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Background
Personalized medicine requires the integration and analysis of vast amounts of patient data to realize individualized care. With Surgomics, we aim to facilitate personalized therapy recommendations in surgery by integration of intraoperative surgical data and their analysis with machine learning methods to leverage the potential of this data in analogy to Radiomics and Genomics.
Methods
We defined Surgomics as the entirety of surgomic features that are process characteristics of a surgical procedure automatically derived from multimodal intraoperative data to quantify processes in the operating room. In a multidisciplinary team we discussed potential data sources like endoscopic videos, vital sign monitoring, medical devices and instruments and respective surgomic features. Subsequently, an online questionnaire was sent to experts from surgery and (computer) science at multiple centers for rating the features’ clinical relevance and technical feasibility.
Results
In total, 52 surgomic features were identified and assigned to eight feature categories. Based on the expert survey (n = 66 participants) the feature category with the highest clinical relevance as rated by surgeons was “surgical skill and quality of performance” for morbidity and mortality (9.0 ± 1.3 on a numerical rating scale from 1 to 10) as well as for long-term (oncological) outcome (8.2 ± 1.8). The feature category with the highest feasibility to be automatically extracted as rated by (computer) scientists was “Instrument” (8.5 ± 1.7). Among the surgomic features ranked as most relevant in their respective category were “intraoperative adverse events”, “action performed with instruments”, “vital sign monitoring”, and “difficulty of surgery”.
Conclusion
Surgomics is a promising concept for the analysis of intraoperative data. Surgomics may be used together with preoperative features from clinical data and Radiomics to predict postoperative morbidity, mortality and long-term outcome, as well as to provide tailored feedback for surgeons.
Artificial Intelligence-based Assistants AIAs are spreading quickly both in homes and offices. They already have left their original habitats of "intelligent speakers" providing easy access to music collections. The initiated a multitude of new devices and are already populating devices such as TV sets. Characteristic for the intelligent digital assistants is the formation of platforms around their core functionality. Thus, AIS capabilities of the assistants are used to offer new services and create new interfaces for business processes. There are positive network effects between the assistants and the services as well as within the services. Therefore, many companies see the need to get involved in the field of digital assistants but lack a framework to align their initiatives with their corporate strategies. In order to lay the foundation for a comprehensive method, we are therefore investigating intelligent digital assistants. Based on this analysis, we are developing a framework of strategic opportunities and challenges.
Stent graft visualization and planning tool for endovascular surgery using finite element analysis
(2014)
Purpose: A new approach to optimize stent graft selection for endovascular aortic repair is the use of finite element analysis. Once the finite element model is created and solved, a software module is needed to view the simulation results in the clinical work environment. A new tool for Interpretation of simulation results, named Medical Postprocessor, that enables comparison of different stent graft configurations and products was designed, implemented and tested. Methods Aortic endovascular stent graft ring forces and sealing states in the vessel landing zone of three different configurations were provided in a surgical planning software using the Medical Imaging Interaction Tool Kit (MITK) Software system. For data interpretation, software modules for 2D and 3D presentations were implemented. Ten surgeons evaluated the software features of the Medical Postprocessor. These surgeons performed usability tests and answered questionnaires based on their experience with the system.
Results: The Medical Postprocessor visualization system enabled vascular surgeons to determine the configuration with the highest overall fixation force in 16 ± 6 s, best proximal sealing in 56±24 s and highest proximal fixation force in 38 ± 12 s. The majority considered the multiformat data provided helpful and found the Medical Postprocessor to be an efficient decision support system for stent graft selection. The evaluation of the user interface results in an ISONORMconform user interface (113.5 points).
Conclusion: The Medical Postprocessor visualization Software tool for analyzing stent graft properties was evaluated by vascular surgeons. The results show that the software can assist the interpretation of simulation results to optimize stent graft configuration and sizing.
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.
Software process improvement (SPI) has been around for decades: frameworks are proposed, success factors are studied, and experiences have been reported. However, the sheer mass of concepts, approaches, and standards published over the years overwhelms practitioners as well as researchers. What is out there? Are there new trends and emerging approaches? What are open issues? Still, we struggle to answer these questions about the current state of SPI and related research. In this article, we present results from an updated systematic mapping study to shed light on the field of SPI, to develop a big picture of the state of the art, and to draw conclusions for future research directions. An analysis of 769 publications draws a big picture of SPI-related research of the past quarter-century. Our study shows a high number of solution proposals, experience reports, and secondary studies, but only few theories and models on SPI in general. In particular, standard SPI models like CMMI and ISO/IEC 15,504 are analyzed, enhanced, and evaluated for applicability in practice, but these standards are also critically discussed, e.g., from the perspective of SPI in small to-medium-sized companies, which leads to new specialized frameworks. New and specialized frameworks account for the majority of the contributions found (approx. 38%). Furthermore, we find a growing interest in success factors (approx. 16%) to aid companies in conducting SPI and in adapting agile principles and practices for SPI (approx. 10%). Beyond these specific topics, the study results also show an increasing interest into secondary studies with the purpose of aggregating and structuring SPI-related knowledge. Finally, the present study helps directing future research by identifying under-researched topics awaiting further investigation.
Nach Charles Darwin bestimmt die Kompetenz im Bereich Veränderungsmanagement zunehmend die Wettbewerbsfähigkeit von Organisationen: »It's not the strongest of the species that survives, nor the most intelligent. It is the one most adaptable to change.« Diese Sichtweise gewinnt auf Basis der mit Social Media verbundenen Veränderung der Unternehmensumwelt weiter an Bedeutung. Social Media eröffnet neue Freiheitsgrade in der unternehmensinternen aber auch gesellschaftlichen Kommunikation, die unumkehrbar und in einer rasanten Geschwindigkeit Unternehmen mit sich selbst konfrontieren. Wissenschaftliche Untersuchungen legen nahe, dass die meisten Unternehmen die Bedeutung ihrer eigenen Veränderungskompetenz noch nicht vollständig erfasst haben. Der Umgang mit Wandel ist in vielen Fällen naiv und folgt tradierten Organisationsmodellen. Unternehmen lassen sich jedoch nicht mechanisch im Stile einer Maschine verändern. Daher sind Ansätze gefragt, die den Fokus eher auf kulturelle und mikropolitische Faktoren lenken, prozessorientiert vorgehen und Social Media schrittweise in das eigene Geschäftsmodell integrieren. Der wichtigste Faktor ist und bleibt jedoch die Qualität der Führung. Das Top Management und final die Shareholder von Unternehmen müssen sich daher erneut überlegen, ob sie speziell in dieser Hinsicht optimal aufgestellt sind.
Im Kundenbeziehungsmanagement besteht ein großes Interesse an der Nutzung von Social Media. Allerdings finden sich aktuell kaum konzeptionell durchdachte und empirisch überprüfte Lösungen für Social CRM.
Social Media bieten innovative Perspektiven für das Management der Kundenbeziehung. Die Nutzung dieser Möglichkeiten ist jedoch mit hohen Anforderungen an die Marketingstrategie verbunden, was zuweilen vernachlässigt wird.
Das Internet gewinnt für das Marketing zunehmend an Bedeutung. Dabei liegt der Fokus auf sogenannten Social-Media-Anwendungen wie Facebook, Twitter oder XING. Für Unternehmen stellt sich die Frage, ob das veränderte Mediennutzungsverhalten der Kunden eine neue Marketinglogik induziert. Eine aktuelle Untersuchung gibt Einblicke in die Chancen und Risiken, Anwendungsbedingungen und Kontextfaktoren für die Nutzung von Social Media im Marketing.
The shift of populations to cities is creating challenges in many respects, thus leading to increasing demand for smart solutions of urbanization problems. Smart city applications range from technical and social to economic and ecological. The main focus of this work is to provide a systematic literature review of smart city research to answer two main questions: (1) How is current research on smart cities structured? and (2) What directions are relevant for future research on smart cities? To answer these research questions, a text-mining approach is applied to a large number of publications. This provides an overview and gives insights into relevant dimensions of smart city research. Although the main dimensions of research are already described in the literature, an evaluation of the relevance of such dimensions is missing. Findings suggest that the dimensions of environment and governance are popular, while the dimension of economy has received only limited attention.
Purpose
Computerized medical imaging processing assists neurosurgeons to localize tumours precisely. It plays a key role in recent image-guided neurosurgery. Hence, we developed a new open-source toolkit, namely Slicer-DeepSeg, for efficient and automatic brain tumour segmentation based on deep learning methodologies for aiding clinical brain research.
Methods
Our developed toolkit consists of three main components. First, Slicer-DeepSeg extends the 3D Slicer application and thus provides support for multiple data input/ output data formats and 3D visualization libraries. Second, Slicer core modules offer powerful image processing and analysis utilities. Third, the Slicer-DeepSeg extension provides a customized GUI for brain tumour segmentation using deep learning-based methods.
Results
The developed Slicer-DeepSeg was validated using a public dataset of high-grade glioma patients. The results showed that our proposed platform’s performance considerably outperforms other 3D Slicer cloud-based approaches.
Conclusions
Developed Slicer-DeepSeg allows the development of novel AI-assisted medical applications in neurosurgery. Moreover, it can enhance the outcomes of computer-aided diagnosis of brain tumours. Open-source Slicer-DeepSeg is available at github.com/razeineldin/Slicer-DeepSeg.
Purpose
Digital transformation of organizations has major implications for required skills and competencies of the workforce, both as a prerequisite for implementation, and, as a consequence of the transformation. The purpose of this study is to analyze required skills and competencies for digital transformation using the context of robotic process automation (RPA) as an example.
Design/methodology/approach
This study is based on an explorative, thematic coding analysis of 119 job advertisements related to RPA. The data was collected from major online job platforms, qualitatively coded and subsequently analyzed quantitatively.
Findings
The research highlights the general importance of specific skills and competencies for digital transformation and shows a gap between available skills and required skills. Moreover, it is concluded that reskilling the existing workforce might be difficult. Many emerging positions can be found in the consulting sector, which raises questions about the permanent vs temporary nature of the requirements, as well as the difficulty of acquiring the required knowledge.
Originality/value
This paper contributes to knowledge by providing new empirical findings and a novel perspective to the ongoing discussion of digital skills, employment effects and reskilling demands of the existing workforce owing to recent technological developments and automation in the overall context of digital transformation.
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.
The cloud evolved into an attractive execution environment for parallel applications, which make use of compute resources to speed up the computation of large problems in science and industry. Whereas Infrastructure as a Service (IaaS) offerings have been commonly employed, more recently, serverless computing emerged as a novel cloud computing paradigm with the goal of freeing developers from resource management issues. However, as of today, serverless computing platforms are mainly used to process computations triggered by events or user requests that can be executed independently of each other and benefit from on-demand and elastic compute resources as well as per-function billing. In this work, we discuss how to employ serverless computing platforms to operate parallel applications. We specifically focus on the class of parallel task farming applications and introduce a novel approach to free developers from both parallelism and resource management issues. Our approach includes a proactive elasticity controller that adapts the physical parallelism per application run according to user-defined goals. Specifically, we show how to consider a user-defined execution time limit after which the result of the computation needs to be present while minimizing the associated monetary costs. To evaluate our concepts, we present a prototypical elastic parallel system architecture for self-tuning serverless task farming and implement two applications based on our framework. Moreover, we report on performance measurements for both applications as well as the prediction accuracy of the proposed proactive elasticity control mechanism and discuss our key findings.
Science-based analysis for climate action: how HSBC Bank uses the En-ROADS climate policy simulation
(2021)
In 2018, the Intergovernmental Panel on Climate Change (IPCC, 2018) found that rapid decarbonization and net negative greenhouse gas (GHG) emissions by mid-century are required to "hold the increase in global average temperature to well below 2°C above pre-industrial levels and pursue efforts to limit the temperature increase to 1.5°C," as stipulated by the Paris Agreement (UNFCCC, 2015, p. 2). Meeting these goals reduces physical climate-related risks from, for example, sea-level rise, ocean acidification, extreme weather, water shortages, declining crop yields, and other impacts. These impacts threaten our economy, security, health, and lives.
At the same time, policies to mitigate these harms by rapidly reducing GHG emissions can create transition risks for businesses - for example, stranded assets and loss of market value for fossil fuel producers and firms dependent on fossil energy (Carney, 2019). Rapid decarbonization requires an unprecedented energy transition (IEA, 2021a) driven by and affecting economic players including businesses, asset managers, and investors in all sectors and all countries (Kriegler et al., 2014).
However, GHG emissions are not falling rapidly enough to meet the goals of the Paris Agreement (Holz et al., 2018). The UNFCCC, 2021 found that the emissions reductions pledged by all nations as of early 2021 "fall far short of what is required, demonstrating the need for Parties to further strengthen their mitigation commitments under the Paris Agreement" (2021, p. 5). Businesses are faring no better. Despite high-profile calls to action from influential firms such as BlackRock (Fink, 2018, 2021), corporate action to meet climate goals has thus far fallen short (e.g. the Right, 2019 analysis of the German DAX 30 companies' emissions targets by NGO "right."). Instead of implementing climate strategies that might mitigate the risks, managers are often caught up in "firefighting" and capability traps that erode the resources needed for ambitious climate action (Sterman, 2015). Firms may also exaggerate environmental accomplishments, leading to greenwashing (Lyon and Maxwell, 2011); implement policies that are vague, rely on unproven offsets, or are not climate neutral (e.g. Sterman et al., 2018); or simply take no action at all (Delmas and Burbano, 2011; Sterman, 2015).
Adding to the confusion are difficulties evaluating the effectiveness of different climate policies. Misperceptions include wait-and-see approaches (Dutt and Gonzalez, 2012; Sterman, 2008), underestimating time delays and ignoring the unintended consequences of policies (Sterman, 2008), and beliefs in "silver bullet" solutions (Gilbert, 2009; Kriegler et al., 2013; Shackley and Dütschke, 2012). These beliefs arise in part because the climate–energy system is a high-dimensional dynamic system characterized by long time delays, multiple feedback loops, and nonlinearities (Sterman, 2011), while even simple systems are difficult for people to understand (Booth Sweeney and Sterman, 2000; Cronin et al., 2009; Kapmeier et al., 2017). Although senior executives might receive briefings on climate change, simply providing more information does not necessarily lead to more effective action (Pearce et al., 2015; Sterman, 2011).
Alternatively, interactive approaches to learning about climate change and policies to mitigate it can trigger climate action (Creutzig and Kapmeier, 2020). Decision-makers require tools and methods grounded in science that enable them to learn for themselves how a low-carbon economy can be achieved and how climate policies condition physical and transition risks. The system dynamics climate–energy simulation En-ROADS (Energy-Rapid Overview and Decision Support; Jones et al., 2019b), codeveloped by the climate think-tank Climate Interactive and the MIT Sloan Sustainability Initiative, provides such a tool.
Here we show how En-ROADS helps HSBC Bank U.S.A., the American subsidiary of U.K.-based multinational financial services company HSBC Holdings plc, focus its global sustainability strategy on activities with higher impact and relevance, communicate and implement the strategy, understand transition risks, and better align the strategy with global climate goals. We show how the versatility and interactivity of En-ROADS increases its reach throughout the organization. Finally, we discuss challenges and lessons learned that may be helpful to other organizations.
Context: An experiment-driven approach to software product and service development is gaining increasing attention as a way to channel limited resources to the efficient creation of customer value. In this approach, software capabilities are developed incrementally and validated in continuous experiments with stakeholders such as customers and users. The experiments provide factual feedback for guiding subsequent development.
Objective: This paper explores the state of the practice of experimentation in the software industry. It also identifies the key challenges and success factors that practitioners associate with the approach.
Method: A qualitative survey based on semi-structured interviews and thematic coding analysis was conducted. Ten Finnish software development companies, represented by thirteen interviewees, participated in the study.
Results: The study found that although the principles of continuous experimentation resonated with industry practitioners, the state of the practice is not yet mature. In particular, experimentation is rarely systematic and continuous. Key challenges relate to changing the organizational culture, accelerating the development cycle speed, and finding the right measures for customer value and product success. Success factors include a supportive organizational culture, deep customer and domain knowledge, and the availability of the relevant skills and tools to conduct experiments.
Conclusions: It is concluded that the major issues in moving towards continuous experimentation are on an organizational level; most significant technical challenges have been solved. An evolutionary approach is proposed as a way to transition towards experiment-driven development.
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.
Putting actions in context: visual action adaptation aftereffects are modulated by social contexts
(2014)
The social context in which an action is embedded provides important information for the interpretation of an action. Is this social context integrated during the visual recognition of an action? We used a behavioural visual adaptation paradigm to address this question and measured participants’ perceptual bias of a test action after they were adapted to one of two adaptors (adaptation after-effect). The action adaptation after effect was measured for the same set of adaptors in two different social contexts. Our results indicate that the size of the adaptation effect varied with social context (social context modulation) although the physical appearance of the adaptors remained unchanged. Three additional experiments provided evidence that the observed social context modulation of the adaptation effect are owed to the adaptation of visual action recognition processes. We found that adaptation is critical for the social context modulation (experiment 2). Moreover, the effect is not mediated by emotional content of the action alone (experiment 3) and visual information about the action seems to be critical for the emergence of action adaptation effects (experiment 4). Taken together these results suggest that processes underlying visual action recognition are sensitive to the social context of an action.
Preliminary results of homomorphic deconvolution application to surface EMG signals during walking
(2021)
Homomorphic deconvolution is applied to sEMG signals recorded during walking. Gastrocnemius lateralis and tibialis anterior signals were acquired according to SENIAM recommendation. MUAP parameters like amplitude and scale were estimated, whilst the MUAP shape parameter was fixed. This features a useful time-frequency representation of sEMG signal. Estimation of scale MUAP parameter was verified extracting the mean frequency of filtered EMG signal, extracted from the scale parameter estimated with two different MUAP shape values.
Predictive maintenance information systems: the underlying conditions and technological aspects
(2020)
Predictive maintenance has the potential to improve the reliability of production and service provisioning. However, there is little knowledge about the proper implementation of predictive maintenance in research and practice. Therefore, we conducted a multi-case study and investigated underlying conditions and technological aspects for implementing a predictive maintenance system and where it leads to. We found that predictive maintenance initiatives are triggered by severe impacts of failures on revenue and profit. Furthermore, successful predictive maintenance initiatives require that pre-conditions are fulfilled: Data must be available and accessible. Very important is also the support by the management. We identified four factors important for the implementation of predictive maintenance. The integration of data is highly facilitated by Cloud-based mechanisms. The detection of events is enabled by advanced analytics. The execution of predictive maintenance operations is supported by data-driven process automation and visualization.
Monitoring heart rate and breathing is essential in understanding the physiological processes for sleep analysis. Polysomnography (PSG) system have traditionally been used for sleep monitoring, but alternative methods can help to make sleep monitoring more portable in someone's home. This study conducted a series of experiments to investigate the use of pressure sensors placed under the bed as an alternative to PSG for monitoring heart rate and breathing during sleep. The following sets of experiments involved the addition of small rubber domes - transparent and black - that were glued to the pressure sensor. The resulting data were compared with the PSG system to determine the accuracy of the pressure sensor readings. The study found that the pressure sensor provided reliable data for extracting heart rate and respiration rate, with mean absolute errors (MAE) of 2.32 and 3.24 for respiration and heart rate, respectively. However, the addition of small rubber hemispheres did not significantly improve the accuracy of the readings, with MAEs of 2.3 bpm and 7.56 breaths per minute for respiration rate and heart rate, respectively. The findings of this study suggest that pressure sensors placed under the bed may serve as a viable alternative to traditional PSG systems for monitoring heart rate and breathing during sleep. These sensors provide a more comfortable and non-invasive method of sleep monitoring. However, the addition of small rubber domes did not significantly enhance the accuracy of the readings, indicating that it may not be a worthwhile addition to the pressure sensor system.