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Introduction
In regard of surgical training, the reproducible simulation of life-like proximal humerus fractures in human cadaveric specimens is desirable. The aim of the present study was to develop a technique that allows simulation of realistic proximal humerus fractures and to analyse the influence of rotator cuff preload on the generated lesions in regards of fracture configuration.
Materials and methods
Ten cadaveric specimens (6 left, 4 right) were fractured using a custom-made drop-test bench, in two groups. Five specimens were fractured without rotator cuff preload, while the other five were fractured with the tendons of the rotator cuff preloaded with 2 kg each. The humeral shaft and the shortened scapula were potted. The humerus was positioned at 90° of abduction and 10° of internal rotation to simulate a fall on the elevated arm. In two specimens of each group, the emergence of the fractures was documented with high-speed video imaging. Pre-fracture radiographs were taken to evaluate the deltoid-tuberosity index as a measure of bone density. Post-fracture X-rays and CT scans were performed to define the exact fracture configurations. Neer’s classification was used to analyse the fractures.
Results
In all ten cadaveric specimens life-like proximal humerus fractures were achieved. Two III-part and three IV-part fractures resulted in each group. The preloading of the rotator cuff muscles had no further influence on the fracture configuration. High-speed videos of the fracture simulation revealed identical fracture mechanisms for both groups. We observed a two-step fracture mechanism, with initial impaction of the head segment against the glenoid followed by fracturing of the head and the tuberosities and then with further impaction of the shaft against the acromion, which lead to separation of the tuberosities.
Conclusion
A high energetic axial impulse can reliably induce realistic proximal humerus fractures in cadaveric specimens. The preload of the rotator cuff muscles had no influence on initial fracture configuration. Therefore, fracture simulation in the proximal humerus is less elaborate. Using the presented technique, pre-fractured specimens are available for real-life surgical education.
Introduction: In peripheral percutaneous (VA) extracorporeal membrane oxygenation (ECMO) procedures the femoral arteries perfusion route has inherent disadvantages regarding poor upper body perfusion due to watershed. With the advent of new long flexible cannulas an advancement of the tip up to the ascending aorta has become feasible. To investigate the impact of such long endoluminal cannulas on upper body perfusion, a Computational Fluid Dynamics (CFD) study was performed considering different support levels and three cannula positions.
Methods: An idealized literature-based- and a real patient proximal aortic geometry including an endoluminal cannula were constructed. The blood flow was considered continuous. Oxygen saturation was set to 80% for the blood coming from the heart and to 100% for the blood leaving the cannula. 50% and 90% venoarterial support levels from the total blood flow rate of 6 l/min were investigated for three different positions of the cannula in the aortic arch.
Results: For both geometries, the placement of the cannula in the ascending aorta led to a superior oxygenation of all aortic blood vessels except for the left coronary artery. Cannula placements at the aortic arch and descending aorta could support supra-aortic arteries, but not the coronary arteries. All positions were able to support all branches with saturated blood at 90% flow volume.
Conclusions: In accordance with clinical observations CFD analysis reveals, that retrograde advancement of a long endoluminal cannula can considerably improve the oxygenation of the upper body and lead to oxygen saturation distributions similar to those of a central cannulation.
Additive Manufacturing (AM) of metallic workpieces faces a continuously rising technological relevance and market size. Producing complex or highly strained unique workpieces is a significant field of application, making AM highly relevant for tool components. Its successful economic application requires systematic workpiece based decisions and optimizations. Considering geometric and technological requirements as well as the necessary post-processing makes deciding effortful and requires in-depth knowledge. As design is usually adjusted to established manufacturing, associated technological and strategic potentials are often neglected. To embed AM in a future proof industrial environment, software-based self-learning tools are necessary. Integrated into production planning, they enable companies to unlock the potentials of AM efficiently. This paper presents an appropriate methodology for the analysis of process-specific AM-eligibility and optimization potential, added up by concrete optimization proposals. For an integrated workpiece characterization, proven methods are enlarged by tooling-specific figures.
The first stage of the approach specifies the model’s initialization. A learning set of tooling components is described using the developed key figure system. Based on this, a set of applicable rules for workpiece-specific result determination is generated through clustering and expert evaluation. Within the following application stage, strategic orientation is quantified and workpieces of interest are described using the developed key figures. Subsequently, the retrieved information is used for automatically generating specific recommendations relying on the generated ruleset of stage one. Finally, actual experiences regarding the recommendations are gathered within stage three. Statistic learning transfers those to the generated ruleset leading to a continuously deepening knowledge base. This process enables a steady improvement in output quality.
Gamification applications are on the rise in the manufacturing sector to customize working scenarios, offer user-specific feedback, and provide personalized learning offerings. Commonly, different sensors are integrated into work environments to track workers’ actions. Game elements are selected according to the work task and users’ preferences. However, implementing gamified workplaces remains challenging as different data sources must be established, evaluated, and connected. Developers often require information from several areas of the companies to offer meaningful gamification strategies for their employees. Moreover, work environments and the associated support systems are usually not flexible enough to adapt to personal needs. Digital twins are one primary possibility to create a uniform data approach that can provide semantic information to gamification applications. Frequently, several digital twins have to interact with each other to provide information about the workplace, the manufacturing process, and the knowledge of the employees. This research aims to create an overview of existing digital twin approaches for digital support systems and presents a concept to use digital twins for gamified support and training systems. The concept is based upon the Reference Architecture Industry 4.0 (RAMI 4.0) and includes information about the whole life cycle of the assets. It is applied to an existing gamified training system and evaluated in the Industry 4.0 model factory by an example of a handle mounting.
The recent amendment to the Ethernet physical layer known as the IEEE 802.3cg specification, allows to connect devices up to a distance of one kilometer and delivers a maximum of 60 watts of power over a twisted pair of wires. This new standard, also known as 10BASE-TIL, promises to overcome the limits of current physical layers used for field devices and bring them a step closer to Ethernet-based applications. The main advantage of 10BASE- TIL is that it can deliver power and data over the same line over a long distance, where traditional solutions (e.g., CAN, IO-Link, HART) fall short and cannot match its 10 Mbps bandwidth. Due to its recentness, IOBASE- TIL is still not integrated into field devices and it has been less than two years since silicon manufacturers released the first Ethernet-PHY chips. In this paper, we present a design proposal on how field devices could be integrated into a IOBASE-TIL smart switch that allows plug-and-play connectivity for sensors and actuators and is compliant with the Industry 4.0 vision. Instead of presenting a new field-level protocol for this work, we have decided to adopt the IO-Link specification which already includes a plug-and-play approach with features such as diagnosis and device configuration. The main objective of this work is to explore how field devices could be integrated into 10BASE-TIL Ethernet, its adaption with a well-known protocol, and its integration with Industry 4.0 technologies.
Virtual Reality (VR) offers novel possibilities for remote training regardless of the availability of the actual equipment, the presence of specialists, and the training locations. Research shows that training environments that adapt to users' preferences and performance can promote more effective learning. However, the observed results can hardly be traced back to specific adaptive measures but the whole new training approach. This study analyzes the effects of a combined point and leveling VR-based gamification system on assembly training targeting specific training outcomes and users' motivations. The Gamified-VR-Group with 26 subjects received the gamified training, and the Non-Gamified-VR-Group with 27 subjects received the alternative without gamified elements. Both groups conducted their VR training at least three times before assembling the actual structure. The study found that a level system that gradually increases the difficulty and error probability in VR can significantly lower real-world error rates, self-corrections, and support usages. According to our study, a high error occurrence at the highest training level reduced the Gamified-VR-Group's feeling of competence compared to the Non-Gamified-VR-Group, but at the same time also led to lower error probabilities in real-life. It is concluded that a level system with a variable task difficulty should be combined with carefully balanced positive and negative feedback messages. This way, better learning results, and an improved self-evaluation can be achieved while not causing significant impacts on the participants' feeling of competence.
In this article we describe an Internet-of-Things sensing device with a wireless interface which is powered by the oftenoverlooked harvesting method of the Wiegand effect. The sensor can determine position, temperature or other resistively measurable quantities and can transmit the data via an ultra-low power ultra-wideband (UWB) data transmitter. With this approach we can energy-self-sufficiently acquire, process, and wirelessly transmit data in a pulsed operation. A proof-of-concept system was built up to prove the feasibility of the approach. The energy consumption of the system is analyzed and traced back in detail to the individual components, compared to the generated energy and processed to identify further optimization options. Based on the proof-of-concept, an application demonstrator was developed. Finally, we point out possible use cases.
Sleep spindles are neurophysiological phenomena that appear to be linked to memory formation and other functions of the central nervous system, and that can be observed in electroencephalographic recordings (EEG) during sleep. Manually identified spindle annotations in EEG recordings suffer from substantial intra- and inter-rater variability, even if raters have been highly trained, which reduces the reliability of spindle measures as a research and diagnostic tool. The Massive Online Data Annotation (MODA) project has recently addressed this problem by forming a consensus from multiple such rating experts, thus providing a corpus of spindle annotations of enhanced quality. Based on this dataset, we present a U-Net-type deep neural network model to automatically detect sleep spindles. Our model’s performance exceeds that of the state-of-the-art detector and of most experts in the MODA dataset. We observed improved detection accuracy in subjects of all ages, including older individuals whose spindles are particularly challenging to detect reliably. Our results underline the potential of automated methods to do repetitive cumbersome tasks with super-human performance.
Miniaturized electrolyte–insulator–semiconductor capacitors (EISCAPs) with ultrathin gate insulators have been studied in terms of their pH-sensitive sensor characteristics: three different EISCAP systems consisting of Al–p-Si–Ta2O5(5 nm), Al–p-Si–Si3N4(1 or 2 nm)–Ta2O5 (5 nm), and Al–p-Si–SiO2(3.6 nm)–Ta2O5(5 nm) layer structures are characterized in buffer solution with different pH values by means of capacitance–voltage and constant capacitance method. The SiO2 and Si3N4 gate insulators are deposited by rapid thermal oxidation and rapid thermal nitridation, respectively, whereas the Ta2O5 film is prepared by atomic layer deposition. All EISCAP systems have a clear pH response, favoring the stacked gate insulators SiO2–Ta2O5 when considering the overall sensor characteristics, while the Si3N4(1 nm)–Ta2O5 stack delivers the largest accumulation capacitance (due to the lower equivalent oxide thickness) and a higher steepness in the slope of the capacitance–voltage curve among the studied stacked gate insulator systems.
Vitamin D plays an essential role in calcium and inorganic phosphate (Pi) homeostasis, maintaining their optimal levels to assure adequate bone mineralization. Vitamin D, as calcitriol (1,25(OH)2D), not only increases intestinal calcium and phosphate absorption but also facilitates their renal reabsorption, leading to elevated serum calcium and phosphate levels. The interaction of 1,25(OH)2D with its receptor (VDR) increases the efficiency of intestinal absorption of calcium to 30–40% and phosphate to nearly 80%. Serum phosphate levels can also influence 1,25 (OH)2D and fibroblast growth factor 23 (FGF23) levels, i.e., higher phosphate concentrations suppress vitamin D activation and stimulate parathyroid hormone (PTH) release, while a high FGF23 serum level leads to reduced vitamin D synthesis. In the vitamin D-deficient state, the intestinal calcium absorption decreases and the secretion of PTH increases, which in turn causes the stimulation of 1,25(OH)2D production, resulting in excessive urinary phosphate loss. Maintenance of phosphate homeostasis is essential as hyperphosphatemia is a risk factor of cardiovascular calcification, chronic kidney diseases (CKD), and premature aging, while hypophosphatemia is usually associated with rickets and osteomalacia. This chapter elaborates on the possible interactions between vitamin D and phosphate in health and disease.