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Menopause is the permanent cessation of menstruation occurring naturally in women's aging. The most frequent symptoms associated with menopausal phases are mucosal dryness, increased weight and body fat, and changes in sleep patterns. Oral symptoms in menopause derived from saliva flow reduction can lead to dry mouth, ulcers, and alterations of taste and swallowing patterns. However, the oral health phenotype of postmenopausal women has not been characterized. The aim of the study was to determine postmenopausal women's oral phenotype, including medical history, lifestyle, and oral assessment through artificial intelligence algorithms. We enrolled 100 postmenopausal women attending the Dental School of the University of Seville were included in the study. We collected an extensive questionnaire, including lifestyle, medication, and medical history. We used an unsupervised k-means algorithm to cluster the data following standard features for data analysis. Our results showed the main oral symptoms in our postmenopausal cohort were reduced salivary flow and periodontal disease. Relying on the classical assessment of the collected data, we might have a biased evaluation of postmenopausal women. Then, we used artificial intelligence analysis to evaluate our data obtaining the main features and providing a reduced feature defining the oral health phenotype. We found 6 clusters with similar features, including medication affecting salivation or smoking as essential features to obtain different phenotypes. Thus, we could obtain main features considering differential oral health phenotypes of postmenopausal women with an integrative approach providing new tools to assess the women in the dental clinic.
The massive use of patient data for the training of artificial intelligence algorithms is common nowadays in medicine. In this scientific work, a statistical analysis of one of the most used datasets for the training of artificial intelligence models for the detection of sleep disorders is performed: sleep health heart study 2. This study focuses on determining whether the gender and age of the patients have a relevant influence to consider working with differentiated datasets based on these variables for the training of artificial intelligence models.
Accurate monitoring of a patient's heart rate is a key element in the medical observation and health monitoring. In particular, its importance extends to the identification of sleep-related disorders. Various methods have been established that involve sensor-based recording of physiological signals followed by automated examination and analysis. This study attempts to evaluate the efficacy of a non-invasive HR monitoring framework based on an accelerometer sensor specifically during sleep. To achieve this goal, the motion induced by thoracic movements during cardiac contractions is captured by a device installed under the mattress. Signal filtering techniques and heart rate estimation using the symlets6 wavelet are part of the implemented computational framework described in this article. Subsequent analysis indicates the potential applicability of this system in the prognostic domain, with an average error margin of approximately 3 beats per minute. The results obtained represent a promising advancement in non-invasive heart rate monitoring during sleep, with potential implications for improved diagnosis and management of cardiovascular and sleep-related disorders.
Salivary gland tumors (SGTs) are a relevant, highly diverse subgroup of head and neck tumors whose entity determination can be difficult. Confocal Raman imaging in combination with multivariate data analysis may possibly support their correct classification. For the analysis of the translational potential of Raman imaging in SGT determination, a multi-stage evaluation process is necessary. By measuring a sample set of Warthin tumor, pleomorphic adenoma and non-tumor salivary gland tissue, Raman data were obtained and a thorough Raman band analysis was performed. This evaluation revealed highly overlapping Raman patterns with only minor spectral differences. Consequently, a principal component analysis (PCA) was calculated and further combined with a discriminant analysis (DA) to enable the best possible distinction. The PCA-DA model was characterized by accuracy, sensitivity, selectivity and precision values above 90% and validated by predicting model-unknown Raman spectra, of which 93% were classified correctly. Thus, we state our PCA-DA to be suitable for parotid tumor and non-salivary salivary gland tissue discrimination and prediction. For evaluation of the translational potential, further validation steps are necessary.
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.
Delphi Markets
(2023)
Delphi markets refer to approaches and implementations of integrating prediction markets and Delphi studies (Real-time Delphi). The combination of the two methods for producing forecasts can potentially compensate for each other´s weaknesses. For example, prediction markets can be used to select participants with expertise and also motivate long-term participation through their gamified approach and incentive mechanisms. In this paper, two potentials for prediction markets and four potentials for Delphi studies, which are made possible by integration, are derived theoretically. Subsequently, three different integration approaches are presented, on the basis of which the integration on user, market and Delphi question-level is exemplified and it is shown that, depending on the approach, not all potentials can be achieved. At the end, recommendations for the use of Delphi markets are derived, existing limitations for Delphi markets as well as future developments are pointed out.
Gender Marketing gewinnt sowohl in der Marketing-Theorie als auch in der Unternehmenspraxis zunehmend an Bedeutung. Der Unterschied zwischen den Geschlechtern zeigt sich nicht nur in unterschiedlichen Fähigkeiten und Einstellungen, sondern auch in verschiedenen Bedürfnissen und im Kaufverhalten. Viele Produkte werden von Männern für Männer entwickelt. Produkte, die sich speziell an Frauen richten, werden häufig gemäß dem Motto „pink it and shrink it“ auf den Markt gebracht. Eine erfolgreiche Umsetzung von Gender-Aspekten ist für Unternehmen eine wichtige Marketing-Herausforderung für die Zukunft.
Measuring cardiorespiratory parameters in sleep, using non-contact sensors and the Ballistocardiography technique has received much attention due to the low-cost, unobtrusive, and non-invasive method. Designing a user-friendly, simple-to-use, and easy-to-deployment preserving less error-prone remains open and challenging due to the complex morphology of the signal. In this work, using four forcesensitive resistor sensors, we conducted a study by designing four distributions of sensors, in order to simplify the complexity of the system by identifying the region of interest for heartbeat and respiration measurement. The sensors are deployed under the mattress and attached to the bed frame without any interference with the subjects. The four distributions are combined in two linear horizontal, one linear vertical, and one square, covering the influencing region in cardiorespiratory activities. We recruited 4 subjects and acquired data in four regular sleeping positions, each for a duration of 80 seconds. The signal processing was performed using discrete wavelet transform bior 3.9 and smooth level of 4 as well as bandpass filtering. The results indicate that we have achieved the mean absolute error of 2.35 and 4.34 for respiration and heartbeat, respectively. The results recommend the efficiency of a triangleshaped structure of three sensors for measuring heartbeat and respiration parameters in all four regular sleeping positions.
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.
Recent advances in artificial intelligence have enabled promising applications in neurosurgery that can enhance patient outcomes and minimize risks. This paper presents a novel system that utilizes AI to aid neurosurgeons in precisely identifying and localizing brain tumors. The system was trained on a dataset of brain MRI scans and utilized deep learning algorithms for segmentation and classification. Evaluation of the system on a separate set of brain MRI scans demonstrated an average Dice similarity coefficient of 0.87. The system was also evaluated through a user experience test involving the Department of Neurosurgery at the University Hospital Ulm, with results showing significant improvements in accuracy, efficiency, and reduced cognitive load and stress levels. Additionally, the system has demonstrated adaptability to various surgical scenarios and provides personalized guidance to users. These findings indicate the potential for AI to enhance the quality of neurosurgical interventions and improve patient outcomes. Future work will explore integrating this system with robotic surgical tools for minimally invasive surgeries.
Introduction: Even if there is a standard procedure of CI surgery, especially in pediatric surgery surgical steps often differ individually due to anatomical variations, malformations or unforseen events. This is why every surgical report should be created individually, which takes time and relies on the correct memory of the surgeon. A standardized recording of intraoperative data and subsequent storage as well as text processing would therefore be desirable and provides the basis for subsequent data processing, e.g. in the context of research or quality assurance.
Method: In cooperation with Reutlingen University, we conducted a workflow analysis of the prototype of a semi-automatic checklist tool. Based on automatically generated checklists generated from BPMN models a prototype user interface was developed for an android tablet. Functions such as uploading photos and files, manual user entries, the interception of foreseeable deviations from the normal course of operations and the automatic creation of OP documentation could be implemented. The system was tested in a remote usability test on a petrous bone model.
Result: The user interface allows a simple intuitive handling, which can be well implemented in the intraoperative setting. Clinical data as well as surgical steps could be individually recorded and saved via DICOM. An automatic surgery report could be created and saved.
Summary: The use of a dynamic checklist tool facilitates the capture, storage and processing of surgical data. Further applications in clinical practice are pending.
This project aims to evaluate existing big data infrastructures for their applicability in the operating room to support medical staff with context-sensitive systems. Requirements for the system design were generated. The project compares different data mining technologies, interfaces, and software system infrastructures with a focus on their usefulness in the peri-operative setting. The lambda architecture was chosen for the proposed system design, which will provide data for both postoperative analysis and real-time support during surgery.
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.
Automatic segmentation is essential for the brain tumor diagnosis, disease prognosis, and follow-up therapy of patients with gliomas. Still, accurate detection of gliomas and their sub-regions in multimodal MRI is very challenging due to the variety of scanners and imaging protocols. Over the last years, the BraTS Challenge has provided a large number of multi-institutional MRI scans as a benchmark for glioma segmentation algorithms. This paper describes our contribution to the BraTS 2022 Continuous Evaluation challenge. We propose a new ensemble of multiple deep learning frameworks namely, DeepSeg, nnU-Net, and DeepSCAN for automatic glioma boundaries detection in pre-operative MRI. It is worth noting that our ensemble models took first place in the final evaluation on the BraTS testing dataset with Dice scores of 0.9294, 0.8788, and 0.8803, and Hausdorf distance of 5.23, 13.54, and 12.05, for the whole tumor, tumor core, and enhancing tumor, respectively. Furthermore, the proposed ensemble method ranked first in the final ranking on another unseen test dataset, namely Sub-Saharan Africa dataset, achieving mean Dice scores of 0.9737, 0.9593, and 0.9022, and HD95 of 2.66, 1.72, 3.32 for the whole tumor, tumor core, and enhancing tumor, respectively.
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.
Mobile monitoring of outpatients during cancer therapy becomes possible through technological advancements. This study leveraged a new remote patient monitoring app for in-between systemic therapy sessions. Patients’ evaluation showed that the handling is feasible. Clinical implementation must consider an adaptive development cycle for reliable operations.
Sleep is extremely important for physical and mental health. Although polysomnography is an established approach in sleep analysis, it is quite intrusive and expensive. Consequently, developing a non-invasive and non-intrusive home sleep monitoring system with minimal influence on patients, that can reliably and accurately measure cardiorespiratory parameters, is of great interest. The aim of this study is to validate a non-invasive and unobtrusive cardiorespiratory parameter monitoring system based on an accelerometer sensor. This system includes a special holder to install the system under the bed mattress. The additional aim is to determine the optimum relative system position (in relation to the subject) at which the most accurate and precise values of measured parameters could be achieved. The data were collected from 23 subjects (13 males and 10 females). The obtained ballistocardiogram signal was sequentially processed using a sixth-order Butterworth bandpass filter and a moving average filter. As a result, an average error (compared to reference values) of 2.24 beats per minute for heart rate and 1.52 breaths per minute for respiratory rate was achieved, regardless of the subject’s sleep position. For males and females, the errors were 2.28 bpm and 2.19 bpm for heart rate and 1.41 rpm and 1.30 rpm for respiratory rate. We determined that placing the sensor and system at chest level is the preferred configuration for cardiorespiratory measurement. Further studies of the system’s performance in larger groups of subjects are required, despite the promising results of the current tests in healthy subjects.
In order to ensure sufficient recovery of the human body and brain, healthy sleep is indispensable. For this purpose, appropriate therapy should be initiated at an early stage in the case of sleep disorders. For some sleep disorders (e.g., insomnia), a sleep diary is essential for diagnosis and therapy monitoring. However, subjective measurement with a sleep diary has several disadvantages, requiring regular action from the user and leading to decreased comfort and potential data loss. To automate sleep monitoring and increase user comfort, one could consider replacing a sleep diary with an automatic measurement, such as a smartwatch, which would not disturb sleep. To obtain accurate results on the evaluation of the possibility of such a replacement, a field study was conducted with a total of 166 overnight recordings, followed by an analysis of the results. In this evaluation, objective sleep measurement with a Samsung Galaxy Watch 4 was compared to a subjective approach with a sleep diary, which is a standard method in sleep medicine. The focus was on comparing four relevant sleep characteristics: falling asleep time, waking up time, total sleep time (TST), and sleep efficiency (SE). After evaluating the results, it was concluded that a smartwatch could replace subjective measurement to determine falling asleep and waking up time, considering some level of inaccuracy. In the case of SE, substitution was also proved to be possible. However, some individual recordings showed a higher discrepancy in results between the two approaches. For its part, the evaluation of the TST measurement currently does not allow us to recommend substituting the measurement method for this sleep parameter. The appropriateness of replacing sleep diary measurement with a smartwatch depends on the acceptable levels of discrepancy. We propose four levels of similarity of results, defining ranges of absolute differences between objective and subjective measurements. By considering the values in the provided table and knowing the required accuracy, it is possible to determine the suitability of substitution in each individual case. The introduction of a “similarity level” parameter increases the adaptability and reusability of study findings in individual practical cases.
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.