific work, both as part of a dissertation or as a stand-alone work. Scientists benefit from the fact that more and more literature is available in electronic form, and finding and accessing relevant literature has become more accessible through scientific databases. However, a traditional literature review method is characterized by a highly manual process, while technologies and methods in big data, machine learning, and text mining have advanced. Especially in areas where research streams are rapidly evolving, and topics are becoming more comprehensive, complex, and heterogeneous, it is challenging to provide a holistic overview and identify research gaps manually. Therefore, we have developed a framework that supports the traditional approach of conducting a literature review using machine learning and text mining methods. The framework is particularly suitable in cases where a large amount of literature is available, and a holistic understanding of the research area is needed. The framework consists of several steps in which the critical mind of the scientist is supported by machine learning. The unstructured text data is transformed into a structured form through data preparation realized with text mining, making it applicable for various machine learning techniques. A concrete example in the field of smart cities makes the framework tangible.
The global demand for resources such as energy, land, or water is constantly increasing. It is therefore not sur- prising that research on the Food-Energy-Water (FEW) nexus has become a scientific as well as a general focus in recent years. A significant increase in publications since 2015 can be observed, and it can be expected that this trend will continue. A multilevel (macro, meso, and micro) perspective is essential, as the FEW nexus has cross- sectoral interdependencies. Several review studies on the FEW nexus can be found in the literature, in general, it can be concluded that the FEW nexus is a multi-disciplinary and complex topic. The studies examined identify essential fields of action for research, policy, and society. However, questions such as what are the main research fields at each level? Is it possible to divide the research into specific clusters? and do the clusters correlate with the levels, and what are the methods of modeling used in the clusters and levels? are still not fully discussed in the literature. An extensive literature review was conducted to get insight into the existing research areas. Especially in such fields as the FEW nexus, the amount of literature can get huge, and a human could get lost analyzing the literature manually. For that, we created word clouds and performed a cluster- and network-analysis to support the selection of most relevant papers for a detailed reading. In 2021, the most publications were published, with 173 publications, which corresponds to a share of 26.6 %. There has been a significant increase since 2015, and it can be expected that this trend will continue in the coming years. Most of the first authors come from the USA (25.4 %), followed by China with 22.4 %. From the word cloud and the top 20 words, which appear in the title and abstract, it can be deduced that the topic water is the most represented. However, the terms system, resource, model, study, change, development, and management also appear to be very important, which indi- cates the importance of a holistic approach to the topic. In total 9 clusters could be identified at the different levels. It can be seen that three clusters form well. For the others, a rather diffuse picture can be observed. In order to find out which topics are hidden behind the individual clusters, 6 publications from each cluster were subjected to a more detailed examination. With these steps, a number of 54 publications were identified for de- tailed consideration. The modeling approaches that are currently being applied in research can be classified into domain-specific tools (e. g. global water models, crop models or global climate models) and into more general tools to perform for example a life cycle analysis, spatial analysis using geographic information system, or system dynamics for a general understanding of the links between the domains. With the domain-specific tools, detailed research questions can be addressed to answer questions for a specific domain. However, these tools have the disadvantage that especially the links between the sectors food, energy, and water are not fully considered. Many implementations that are made today are at lowest level (micro) relate to bounded spatial areas and are derived from macro and meso level goals.
Public transport maps are typically designed in a way to support route finding tasks for passengers, while they also provide an overview about stations, metro lines, and city-specific attractions. Most of those maps are designed as a static representation, maybe placed in a metro station or printed in a travel guide. In this paper, we describe a dynamic, interactive public transport map visualization enhanced by additional views for the dynamic passenger data on different levels of temporal granularity. Moreover, we also allow extra statistical information in form of density plots, calendar-based visualizations, and line graphs. All this information is linked to the contextual metro map to give a viewer insights into the relations between time points and typical routes taken by the passengers. We also integrated a graph-based view on user-selected routes, a way to interactively compare those routes, an attribute- and property-driven automatic computation of specific routes for one map as well as for all available maps in our repertoire, and finally, also the most important sights in each city are included as extra information to include in a user-selected route. We illustrate the usefulness of our interactive visualization and map navigation system by applying it to the railway system of Hamburg in Germany while also taking into account the extra passenger data. As another indication for the usefulness of the interactively enhanced metro maps we conducted a controlled user experiment with 20 participants.
This paper reviews suggestions for changes to database technology coming from the work of many researchers, particularly those working with evolving big data. We discuss new approaches to remote data access and standards that better provide for durability and auditability in settings including business and scientific computing. We propose ways in which the language standards could evolve, with proof-of-concept implementations on Github.
Home health applications have evolved over the last few decades. Assistive systems such as a data platform in connection with health devices can allow for health-related data to be automatically transmitted to a database. However, there remain significant challenges concerning intermodular communication. Central among them is the challenge of achieving interoperability, the ability of devices to communicate and share data with each other. A major goal of this project was to extend an existing data platform (COMES®) and establish working interoperability by connecting assistive devices with differing approaches. We describe this process for a sleep monitoring and a physical exercise device. Furthermore, we aimed to test this setup and the implementation with a data platform in both a laboratory and an in-home setting with 11 elderly participants. The platform modification was realized, and the relevant changes were made so that the incoming data could be processed by the data platform, as well as visually displayed in real-time. Data was recorded by the respective device and transmitted into the data server with minor disruptions. Our observations affirmed that difficulties and data loss are far more likely to occur with increasing technical complexity, in the event of instable internet connection, or when the device setup requires (elderly) subjects to take specific steps for proper functioning. We emphasize the importance for tests and evaluations of home health technologies in real-life circumstances.
The euphoria around microservices has decreased over the years, but the trend of modernizing legacy systems to this novel architectural style is unbroken to date. A variety of approaches have been proposed in academia and industry, aiming to structure and automate the often long-lasting and cost-intensive migration journey. However, our research shows that there is still a need for more systematic guidance. While grey literature is dominant for knowledge exchange among practitioners, academia has contributed a significant body of knowledge as well, catching up on its initial neglect. A vast number of studies on the topic yielded novel techniques, often backed by industry evaluations. However, practitioners hardly leverage these resources. In this paper, we report on our efforts to design an architecture-centric methodology for migrating to microservices. As its main contribution, a framework provides guidance for architects during the three phases of a migration. We refer to methods, techniques, and approaches based on a variety of scientific studies that have not been made available in a similarly comprehensible manner before. Through an accompanying tool to be developed, architects will be in a position to systematically plan their migration, make better informed decisions, and use the most appropriate techniques and tools to transition their systems to microservices.
The scoring of sleep stages is an essential part of sleep studies. The main objective of this research is to provide an algorithm for the automatic classification of sleep stages using signals that may be obtained in a non-obtrusive way. After reviewing the relevant research, the authors selected a multinomial logistic regression as the basis for their approach. Several parameters were derived from movement and breathing signals, and their combinations were investigated to develop an accurate and stable algorithm. The algorithm was implemented to produce successful results: the accuracy of the recognition of Wake/NREM/REM stages is equal to 73%, with Cohen's kappa of 0.44 for the analyzed 19324 sleep epochs of 30 seconds each. This approach has the advantage of using the only movement and breathing signals, which can be recorded with less effort than heart or brainwave signals, and requiring only four derived parameters for the calculations. Therefore, the new system is a significant improvement for non-obtrusive sleep stage identification compared to existing approaches.
Healthy sleep is required for sufficient restoration of the human body and brain. Therefore, in the case of sleep disorders, appropriate therapy should be applied timely, which requires a prompt diagnosis. Traditionally, a sleep diary is a part of diagnosis and therapy monitoring for some sleep disorders, such as cognitive behaviour therapy for insomnia. To automatise sleep monitoring and make it more comfortable for users, substituting a sleep diary with a smartwatch measurement could be considered. With the aim of providing accurate results, a study with a total of 30 night recordings was conducted. Objective sleep measurement with a Samsung Galaxy Watch 4 was compared with a subjective approach (sleep diary), evaluating the four relevant sleep characteristics: time of getting asleep, wake up time, sleep efficiency (SE), and total sleep time (TST). The performed analysis has demonstrated that the median difference between both measurement approaches was equal to 7 and 3 minutes for a time of getting asleep and wake up time correspondingly, which allows substituting a subjective measurement with a smartwatch. The SE was determined with a median difference between the two measurement methods of 5.22%. This result also implicates a possibility of substitution. Some single recordings have indicated a higher variance between the two approaches. Therefore, the conclusion can be made that a substitution provides reliable results primarily in the case of long-term monitoring. The results of the evaluation of the TST measurement do not allow to recommend substitution of the measurement method.
Geometry of music perception
(2022)
Prevalent neuroscientific theories are combined with acoustic observations from various studies to create a consistent geometric model for music perception in order to rationalize, explain and predict psycho-acoustic phenomena. The space of all chords is shown to be a Whitney stratified space. Each stratum is a Riemannian manifold which naturally yields a geodesic distance across strata. The resulting metric is compatible with voice-leading satisfying the triangle inequality. The geometric model allows for rigorous studies of psychoacoustic quantities such as roughness and harmonicity as height functions. In order to show how to use the geometric framework in psychoacoustic studies, concepts for the perception of chord resolutions are introduced and analyzed.
Purpose
Context awareness in the operating room (OR) is important to realize targeted assistance to support actors during surgery. A situation recognition system (SRS) is used to interpret intraoperative events and derive an intraoperative situation from these. To achieve a modular system architecture, it is desirable to de-couple the SRS from other system components. This leads to the need of an interface between such an SRS and context-aware systems (CAS). This work aims to provide an open standardized interface to enable loose coupling of the SRS with varying CAS to allow vendor-independent device orchestrations.
Methods
A requirements analysis investigated limiting factors that currently prevent the integration of CAS in today's ORs. These elicited requirements enabled the selection of a suitable base architecture. We examined how to specify this architecture with the constraints of an interoperability standard. The resulting middleware was integrated into a prototypic SRS and our system for intraoperative support, the OR-Pad, as exemplary CAS for evaluating whether our solution can enable context-aware assistance during simulated orthopedical interventions.
Results
The emerging Service-oriented Device Connectivity (SDC) standard series was selected to specify and implement a middleware for providing the interpreted contextual information while the SRS and CAS are loosely coupled. The results were verified within a proof of concept study using the OR-Pad demonstration scenario. The fulfillment of the CAS’ requirements to act context-aware, conformity to the SDC standard series, and the effort for integrating the middleware in individual systems were evaluated. The semantically unambiguous encoding of contextual information depends on the further standardization process of the SDC nomenclature. The discussion of the validity of these results proved the applicability and transferability of the middleware.
Conclusion
The specified and implemented SDC-based middleware shows the feasibility of loose coupling an SRS with unknown CAS to realize context-aware assistance in the OR.
One of the key challenges for automatic assistance is the support of actors in the operating room depending on the status of the procedure. Therefore, context information collected in the operating room is used to gain knowledge about the current situation. In literature, solutions already exist for specific use cases, but it is doubtful to what extent these approaches can be transferred to other conditions. We conducted a comprehensive literature research on existing situation recognition systems for the intraoperative area, covering 274 articles and 95 cross-references published between 2010 and 2019. We contrasted and compared 58 identified approaches based on defined aspects such as used sensor data or application area. In addition, we discussed applicability and transferability. Most of the papers focus on video data for recognizing situations within laparoscopic and cataract surgeries. Not all of the approaches can be used online for real-time recognition. Using different methods, good results with recognition accuracies above 90% could be achieved. Overall, transferability is less addressed. The applicability of approaches to other circumstances seems to be possible to a limited extent. Future research should place a stronger focus on adaptability. The literature review shows differences within existing approaches for situation recognition and outlines research trends. Applicability and transferability to other conditions are less addressed in current work.
„Bürgerrechtler klagen gegen Weitergabe von Gesundheitsdaten“ – so titelt (spiegel.de, 2022) am 29.04.2022. Dabei geht es um die Weitergabe pseudonymisierter Daten von 73 Millionen Versicherten durch die gesetzlichen Krankenkassen. Diese Daten sollen der Forschung zur Verfügung gestellt werden. Die Kläger bezweifeln, dass die Daten nicht deanonymisiert werden können. Dieses aktuelle Beispiel zeigt einen konkreten und relevanten Anwendungsfall des Themas Anonymisierung/Pseudonymisierung im aktuariellen Kontext auf. Es ist davon auszugehen, dass die Relevanz in den kommenden Jahren weiter zunehmen wird.
Spätestens seit dem Inkrafttreten der DSGVO ist das Thema Datenschutz allgegenwärtig und stellt uns Aktuare vor große Herausforderungen. Europäische Initiativen zur Schaffung eines Binnenmarktes für Daten sollen zwar die Möglichkeit schaffen, Daten einfacher zu teilen und so beispielsweise Dritten für Forschungszwecke zur Verfügung zu stellen, werfen aber auch viele Fragestellungen auf. Eine naheliegende Lösung ist es, Daten zu anonymisieren oder zu pseudonymisieren. Aber was bedeutet das konkret und welche Konsequenzen ergeben sich daraus? Bis zu welchem Grad müssen Daten anonymisiert werden und welche ReIdentifikationsrisiken bestehen weiterhin?
Background
Although teledermatology has been proven internationally to be an effective and safe addition to the care of patients in primary care, there are few pilot projects implementing teledermatology in routine outpatient care in Germany. The aim of this cluster randomized controlled trial was to evaluate whether referrals to dermatologists are reduced by implementing a store-and-forward teleconsultation system in general practitioner practices.
Methods
Eight counties were cluster randomized to the intervention and control conditions. During the 1-year intervention period between July 2018 and June 2019, 46 general practitioner practices in the 4 intervention counties implemented a store-and-forward teledermatology system with Patient Data Management System interoperability. It allowed practice teams to initiate teleconsultations for patients with dermatologic complaints. In the four control counties, treatment as usual was performed. As primary outcome, number of referrals was calculated from routine health care data. Poisson regression was used to compare referral rates between the intervention practices and 342 control practices.
Results
The primary analysis revealed no significant difference in referral rates (relative risk = 1.02; 95% confidence interval = 0.911–1.141; p = .74). Secondary analyses accounting for sociodemographic and practice characteristics but omitting county pairing resulted in significant differences of referral rates between intervention practices and control practices. Matched county pair, general practitioner age, patient age, and patient sex distribution in the practices were significantly related to referral rates.
Conclusions
While a store-and-forward teleconsultation system was successfully implemented in the German primary health care setting, the intervention's effect was superimposed by regional factors. Such regional factors should be considered in future teledermatology research.
Ultra wideband real-time locating system for tracking people and devices in the operating room
(2022)
Position tracking within the OR could be one possible input for intraoperative situation recognition. Our approach demonstrates a Real-time Locating System (RTLS) using the Ultra Wideband (UWB) technology to determine the position of people or objects. The UWB RTLS was integrated into the research OR at Reutlingen University and the system’s settings were optimized regarding the four factors accuracy, susceptibility to interference, range, and latency. Therefore, different parameters were adapted and the effects on the factors were compared. Goodtracking quality could be achieved under optimal settings. These results indicate that a UWB RTLS is well suited to determine the position of people and devices in our setting. The feasibility of the system needsto be evaluated under real OR conditions.
Hintergrund: Endoskopische Operationsverfahren haben sich als Goldstandard in der Nasennebenhöhlen-(NNH-)Chirurgie etabliert. Den sich daraus ergebenden Herausforderungen für die chirurgische Ausbildung kann durch den Einsatz von Virtuelle-Realität-(VR-)Trainingssimulatoren begegnet werden. Bislang wurde eine Reihe von Simulatoren für NNH-Operationen entwickelt. Frühere Studien im Hinblick auf den Trainingseffekt wurden jedoch nur mit medizinisch vorgebildeten Probanden durchgeführt oder es wurde nicht über dessen zeitlichen Verlauf berichtet.
Methoden: Ein NNH-CT-Datensatz wurde nach der Segmentierung in ein 3-dimensionales, polygonales Oberflächenmodell überführt und mithilfe von originalem Fotomaterial texturiert. Die Interaktion mit der virtuellen Umgebung erfolgte über ein haptisches Eingabegerät. Während der Simulation wurden die Parameter Eingriffsdauer und Fehleranzahl erfasst. Zehn Probanden absolvierten jeweils eine Trainingseinheit bestehend aus je 5 Übungsdurchläufen an 10 aufeinanderfolgenden Tagen.
Ergebnisse: Vier Probanden verringerten die benötigte Zeit um mehr als 60% im Verlauf des Übungszeitraums. Vier der Probanden verringerten ihre Fehleranzahl um mehr als 60%. Acht von 10 Probanden zeigten eine Verbesserung bezüglich beider Parameter. Im Median wurde im gesamten gemessenen Zeitraum die Dauer des Eingriffs um 46 Sekunden und die Fehleranzahl um 191 reduziert. Die Überprüfung eines Zusammenhangs zwischen den 2 Parametern ergab eine positive Korrelation.
Schlussfolgerung: Zusammenfassend lässt sich feststellen, dass das Training am NNH-Simulator auch bei unerfahrenen Personen die Performance beträchtlich verbessert, sowohl in Bezug auf die Dauer als auch auf die Genauigkeit des Eingriffs.
Hybrid project management is an approach that combines traditional and agile project management techniques. The goal is to benefit from the strengths of each approach, and, at the same time avoid the weaknesses. However, due to the variety of hybrid methodologies that have been presented in the meantime, it is not easy to understand the differences or similarities of the methodologies, as well as, the advantages or disadvantages of the hybrid approach in general. Additionally, there is only fragmented knowledge about prerequisites and success factors for successfully implementing hybrid project management in organizations. Hence, the aim of this study is to provide a structured overview of the current state of research regarding the topic. To address this aim, we have conducted a systematic literature review focusing on a set of specific research questions. As a result, four different hybrid methodologies are discussed, as well as, the definition, benefits, challenges, suitability and prerequisites of hybrid project management. Our study contributes to knowledge by synthesizing and structuring prior work in this growing area of research, which serves as a basis for purposeful and targeted research in the future.
Uncontrolled movement of instruments in laparoscopic surgery can lead to inadvertent tissue damage, particularly when the dissecting or electrosurgical instrument is located outside the field of view of the laparoscopic camera. The incidence and relevance of such events are currently unknown. The present work aims to identify and quantify potentially dangerous situations using the example of laparoscopic cholecystectomy (LC). Twenty-four final year medical students were prompted to each perform four consecutive LC attempts on a well-established box trainer in a surgical training environment following a standardized protocol in a porcine model. The following situation was defined as a critical event (CE): the dissecting instrument was inadvertently located outside the laparoscopic camera’s field of view. Simultaneous activation of the electrosurgical unit was defined as a highly critical event (hCE). Primary endpoint was the incidence of CEs. While performing 96 LCs, 2895 CEs were observed. Of these, 1059 (36.6%) were hCEs. The median number of CEs per LC was 20.5 (range: 1–125; IQR: 33) and the median number of hCEs per LC was 8.0 (range: 0–54, IQR: 10). Mean total operation time was 34.7 min (range: 15.6–62.5 min, IQR: 14.3 min). Our study demonstrates the significance of CEs as a potential risk factor for collateral damage during LC. Further studies are needed to investigate the occurrence of CE in clinical practice, not just for laparoscopic cholecystectomy but also for other procedures. Systematic training of future surgeons as well as technical solutions address this safety issue.