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Background: Polysomnography (PSG) is the gold standard for detecting obstructive sleep apnea (OSA). However, this technique has many disadvantages when using it outside the hospital or for daily use. Portable monitors (PMs) aim to streamline the OSA detection process through deep learning (DL).
Materials and methods: We studied how to detect OSA events and calculate the apnea-hypopnea index (AHI) by using deep learning models that aim to be implemented on PMs. Several deep learning models are presented after being trained on polysomnography data from the National Sleep Research Resource (NSRR) repository. The best hyperparameters for the DL architecture are presented. In addition, emphasis is focused on model explainability techniques, concretely on Gradient-weighted Class Activation Mapping (Grad-CAM).
Results: The results for the best DL model are presented and analyzed. The interpretability of the DL model is also analyzed by studying the regions of the signals that are most relevant for the model to make the decision. The model that yields the best result is a one-dimensional convolutional neural network (1D-CNN) with 84.3% accuracy.
Conclusion: The use of PMs using machine learning techniques for detecting OSA events still has a long way to go. However, our method for developing explainable DL models demonstrates that PMs appear to be a promising alternative to PSG in the future for the detection of obstructive apnea events and the automatic calculation of AHI.
Context
In a world of high dynamics and uncertainties, it is almost impossible to have a long-term prediction of which products, services, or features will satisfy the needs of the customer. To counter this situation, the conduction of Continuous Improvement or Design Thinking for product discovery are common approaches. A major constraint in conducting product discovery activities is the high effort to discover and validate features and requirements. In addition, companies struggle to integrate product discovery activities into their agile processes and iterations.
Objective
This paper aims at suggests a supportive tool, the “Discovery Effort Worthiness (DEW) Index”, for product owners and agile teams to determine a suitable amount of effort that should be spent on Design Thinking activities. To operationalize DEW, proposals for practitioners are presented that can be used to integrate product discovery into product development and delivery.
Method
A case study was conducted for the development of the DEW index. In addition, we conducted an expert workshop to develop proposals for the integration of product discovery activities into the product development and delivery process.
Results
First, we present the "Discovery Effort Worthiness Index" in form of a formula. Second, we identified requirements that must be fulfilled for systematic integration of product discovery activities into product development and delivery. Third, we derived from the requirements proposals for the integration of product discovery activities with a company's product development and delivery.
Conclusion
The developed "Discovery Effort Worthiness Index" provides a tool for companies and their product owners to determine how much effort they should spend on Design Thinking methods to discover and validate requirements. Integrating product discovery with product development and delivery should ensure that the results of product discovery are incorporated into product development. This aims to systematically analyze product risks to increase the chance of product success.
Blockchains have become increasingly important in recent years and have expanded their applicability to many domains beyond finance and cryptocurrencies. This adoption has particularly increased with the introduction of smart contracts, which are immutable, user-defined programs directly deployed on blockchain networks. However, many scenarios require business transactions to simultaneously access smart contracts on multiple, possibly heterogeneous blockchain networks while ensuring the atomicity and isolation of these transactions, which is not natively supported by current blockchain systems. Therefore, in this work, we introduce the Transactional Cross-Chain Smart Contract Invocation (TCCSCI) approach that supports such distributed business transactions while ensuring their global atomicity and serializability. The approach introduces the concept of Resource Manager Smart Contracts, and 2PC for Blockchains (2PC4BC), a client-driven Atomic Commit Protocol (ACP) specialized for blockchain-based distributed transactions. We validate our approach using a prototypical implementation, evaluate its introduced overhead, and prove its correctness.
While driving, stress is caused by situations in which the driver estimates their ability to manage the driving demands as insufficient or loses the capability to handle the situation. This leads to increased numbers of driver mistakes and traffic violations. Additional stressing factors are time pressure, road conditions, or dislike for driving. Therefore, stress affects driver and road safety. Stress is classified into two categories depending on its duration and the effects on the body and psyche: short-term eustress and constantly present distress, which causes degenerative effects. In this work, we focus on distress. Wearable sensors are handy tools for collecting biosignals like heart rate, activity, etc. Easy installation and non-intrusive nature make them convenient for calculating stress. This study focuses on the investigation of stress and its implications. Specifically, the research conducts an analysis of stress within a select group of individuals from both Spain and Germany. The primary objective is to examine the influence of recognized psychological factors, including personality traits such as neuroticism, extroversion, psychoticism, stress and road safety. The estimation of stress levels was accomplished through the collection of physiological parameters (R-R intervals) using a Polar H10 chest strap. We observed that personality traits, such as extroversion, exhibited similar trends during relaxation, with an average heart rate 6% higher in Spain and 3% higher in Germany. However, while driving, introverts, on average, experienced more stress, with rates 4% and 1% lower than extroverts in Spain and Germany, respectively.
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.
Fragestellung: Das klinische Standardverfahren und Referenz der Schlafmessung und der Klassifizierung der einzelnen Schlafstadien ist die Polysomnographie (PSG). Alternative Ansätze zu diesem aufwändigen Verfahren könnten einige Vorteile bieten, wenn die Messungen auf eine komfortablere Weise durchgeführt werden. Das Hauptziel dieser Forschung Studie ist es, einen Algorithmus für die automatische Klassifizierung von Schlafstadien zu entwickeln, der ausschließlich Bewegungs- und Atmungssignale verwendet [1].
Patienten und Methoden: Nach der Analyse der aktuellen Forschungsarbeiten haben wir multinomiale logistische Regression als Grundlage für den Ansatz gewählt [2]. Um die Genauigkeit der Auswertung zu erhöhen, wurden vier Features entwickelt, die aus Bewegungs- und Atemsignalen abgeleitet wurden. Für die Auswertung wurden die nächtlichen Aufzeichnungen von 35 Personen verwendet, die von der Charité-Universitätsmedizin Berlin zur Verfügung gestellt wurden. Das Durchschnittsalter der Teilnehmer betrug 38,6 +/– 14,5 Jahre und der BMI lag bei durchschnittlich 24,4 +/– 4,9 kg/m2. Da der Algorithmus mit drei Stadien arbeitet, wurden die Stadien N1, N2 und N3 zum NREM-Stadium zusammengeführt. Der verfügbare Datensatz wurde strikt aufgeteilt: in einen Trainingsdatensatz von etwa 100 h und in einen Testdatensatz mit etwa 160 h nächtlicher Aufzeichnungen. Beide Datensätze wiesen ein ähnliches Verhältnis zwischen Männern und Frauen auf, und der durchschnittliche BMI wies keine signifikante Abweichung auf.
Ergebnisse: Der Algorithmus wurde implementiert und lieferte erfolgreiche Ergebnisse: die Genauigkeit der Erkennung von Wach-/NREM-/REM-Phasen liegt bei 73 %, mit einem Cohen’s Kappa von 0,44 für die analysierten 19.324 Schlafepochen von jeweils 30 s. Die beobachtete gewisse Überschätzung der NREM-Phase lässt sich teilweise durch ihre Prävalenz in einem typischen Schlafmuster erklären. Selbst die Verwendung eines ausbalancierten Trainingsdatensatzes konnte dieses Problem nicht vollständig lösen.
Schlussfolgerungen: Die erreichten Ergebnisse haben die Tauglichkeit des Ansatzes prinzipiell bestätigt. Dieser hat den Vorteil, dass nur Bewegungs- und Atemsignale verwendet werden, die mit weniger Aufwand und komfortabler für Benutzer aufgezeichnet werden können als z. B. Herz- oder EEG-Signale. Daher stellt das neue System eine deutliche Verbesserung im Vergleich zu bestehenden Ansätzen dar. Die Zusammenführung der beschriebenen algorithmischen Software mit dem in [1] beschriebenen Hardwaresystem zur Messung von Atem- und Körperbewegungssignalen zu einem autonomen, berührungslosen System zur kontinuierlichen Schlafüberwachung ist eine mögliche Richtung zukünftiger Arbeiten.
The scoring of sleep stages is one of the essential tasks in sleep analysis. Since a manual procedure requires considerable human and financial resources, and incorporates some subjectivity, an automated approach could result in several advantages. There have been many developments in this area, and in order to provide a comprehensive overview, it is essential to review relevant recent works and summarise the characteristics of the approaches, which is the main aim of this article. To achieve it, we examined articles published between 2018 and 2022 that dealt with the automated scoring of sleep stages. In the final selection for in-depth analysis, 125 articles were included after reviewing a total of 515 publications. The results revealed that automatic scoring demonstrates good quality (with Cohen's kappa up to over 0.80 and accuracy up to over 90%) in analysing EEG/EEG + EOG + EMG signals. At the same time, it should be noted that there has been no breakthrough in the quality of results using these signals in recent years. Systems involving other signals that could potentially be acquired more conveniently for the user (e.g. respiratory, cardiac or movement signals) remain more challenging in the implementation with a high level of reliability but have considerable innovation capability. In general, automatic sleep stage scoring has excellent potential to assist medical professionals while providing an objective assessment.
In the last few years, business firms have substantially invested into the artificial intelligence (AI) technology. However, according to several studies, a significant percentage of AI projects fail or do not deliver business value. Due to the specific characteristics of AI projects, the existing body of knowledge about success and failure of information systems (IS) projects in general may not be transferrable to the context of AI. Therefore, the objective of our research has been to identify factors that can lead to AI project failure. Based on interviews with AI experts, this article identifies and discusses 12 factors that can lead to project failure. The factors can be further classified into five categories: unrealistic expectations, use case related issues, organizational constraints, lack of key resources, and, technological issues. This research contributes to knowledge by providing new empirical data and synthesizing the results with related findings from prior studies. Our results have important managerial implications for firms that aim to adopt AI by helping the organizations to anticipate and actively manage risks in order to increase the chances of project success.
During the first years of the last decade, Egypt used to face recurrent electricity cut-offs in summer. In the past few years, the electricity tariff dramatically increased. Radiative cooling to the clear night sky is a renewable energy source that represents a relative solution. The dry desert climate promotes nocturnal radiative cooling applications. This study investigates the potential of nocturnal radiative cooling systems (RCSs) to reduce the energy consumption of the residential building sector in Egypt. The system technology proposed in this work is based on uncovered solar thermal collectors integrated into the building hydronic system. By implementing different control strategies, the same system could be used for both cooling and heating applications. The goal of this paper is to analyze the performance of RCSs in residential buildings in Egypt. The dynamic simulation program TRNSYS was used to simulate the thermal behavior of the system. The relevant issues of Egypt as a case-study are firstly overviewed. Then the paper introduces the work done to develop a building model that represents a typical residential apartment in Egypt. Typical occupancy profiles were developed to define the internal thermal gains. The adopted control strategy to optimize the system operation is presented as well. To fully understand and hence evaluate the operation of the proposed RCS, four simulation cases were considered: 1. a reference case (fully passive), 2. the stand-alone operation of the RCS, 3. ideal heating & cooling operation (fully-active), and 4. the hybrid-operation (when the active cooling system is supported by the proposed RCS). The analysis considered the main three distinct climates in Egypt, represented by the cities of Alexandria, Cairo and Asyut. The hotter and drier weather conditions resulted in a higher cooling potential and larger temperature differences. The simulated cooling power in Asyut was 28.4 W/m² for a 70 m² absorber field. For a smaller field area of 10 m², the cooling power reached 109 W/m² but with humble temperature differences. To meet the rigorous thermal comfort conditions, the proposed sensible RCS cannot fully replace conventional air-conditioning units, especially in humid areas like Alexandria. When working in a hybrid system, a 10% reduction in the active cooling energy demand could be achieved in Asyut to keep the cooling set-point at 24 °C. This percentage reduction was nearly doubled when the thermal comfort set-point was increased by two degrees (26 °C). In a sensitivity analysis, external shading devices as a passive measure as well as the implementation of the Egyptian code for buildings (ECP306/1–2005) were also investigated. The analysis of this study raised other relevant aspects to discuss, e.g. system-sizing, environmental effects, limitations and recommendations.
Introduction: Telemedicine reduces greenhouse gas emissions (CO2eq); however, results of studies vary extremely in dependence of the setting. This is the first study to focus on effects of telemedicine on CO2 imprint of primary care.
Methods: We conducted a comprehensive retrospective study to analyze total CO2eq emissions of kilometers (km) saved by telemedical consultations. We categorized prevented and provoked patient journeys, including pharmacy visits. We calculated CO2eq emission savings through primary care telemedical consultations in comparison to those that would have occurred without telemedicine. We used the comprehensive footprint approach, including all telemedical cases and the CO2eq emissions by the telemedicine center infrastructure. In order to determine the net ratio of CO2eq emissions avoided by the telemedical center, we calculated the emissions associated with the provision of telemedical consultations (including also the total consumption of physicians’ workstations) and subtracted them from the total of avoided CO2eq emissions. Furthermore, we also considered patient cases in our calculation that needed to have an in-person visit after the telemedical consultation. We calculated the savings taking into account the source of the consumed energy (renewable or not).
Results: 433 890 telemedical consultations overall helped save 1 800 391 km in travel. On average, 1 telemedical consultation saved 4.15 km of individual transport and consumed 0.15 kWh. We detected savings in almost every cluster of patients. After subtracting the CO2eq emissions caused by the telemedical center, the data reveal savings of 247.1 net tons of CO2eq emissions in total and of 0.57 kg CO2eq per telemedical consultation. The comprehensive footprint approach thus indicated a reduced footprint due to telemedicine in primary care.
Discussion: Integrating a telemedical center into the health care system reduces the CO2 footprint of primary care medicine; this is true even in a densely populated country with little use of cars like Switzerland. The insight of this study complements previous studies that focused on narrower aspects of telemedical consultations.
Assistant platforms
(2023)
Many assistant systems have evolved toward assistant platforms. These platforms combine a range of resources from various actors via a declarative and generative interface. Among the examples are voice-oriented assistant platforms like Alexa and Siri, as well as text-oriented assistant platforms like ChatGPT and Bard. They have emerged as valuable tools for handling tasks without requiring deeper domain expertise and have received large attention with the present advances in generative artificial intelligence. In view of their growing popularity, this Fundamental outlines the key characteristics and capabilities that define assistant platforms. The former comprise a multi-platform architecture, a declarative interface, and a multi-platform ecosystem, while the latter include capabilities for composition, integration, prediction, and generativity. Based on this framework, a research agenda is proposed along the capabilities and affordances for assistant platforms.
Digitalization and enterprise architecture management: a perspective on benefits and challenges
(2023)
Many companies digitally transform their business models, processes, and services. They have also been using Enterprise Architecture Management approaches for a long time to synchronize corporate strategy and information technology. Such digitalization projects bring different challenges for Enterprise Architecture Management. Without understanding and addressing them, Enterprise Architecture Management projects will fail or not deliver the expected value. Since existing research has not yet addressed these challenges, they were investigated based on a qualitative expert study with leading industry experts from Europe. Furthermore, potential benefits of digitalization projects for Enterprise Architecture Management were researched. Our results provide a theoretical framework consisting of five identified challenges, triggers and a number of benefits. Furthermore, we discuss in what ways digitalization and EAM is a promising topic for future research.
Purpose
For the modeling, execution, and control of complex, non-standardized intraoperative processes, a modeling language is needed that reflects the variability of interventions. As the established Business Process Model and Notation (BPMN) reaches its limits in terms of flexibility, the Case Management Model and Notation (CMMN) was considered as it addresses weakly structured processes.
Methods
To analyze the suitability of the modeling languages, BPMN and CMMN models of a Robot-Assisted Minimally Invasive Esophagectomy and Cochlea Implantation were derived and integrated into a situation recognition workflow. Test cases were used to contrast the differences and compare the advantages and disadvantages of the models concerning modeling, execution, and control. Furthermore, the impact on transferability was investigated.
Results
Compared to BPMN, CMMN allows flexibility for modeling intraoperative processes while remaining understandable. Although more effort and process knowledge are needed for execution and control within a situation recognition system, CMMN enables better transferability of the models and therefore the system. Concluding, CMMN should be chosen as a supplement to BPMN for flexible process parts that can only be covered insufficiently by BPMN, or otherwise as a replacement for the entire process.
Conclusion
CMMN offers the flexibility for variable, weakly structured process parts, and is thus suitable for surgical interventions. A combination of both notations could allow optimal use of their advantages and support the transferability of the situation recognition system.
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.
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.
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.
The paper describes how eye-tracking can be used to explore electronic patient records (EPR) in a sterile environment. As an information display, we used a system that we developed for the presentation of patient data and for supporting surgical hand disinfection. The eye-tracking was performed using the Tobii Eye Tracker 4C, and the connection between the eye-tracker and the HTML website was realized using the Tobii EyeX Chrome Extension. Interactions with the EPR are triggered by fixations of icons. The interaction was working as intended, but test persons reported a high mental load while using the system.
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.
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.
Intraoperative imaging can assist neurosurgeons to define brain tumours and other surrounding brain structures. Interventional ultrasound (iUS) is a convenient modality with fast scan times. However, iUS data may suffer from noise and artefacts which limit their interpretation during brain surgery. In this work, we use two deep learning networks, namely UNet and TransUNet, to make automatic and accurate segmentation of the brain tumour in iUS data. Experiments were conducted on a dataset of 27 iUS volumes. The outcomes show that using a transformer with UNet is advantageous providing an efficient segmentation modelling long-range dependencies between each iUS image. In particular, the enhanced TransUNet was able to predict cavity segmentation in iUS data with an inference rate of more than 125 FPS. These promising results suggest that deep learning networks can be successfully deployed to assist neurosurgeons in the operating room.