A precise performance-based reimbursement model for the multi-centre NAPKON cohorts - development and evaluation.

Fair allocation of funding in multi-centre clinical studies is challenging. Models commonly used in Germany - the case fees ("fixed-rate model", FRM) and up-front staffing and consumables ("up-front allocation model", UFAM) lack transparency and fail to suitably accommodate variations in centre performance. We developed a performance-based reimbursement model (PBRM) with automated calculation of conducted activities and applied it to the cohorts of the National Pandemic Cohort Network (NAPKON) within the Network of University Medicine (NUM). The study protocol activities, which were derived from data management systems, underwent validation through standardized quality checks by multiple stakeholders. The PBRM output (first funding period) was compared among centres and cohorts, and the cost-efficiency of the models was evaluated. Cases per centre varied from one to 164. The mean case reimbursement differed among the cohorts (1173.21€ [95% CI 645.68-1700.73] to 3863.43€ [95% CI 1468.89-6257.96]) and centres and mostly fell short of the expected amount. Model comparisons revealed higher cost-efficiency of the PBRM compared to FRM and UFAM, especially for low recruitment outliers. In conclusion, we have developed a reimbursement model that is transparent, accurate, and flexible. In multi-centre collaborations where heterogeneity between centres is expected, a PBRM could be used as a model to address performance discrepancies.Trial registration: https://clinicaltrials.gov/ct2/show/NCT04768998 ; https://clinicaltrials.gov/ct2/show/NCT04747366 ; https://clinicaltrials.gov/ct2/show/NCT04679584 .

Cross Sectional Analysis of Eurasian Skull Anatomy for 3D Cephalometry-Normative Data Reveal Four Different Skull Types.

The unsolved problem in three-dimensional surgical planning for patients with facial deformity, dysgnathia, or asymmetry is the lack of a normative database of "norm skulls" that can be used as treatment objectives. A study was conducted on 90 Eurasian persons (46 male and 44 female adults) for whom cone beam-computed tomography images were available. Inclusion criteria were adult patients with a skeletal Class I pattern, proper interincisal relationship with normal occlusion, the absence of an open bite both in the anterior and posterior region, and a normal and balanced facial appearance; patients with dysgnathia and malformations were excluded. A total of 18 landmarks were digitized and 3D cephalometric measurements were performed and analyzed by means of proportions calculated from the landmarks. Male and female skulls were analyzed, as well as subdivisions revealed by cluster analysis. The data showed that four subtypes of skulls were distinguishable with statistical significance (p < 0.05). A male and a female type subdivided in a brachiocephalic and dolichocephalic phenotype could be identified. For each type, a mean shape was calculated by a Procrustes transformation, which, in turn, was used to create four template skulls from a male and a female skull. This was accomplished by fitting the polygon models of the two skulls to each of the two subtypes based on the landmarks marked on them using a thin plate spline transformation. The normative data of the subtypes can individually serve as a guide for orthodontic surgery in the Eurasian population, which is especially helpful in 3D planning and the execution of craniofacial operations.

Scale-Aware Multi-View Reconstruction Using an Active Triple-Camera System.

This paper presents an active wide-baseline triple-camera measurement system designed especially for 3D modeling in general outdoor environments, as well as a novel parallel surface refinement algorithm within the multi-view stereo (MVS) framework. Firstly, the pre-processing module converts the synchronized raw triple images from one single-shot acquisition of our setup to aligned RGB-Depth frames, which are then used for camera pose estimation using iterative closest point (ICP) and RANSAC perspective-n-point (PnP) approaches. Afterwards, an efficient dense reconstruction method, mostly implemented on the GPU in a grid manner, takes the raw depth data as input and optimizes the per-pixel depth values based on the multi-view photographic evidence, surface curvature and depth priors. Through a basic fusion scheme, an accurate and complete 3D model can be obtained from these enhanced depth maps. For a comprehensive test, the proposed MVS implementation is evaluated on benchmark and synthetic datasets, and a real-world reconstruction experiment is also conducted using our measurement system in an outdoor scenario. The results demonstrate that (1) our MVS method achieves very competitive performance in terms of modeling accuracy, surface completeness and noise reduction, given an input coarse geometry; and (2) despite some limitations, our triple-camera setup in combination with the proposed reconstruction routine, can be applied to some practical 3D modeling tasks operated in outdoor environments where conventional stereo or depth senors would normally suffer.

Alignment strategy for an optomechanical image derotator using a laser Doppler vibrometer.

When monitoring the condition of technical components, it is of particular interest to obtain information of the current condition of the component during operation. The main objectives are safety and machine efficiency. A special extension in this area is the derotator, since the derotator can be used to extend measuring methods designed for static components to rotating systems. In this paper, we present a new, to the best of our knowledge, approach to align a derotator using a laser Doppler vibrometer (LDV). When aligning the derotator, the optical axis must be coaxial with the rotating object to be measured. Current conventional approaches only ensure that the optical axis and the rotational axis intersect at the center of the measuring object. In our approach, a LDV is used to determine the angular deviation between the two axes, which cannot be determined by common methods. Our approach is easy to implement because the LDV is often already used in combination with the derotator as a measuring device. Experiments are carried out to show that this approach is feasible. In addition, several investigations are being performed to analyze how different parameters affect the result, creating reproducible conditions and deriving an alignment approach. By combining the approach developed in this work for determining a rotational deviation with common image-based approaches for determining a translational deviation of the axes, the derotator can be calibrated entirely. In this way, the quality of the measurement with the derotator can be further increased, as calibration errors can be reduced.

Predictor-corrector framework for the sequential assembly of optical systems based on wavefront sensing.

Alignment of optical components is crucial for the assembly of optical systems to ensure their full functionality. In this paper we present a novel predictor-corrector framework for the sequential assembly of serial optical systems. Therein, we use a hybrid optical simulation model that comprises virtual and identified component positions. The hybrid model is constantly adapted throughout the assembly process with the help of nonlinear identification techniques and wavefront measurements. This enables prediction of the future wavefront at the detector plane and therefore allows for taking corrective measures accordingly during the assembly process if a user-defined tolerance on the wavefront error is violated. We present a novel notation for the so-called hybrid model and outline the work flow of the presented predictor-corrector framework. A beam expander is assembled as demonstrator for experimental verification of the framework. The optical setup consists of a laser, two bi-convex spherical lenses each mounted to a five degree-of-freedom stage to misalign and correct components, and a Shack-Hartmann sensor for wavefront measurements.

Mediastinal staging for lung cancer: the influence of biopsy volume.

OBJECTIVE: Mediastinal staging is of paramount importance prior to surgery for non-small-cell lung cancer (NSCLC) to identify patients with N2-disease. Mediastinoscopy remains the gold standard, and sampling from at least three lymph node stations is generally recommended. It is unknown whether biopsy volume has any influence on the result of conventional cervical mediastinoscopy. In this study, we investigated the influence of biopsy volume and the number of lymph node stations biopsied during mediastinoscopy on the probability of demonstrating N2-disease in patients with NSCLC. METHODS: We identified 678 consecutive patients who underwent mediastinoscopy for staging of NSCLC during an 8-year period (1999-2007), but 111 patients were later excluded from analysis because of misclassification or of missing data. All patient charts and pathology reports of the remaining 567 patients were reviewed retrospectively. Demographics and the number of lymph node stations biopsied were recorded, and the volume of biopsies from each lymph node station was calculated. RESULTS: Multivariate logistic regression analysis demonstrated that larger biopsy volume was significantly associated with increased probability of demonstrating N2-disease (p<0.001). However, sampling from several lymph node stations was significantly associated with a decreased probability of demonstrating N2-disease (p=0.015) and volume was significantly larger per station when fewer stations were sampled (p<0.001). CONCLUSIONS: Biopsy volume from lymph nodes during mediastinoscopy was significantly associated with the probability of demonstrating N2-disease; however, contrary to common belief, sampling from several lymph node stations was not associated with an increased probability of detecting N2-disease. Although purely speculative, these findings may be explained by a perioperative clinical decision by the surgeon: large volumes are secured from macroscopically large and suspicious lymph nodes if detected. Consequently, further dissection and possible complications were avoided.