Truma (Germany)

Artificial intelligence (AI), with its technologies such as machine perception, robotics, natural language processing, expert systems, and machine learning (ML) with its subset deep learning, have transformed patient care and administration in all fields of modern medicine. For many clinicians, however, the nature, scope, and resulting possibilities of ML and deep learning might not yet be fully clear. This narrative review provides an overview of the application of ML and deep learning in musculoskeletal medicine. It first introduces the concept of AI and machine learning and its associated fields. Different machine concepts such as supervised, unsupervised and reinforcement learning will then be presented with current applications and clinical perspective. Finally deep learning applications will be discussed. With significant improvements over the last decade, ML and its subset deep learning today offer potent tools for numerous applications to implement in clinical practice. While initial setup costs are high, these investments can reduce workload and cost globally. At the same time, many challenges remain, such as standardisation in data labelling and often insufficient validity of the obtained results. In addition, legal aspects still will have to be clarified. Until good analyses and predictions are obtained by an ML tool, patience in training and suitable data sets are required. Awareness of the strengths of ML and the limitations that lie within it will help put this technique to good use.

Self-reported physical activity questionnaires (e.g., International Physical Activity Questionnaire, IPAQ) are a cost-effective, time-saving, and accessible method to assess sedentary behaviour and physical activity. There are conflicting findings regarding the validity of self-reported questionnaires in comparison to accelerometer-measured data in a free-living environment. This study aimed to investigate the concurrent validity between self-reported Arabic–English IPAQ short form (IPAQ-SF) and Fibion (Fibion Inc., Jyväskylä, Finland) accelerometer-measured sedentary and physical activity time among young adults. One hundred and one young healthy adults (mean age 20.8 ± 2.4 years) filled in the IPAQ short form (IPAQ-SF) and wore the Fibion device on the anterior thigh for ≥ 600 min per day for 4–7 days. Concurrent validity between the IPAQ-SF and Fibion accelerometer for sitting, walking, moderate activity, and vigorous activity time was assessed using the Spearman correlation coefficient (ρ\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$\\rho$$\\end{document}) and Bland–Altman plots. Significant weak associations between IPAQ-SF and Fibion measurements were found for total activity time (ρ\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$\\rho$$\\end{document} = 0.4; P < 0.001) and for the duration of walking (ρ\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$\\rho$$\\end{document} = 0.3; P = 0.01), moderate (ρ\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$\\rho$$\\end{document} = 0.2; P = 0.02), and vigorous-intensity activities (ρ\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$\\rho$$\\end{document} = 0.4; P < 0.001). However, ρ\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$\\rho$$\\end{document} was not significant (ρ\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$\\rho$$\\end{document} = − 0.2; P = 0.09) for sitting time. In addition, all the plots of the measured variables showed a proportional bias. A low association and agreement were found between self-reported IPAQ-SF scores and Fibion accelerometer measurements among young adults in the UAE. Adult sedentary and physical activity measurements should be obtained objectively with accelerometers rather than being limited to self-reported measures.

Schroeder, Gregory D. MD; Wilson, Jefferson R. MD, PhD; Hollern, Douglas A. MD; Hartjen, Eric BS; Olsson, Erik C. MD; Vaccaro, Alexander R. MD, PhD, MBA Author Information

One evaluation measure available through the Positive Behavioral Interventions and Supports framework is the Effective Behavior Support Self-Assessment Survey (SAS). Evaluations of the SAS have supported its factor structure. However, the SAS is designed to be completed by school personnel who are nested within other levels of analysis (e.g., schools, grade level, district). There have been no studies examining the SAS from a multilevel perspective. The current study addressed this gap by evaluating the SAS using data from 1,726 respondents across 36 public schools in 3 school districts. Another purpose of this study was to evaluate whether the SAS can be shortened yet remain psychometrically sound to encourage completion of the survey by busy school staff members. Intraclass correlation coefficients indicated substantial dependence in item responses. Factor correlations were substantial across all models tested. Compared with a 2nd-order, hierarchical model and the basic 4-factor model based on the original hypothesized structure of the SAS, the best combination of fit and parsimony was obtained from a reduced set of 24 of the original 46 items organized within a multilevel bifactor structure (e.g., comparative fit index = .979, root-mean-square error of approximation = .019), suggesting that the SAS may be shortened. The bifactor model partitioned item variances to a general implementation fidelity factor and to 1 of the 4 hypothesized factors. These results suggest that the SAS items aim to describe dimensions for measuring implementation status that may be as relevant at the school level as they are at the individual level. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Our aims were to describe stress trajectories for newly diagnosed type 1 diabetes (T1D) in adolescents and their parents, explore whether resilience is associated with stress trajectories, and to examine the effects of stress trajectories on diabetes-specific outcomes. Fifty-nine youth aged 10-18 years with newly diagnosed T1D and a primary caregiver were followed for 12 months. Stress and resilience were assessed using questionnaires every 3 months, and diabetes-specific outcomes (self-care, quality of life, and hemoglobin A1C) at 6 and 12 months. Parent and adolescent stress trajectories were identified using semiparametric group-based modeling. Four stress trajectories emerged for parents and three emerged for adolescents. Adolescent trajectories were stable throughout the 12 months, and those with stable low stress had the highest levels of resilience. Further, the stable low stress group had higher quality of life scores at 12-month postdiagnosis. In contrast, stress for parents changed considerably over the 12-month period, and trajectory groups did not associate with 12-month outcomes. Distinct patterns of stress emerged for both the adolescent and parent cohorts. Resilience at the time of diagnosis was particularly protective for adolescents. These results suggest that stress-reducing and resilience-promoting interventions for newly diagnosed adolescents with T1D may have potential to improve longer-term outcomes.

Background: Wearable technologies offer potential telestroke applications that are more mobile and potentially less expensive than traditional telemedicine carts. In an earlier, pilot phase of this research program the best performing software and hardware combination for transmission of encrypted video and audio streaming was selected for further testing. Method: We tested Vuzix M100 smart glasses device and Pristine EyeSight HIPAA-compliant video streaming services. The device wearers, emergency physicians, performed the NIHSS, and a remote vascular neurologist or neurology resident viewed the exam. Providers recorded their score and evaluated the functionality of the device with a standardized list of questions. Results: The device was assessed in 52 subjects. The providers wearing the device reported the device useful (Agree or Strongly Agree) in making an assessment in 79% of cases and that they could assess the patient well 90% of the time. However, the wearers also reported both distraction from and interference with patient interaction due to the device in 98% of cases evaluated. The viewers also reported finding the device useful in making an assessment of stroke symptoms in 79% of cases (a different set of 79% than the wearers), but in only 65% of cases did they Agree or Strongly Agree that they could assess the patient well. Viewers reported an inadequate field of view for visual field testing in 63% of cases. The inter-rater agreement between the wearer and viewer on the total NIHSS showed moderate agreement (κ = 0.45). Although the technology was easy to use in 92% of the assessments, technical problems (mainly connectivity lags) were reported by the wearer 46% of the time and by the viewer 31% of the time. The technology was rated inadequate for assessing patients in 1 case by the wearers and 3 cases by the viewers. Conclusion: Wearable smart glass technology is feasible in assessing stroke patients and shows promise as a telestroke solution, however interference with physician-patient interaction, limited field of view for visual field testing and connectivity glitches are perceived limitations.

Heart, Trauma, and Sepsis Research Laboratory, Australian Institute of Tropical Health and Medicine, College of Medicine and Dentistry, James Cook University, Queensland, Australia Dr. Dobson has disclosed a patent (he is the sole inventor of the adenosine, lidocaine, and magnesium technology for cardiac surgery, trauma, and sepsis) and received funding from the Internal Research Grant.

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IntroductionNecrotizing soft tissue infection is a life-threatening disease characterized by rapid progressive inflammation and necrosis of the subcutaneous and deep fascia with or without involvement of the adjacent muscles.Case presentationWe report the case of a 62-year-old Caucasian woman with goiter recurrence who underwent a right-sided hemithyroidectomy. Postoperatively, she developed fulminant mediastinitis caused by group A β-hemolytic streptococcus and septic shock. Our patient survived this rare life-threatening complication.ConclusionsInitial atypical postoperative symptoms, such as personality changes or an unstable circulatory system, should lead a practitioner to consider the possibility of this severe complication and to begin therapy immediately.

To understand fully what is at issue in Jeffrey S. Sposato's book, it is necessary to review some of the historiography behind it. In 1963, following a series of prefatory articles, Eric Werner published (in a translation by the late Dika Newlin) a major work: Mendelssohn: A New Image of the Composer and his Life. Basing his ‘new image’ largely on unpublished Mendelssohn letters in the New York Public Library, Werner proposed that his subject remained far more attached to his Jewish heritage than had previously been realized. From this position he drew far-reaching conclusions about the composer's view of life and presumed authorial intentions, particularly in music with religious texts. Werner's position remained unchanged in a revised edition of the original German text (Zürich, 1980). This position did in fact project a ‘new image’; one nineteenth-century view of Mendelssohn as ‘a conspicuously cultured, Christian gentleman’ (Joseph Mussulman, ‘Mendelssohnism in America’, Musical Quarterly, 52 (1967), 335–46) was widely held—and not only in America. (The opposing view, of course, was thoroughly tainted by anti-Semitism.)