[Benefits of participatory involvement of patients in the development of a dermatological treatment app-A report from the practice]. / Nutzen der partizipatorischen Mitwirkung von PatientInnen an der Entwicklung einer dermatologischen Therapie-App ­ ein Bericht aus der Praxis.

Approximately 2% of the German population suffer from psoriasis. HybridVITA has developed a mobile application (app) that enables psoriasis patients to independently document the progression of the disease and the current psychological stress at home. The HybridVITA app was created in close collaboration with user groups to ensure optimal adaptation to their needs. Two interactive workshops were held with the user groups and the technical developers of the app as a core element of the developmental process. The workshops identified the needs and suggestions for improvement of the various user groups and formulated user stories for the further development of the app using the Scrum method. The participatory approach of the workshop enabled the project team to gather valuable practical knowledge at an early stage of development. The team's awareness of potential obstacles during the early stages of the project enabled them to proactively identify and address these issues prior to implementing the app in dermatological care. We are confident that a patient-centered and participatory approach to health app development can provide valuable insights for developers.

Nanosecond multipulse retinal damage thresholds of elongated irradiance profiles in explant measurements and simulations.

Significance: The database for multipulse retinal damage thresholds for the laser safety standard (IEC 60825-1:2014) is confined, especially for elongated irradiation profiles. To ensure eye safety, retinal damage thresholds (ED50 values) need to be determined. Aim: This study aims to examine nanosecond multipulse scenarios. Approach: To determine ED50 values in ex vivo measurements, an optical laser setup is presented. Porcine explant tissue is irradiated with rectangular top-hat profiles. Thermal simulations are carried out on a validated computer model and retinal injury thresholds are obtained. Results: The measurements resulted in ED50 values from 8.46 to 42.72 µJ with a slope from 1.15 to 1.4. A thermal damage in the measurements can be excluded due to the level value in combination with a different type of declining behavior for increasing pulses compared to the simulations. A dependence with increasing elongation or area of the retinal image emerges in the simulations but could not be confirmed in the measurements due to the influencing factors (biological variability, focusing, and measuring procedure). Conclusions: Using slit apertures for beam shaping, variable rectangular spot geometries are realized without changing elements in the setup. For further evaluation of the behavior of elongated irradiation profiles, additional measurements to improve the measurement accuracy are necessary.

Dimensional emotion recognition from camera-based PRV features.

Heart rate variability (HRV) is an important indicator of autonomic nervous system activity and can be used for the identification of affective states. The development of remote Photoplethysmography (rPPG) technology has made it possible to measure pulse rate variability (PRV) using a camera without any sensor-skin contact, which is highly correlated to HRV, thus, enabling contactless assessment of emotional states. In this study, we employed ten machine learning techniques to identify emotions using camera-based PRV features. Our experimental results show that the best classification model achieved a coordination correlation coefficient of 0.34 for value recognition and 0.36 for arousal recognition. The rPPG-based measurement has demonstrated promising results in detecting HAHV (high-arousal high-valence) emotions with high accuracy. Furthermore, for emotions with less noticeable variations, such as sadness, the rPPG-based measure outperformed the baseline deep network for facial expression analysis.

Model-Driven Dementia Prevention and Intervention Platform.

Most types of dementia, including Alzheimer's disease, are not curable. However, there are risk factors, such as obesity or hypertension, that can promote the development of dementia. Holistic treatment of these risk factors can prevent the onset of dementia or delay it in its early stages. To support individualized treatment of risk factors in dementia, this paper presents a model-driven digital platform. It enables monitoring of biomarkers using smart devices from the internet of medical things (IoMT) for the target group. The collected data from such devices can be used to optimize and adjust treatment in a patient in the loop manner. To this end, providers such as Google Fit and Withings have been connected to the platform as example data sources. To achieve treatment and monitoring data interoperability with existing medical systems, internationally accepted standards such as FHIR are used. The configuration and control of the personalized treatment processes are achieved using a self-developed domain-specific language. For this language, an associated diagram editor was implemented, which allows the management of the treatment processes through graphical models. This graphical representation should help treatment providers to understand and manage these processes more easily. To investigate this hypothesis, a usability study was conducted with twelve participants. We were able to show that such graphical representations provide advantages in clarity in reviewing the system, but lack in easy set-up (compared to wizard-style systems).

Digital Health Apps in the Context of Dementia: Questionnaire Study to Assess the Likelihood of Use Among Physicians.

BACKGROUND: Age-related diseases such as dementia are playing an increasingly important role in global population development. Thus, prevention, diagnostics, and interventions require more accessibility, which can be realized through digital health apps. With the app on prescription, Germany made history by being the first country worldwide to offer physicians the possibility to prescribe and reimburse digital health apps as of the end of the year 2020. OBJECTIVE: Considering the lack of knowledge about correlations with the likelihood of use among physicians, this study aimed to address the question of what makes the use of a digital health app by physicians more likely. METHODS: We developed and validated a novel measurement tool-the Digital Health Compliance Questionnaire (DHCQ)-in an interdisciplinary collaboration of experts to assess the role of proposed factors in the likelihood of using a health app. Therefore, a web-based survey was conducted to evaluate the likelihood of using a digital app called DemPredict to screen for Alzheimer dementia. Within this survey, 5 latent dimensions (acceptance, attitude toward technology, technology experience, payment for time of use, and effort of collection), the dependent variable likelihood of use, and answers to exploratory questions were recorded and tested within directed correlations. Following a non-probability-sampling strategy, the study was completed by 331 physicians from Germany in the German language, of whom 301 (90.9%) fulfilled the study criteria (eg, being in regular contact with patients with dementia). These data were analyzed using a range of statistical methods to validate the dimensions of the DHCQ. RESULTS: The DHCQ revealed good test theoretical measures-it showed excellent fit indexes (Tucker-Lewis index=0.98; comparative fit index=0.982; standardized root mean square residual=0.073; root mean square error of approximation=0.037), good internal consistency (Cronbach α=.83), and signs of moderate to large correlations between the DHCQ dimensions and the dependent variable. The correlations between the variables acceptance, attitude toward technology, technology experience, and payment for the time of use and the dependent variable likelihood of use ranged from 0.29 to 0.79, and the correlation between effort of the collection and likelihood of use was -0.80. In addition, we found high levels of skepticism regarding data protection, and the age of the participants was found to be negatively related to their technical experience and attitude toward technology. CONCLUSIONS: In the context of the results, increased communication between the medical and technology sectors and significantly more awareness raising are recommended to make the use of digital health apps more attractive to physicians as they can be adjusted to their everyday needs. Further research could explore the connection between areas such as adherence on the patient side and its impact on the likelihood of use by physicians.

Explainable Artificial Intelligence in Ambulatory Digital Dementia Screenings.

Recently, digital apps have entered the market to enable the early diagnosis of dementia by offering digital dementia screenings. Some of these apps use Machine Learning (ML) to predict cognitive impairment. The aim of this work is to find explanations for the predictions of such a mobile application called DemPredict using methods from the field of Explainable Artificial Intelligence (XAI). In order to evaluate which method is best suited, different XAI approaches are used and compared. However, the comparability of the results is a key challenge. By evaluating the trustworthiness, stability, and computation time of the methods, it is possible to identify the optimal XAI approaches for the respective algorithms.

Compensation of lens manufacturing errors and inhomogeneities by filtering view images in three-dimensional lenticular displays.

For a multiview autostereoscopic three-dimensional display based on the lenticular lens, the manufacturing errors and inhomogeneities of the lenticular sheet can deteriorate the view image quality. A calibration method is proposed by filtering the pixel mapping of all view images. Each view is first sequentially turned on to show a white test image, and the intensity distribution of every view will be analyzed. Then individual filter functions are derived and applied to the corresponding view images to correct the subpixel value. Experimental results show that the proposed method can solve view image loss and significantly improve the quality of stereoscopic images.

Development of an Emotion-Sensitive mHealth Approach for Mood-State Recognition in Bipolar Disorder.

Internet- and mobile-based approaches have become increasingly significant to psychological research in the field of bipolar disorders. While research suggests that emotional aspects of bipolar disorders are substantially related to the social and global functioning or the suicidality of patients, these aspects have so far not sufficiently been considered within the context of mobile-based disease management approaches. As a multiprofessional research team, we have developed a new and emotion-sensitive assistance system, which we have adapted to the needs of patients with bipolar disorder. Next to the analysis of self-assessments, third-party assessments, and sensor data, the new assistance system analyzes audio and video data of these patients regarding their emotional content or the presence of emotional cues. In this viewpoint, we describe the theoretical and technological basis of our emotion-sensitive approach and do not present empirical data or a proof of concept. To our knowledge, the new assistance system incorporates the first mobile-based approach to analyze emotional expressions of patients with bipolar disorder. As a next step, the validity and feasibility of our emotion-sensitive approach must be evaluated. In the future, it might benefit diagnostic, prognostic, or even therapeutic purposes and complement existing systems with the help of new and intuitive interaction models.

Capabilities and limitations of a new thermal finite volume model for the evaluation of laser-induced thermo-mechanical retinal damage.

Many experimental studies focus on the physical damage mechanisms of short-term exposure to laser radiation. In the nanosecond (ns) pulse range, damage in the Retinal Pigment Epithelium (RPE) will most likely occur at threshold levels due to bubble formation at the surface of the absorbing melanosome. The energy uptake of the melanosomes is one key aspect in modeling the bubble formation and damage thresholds. This work presents a thermal finite volume model for the investigation of rising temperatures and the temperature distribution of irradiated melanosomes. The model takes the different geometries and thermal properties of melanosomes into account, such as the heat capacity and thermal conductivity of the heterogeneous absorbing melanosomes and the surrounding tissue. This is the first time the size and shape variations on the melanosomes' thermal behavior are considered. The calculations illustrate the effect of the geometry on the maximum surface temperature of the irradiated melanosome and the impact on the bubble formation threshold. A comparison between the calculated bubble formation thresholds and the RPE cell damage thresholds within a pulse range of 3 to 5000 ns leads to a mean deviation of µ=22mJ/cm2 with a standard deviation of σ=21mJ/cm2. The best results are achieved between the simulation and RPE cell damage thresholds for pulse durations close to the thermal confinement time of individual melanosomes.

Multiple-pulse damage thresholds of retinal explants in the ns-time regime.

The data situation of laser-induced damage measurements after multiple-pulse irradiation in the ns-time regime is limited. Since the laser safety standard is based on damage experiments, it is crucial to determine damage thresholds. For a better understanding of the underlying damage mechanism after repetitive irradiation, we generate damage thresholds for pulse sequences up to N = 20 000 with 1.8 ns-pulses using a square-core fiber and a pulsed Nd:YAG laser. Porcine retinal pigment epithelial layers were used as tissue samples, irradiated with six pulse sequences and evaluated for damage by fluorescence microscopy. The damage thresholds decreased from 31.16 µJ for N = 1 to 11.56 µJ for N = 20 000. The reduction indicates photo-chemical damage mechanisms after reaching a critical energy dose.

Development of a Knowledge Base for Enduser Consultation of AAL-Systems.

Manufacturer information, user experiences and product availability of assistive living technologies are usually not known to citizens or consultation centers. The different knowledge levels concerning the availability of technology shows the need for building up a knowledge base. The aim of this contribution is the definition of requirements in the development of knowledge bases for AAL consultations. The major requirements, such as a maintainable and easy to use structure were implemented into a web based knowledge base, which went productive in ~3700 consulting interviews of municipal technology information centers. Within this field phase the implementation of the requirements for a knowledge base in the field of AAL consulting was evaluated and further developed.

Influence of laser coherence on reference-matched laser Doppler velocimetry.

The probe length is investigated under the influence of the coherence length of Gaussian and Lorentzian spectra for the case that the focal point and the point of highest interference are matched in a strongly focused laser Doppler velocimetry setup (LDV). Isosurfaces of a -3 dB drop of the intensity maximum are estimated and suggested as an alternative, comprehensible way to define probe volumes. In the end, the equations are applied for an exemplary lidar setup to show the reduction of requirements for the coherence length of the laser source in comparison to unmatched cases.

Sit-to-Stand Transition Reveals Acute Fall Risk in Activities of Daily Living.

The focus of this paper was on finding wrist sensor-derived features for detecting highly acute fall risk from the sit-to-stand transitions performed in a non-ambulatory environment. Furthermore, the influence of the dominant and non-dominant hand on these features was investigated. A cohort of 174 older subjects was monitored for seven consecutive days in their home setting by using inertial sensors attached at the wrist. Based on the reported falls during a one-month follow-up phase, two groups were defined. Twenty-one time and frequency domain features were implemented for the quantitative assessment of extracted sit-to-stand transitions. The statistical analysis yielded two features that could convincingly distinguish fallers from non-fallers for the dominant hand, and six for the non-dominant hand. A novel feature, energy of the applied support during standing up, showed statistically good performance independently of on which hand the sensor node was worn, as well as for the dominant and non-dominant hand ([Formula: see text], [Formula: see text], and [Formula: see text], respectively). This paper overcomes limitations of clinical tests and shows a reliable application of wrist-worn bands in terms of assessment of highly acute fall risk. In addition, it reveals the sit-to-stand transition as a potential assessment source for the wrist-worn devices in the elderly population. Early assessment of the risk of falling in a widely accepted and non-stigmatized manner has the ability to bring crucial changes in fall prevention strategies, reducing the number of falls and the fall rate.

A prediction model for ocular damage - Experimental validation.

With the increasing number of laser applications in medicine and technology, accidental as well as intentional exposure of the human eye to laser sources has become a major concern. Therefore, a prediction model for ocular damage (PMOD) is presented within this work and validated for long-term exposure. This model is a combination of a raytracing model with a thermodynamical model of the human and an application which determines the thermal damage by the implementation of the Arrhenius integral. The model is based on our earlier work and is here validated against temperature measurements taken with porcine eye samples. For this validation, three different powers were used: 50mW, 100mW and 200mW with a spot size of 1.9mm. Also, the measurements were taken with two different sensing systems, an infrared camera and a fibre optic probe placed within the tissue. The temperatures were measured up to 60s and then compared against simulations. The measured temperatures were found to be in good agreement with the values predicted by the PMOD-model. To our best knowledge, this is the first model which is validated for both short-term and long-term irradiations in terms of temperature and thus demonstrates that temperatures can be accurately predicted within the thermal damage regime.

Prediction of temperature and damage in an irradiated human eye-Utilization of a detailed computer model which includes a vectorial blood stream in the choroid.

The work presented here describes the development and use of a three-dimensional thermo-dynamic model of the human eye for the prediction of temperatures and damage thresholds under irradiation. This model takes into account the blood flow by the implementation of a vectorial blood stream in the choroid and also uses the actual physiological extensions and tissue parameters of the eye. Furthermore it considers evaporation, radiation and convection at the cornea as well as the eye lid. The predicted temperatures were successfully validated against existing eye models in terms of corneal and global thermal behaviour. The model׳s predictions were additionally checked for consistency with in-vivo temperature measurements of the cornea, the irradiated retina and its damage thresholds. These thresholds were calculated from the retinal temperatures using the Arrhenius integral. Hence the model can be used to predict the temperature increase and irradiation hazard within the human eye as long as the absorption values and the Arrhenius coefficients are known and the damage mechanism is in the thermal regime.

Large aperture at low cost three-dimensional time-of-flight range sensor using scanning micromirrors and synchronous detector switching.

In this article the problem of achieving fast scanning of a time-of-flight range sensor with a large optical receiver aperture at low system cost is targeted. The presented approach to solve this problem consists of a micromirror-based transmitter unit and a receiver unit consisting of a large aperture lens system with a small field of view and a detector array. A concept, which is called synchronous detector switching, is applied to the detector array. Thereby electronic steering of the small receiver field of view is possible. The overall approach is compared to alternative approaches, and the underlying concept of synchronous detector switching is demonstrated experimentally in an implementation of a three-dimensional time-of-flight range sensor. It is theoretically shown that the presented concept is potentially cheaper than the alternative approaches for applications with a field of view of less than 60×60°. After a discussion of the strengths and limitations of the approach, its effect on broader scientific issues is outlined.

Eye safety for scanning laser projection systems.

In the growing field of pico-projectors, laser-based scanning systems may be advantageous over DLP- or LCoS-based imagers due to their potential for miniaturization, enhanced optical efficiency and cost reduction. The high energy density of a combined laser beam can, however, be hazardous to the human eye. Laser projection systems must therefore be identified with the laser class, depending on their maximum optical output power. This power limits the brightness of the displayed image, which is of particular interest for mobile applications. Various approaches to classifying laser devices by their wavelength and output power are described within the standards for laser safety. It is found that actual safety regulations cannot be directly applied to scanning systems. A detailed analysis of the optical conditions in terms of a two-dimensional extended light source is appropriate for the consideration of laser scanner devices. In this article, alternative ways of applying laser standards for scanning systems are discussed. The dependencies of maximum luminous flux from scanning system parameters are reviewed. It is shown that the evaluation of retinal light exposure in terms of existing laser regulations leads to an overestimation of the hazardous potential. Advanced investigations are proposed to support the definition of suitable criteria for the classification of laser scanning projectors.

Moiré pattern movement compensation and quadrature averaging phase retrieval from time series of speckled arbitrary phase shift interferograms for automatic computation of fundus pulsation curve of the human eye.

PURPOSE: the method described here allows for automatic calculation of the fundus pulse from interferometric measurements. METHOD: a low intensity laser beam is coupled into the eye. Two strong reflections, one of the cornea and one of the retina, interfere on a high-speed complementary metal-oxide-semiconductor camera chip. After eye movement compensation, a speckle-free phase of the interferograms is calculated from a series of interference fringes. Then, the fundus pulsation is calculated from the phase shift between two consecutive interferograms. PROBLEMS: occurring speckle perturbs the fringe images, and therefore, classical geometrical movement compensation algorithms do not work with sufficient accuracy. The movement compensation algorithm needs to work without prior knowledge of the phase. RESULTS: the proposed algorithms yield the fundus pulse from speckled interferograms, overcoming the above mentioned problems.

In vitro strehl ratios with spherical, aberration-free, average, and customized spherical aberration-correcting intraocular lenses.

PURPOSE: To determine in vitro image qualities of artificial eyes achieved with spherical, aberration-free, average spherical aberration-correcting, and customized spherical aberration-correcting IOLs in centered, decentered, and tilted positions. METHODS: The in vitro performance of these IOL models was determined by optical bench measurements. The experimental setup included a laser light source controlled by aperture stops that corresponded to 3- and 5-mm pupil apertures, an artificial eye with three alternative corneal models exhibiting low, intermediate, and high spherical aberration (SA), IOLs mounted to an immersed IOL holder that could be moved laterally and tilted, and a charge-coupled device camera and software to determine three-dimensional point spread function (PSF), modulation transfer function, and Strehl ratio. RESULTS: Differences among the various lens models turned out to be low for a 3-mm pupil. For a pupil aperture of 5 mm, customized IOLs showed the best results for perfect lens positioning. With ongoing decentration and tilt, customized IOLs rapidly lost their advantages, particularly in corneas with high SA and IOLs of high diopters. Spherical IOLs were always inferior to aberration-free IOLs. CONCLUSIONS: Reasonably well-centered aberration-correcting IOLs may provide considerably better image quality than conventional spherical IOLs. In the presence of significant postoperative decentration and tilt of the IOL, aberration-free IOLs are the safest option among the various intraocular lens designs.

Context-aware mobile health monitoring: evaluation of different pattern recognition methods for classification of physical activity.

There are various applications of physical activity monitoring for medical purposes, such as therapeutic rehabilitation, fitness enhancement or the use of physical activity as context information for evaluation of other vital data. Physical activity can be estimated using acceleration sensor-systems fixed on a person's body. By means of pattern recognition methods, it is possible to identify with certain accuracy which movement is being performed. This work presents a comparison of different methods for recognition of daily-life activities, which will serve as basis for the development of an online activity monitoring system.