ABSTRACT
Despite the increasing degree of automation in industry, manual or semi-automated are commonly and inevitable for complex assembly tasks. The transformation to smart processes in manufacturing leads to a higher deployment of data-driven approaches to support the worker. Upcoming technologies in this context are oftentimes based on the gesture-recognition, − monitoring or–control. This contribution systematically reviews gesture or motion capturing technologies and the utilization of gesture data in the ergonomic assessment, gesture-based robot control strategies as well as the identification of COVID-19 symptoms. Subsequently, two applications are presented in detail. First, a holistic human-centric optimization method for line-balancing using a novel indicator–ErgoTakt–derived by motion capturing. ErgoTakt improves the legacy takt-time and helps to find an optimum between the ergonomic evaluation of an assembly station and the takt-time balancing. An optimization algorithm is developed to find the best-fitting solution by minimizing a function of the ergonomic RULA-score and the cycle time of each assembly workstation with respect to the workers' ability. The second application is gesture-based robot-control. A cloud-based approach utilizing a generally accessible hand-tracking model embedded in a low-code IoT programming environment is shown. © 2022 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.
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Background: The COVID-19 pandemic has led to deviations in all sectors of cancer care. We present multidisciplinarily approved recommendations for ethically and empirically based prioritisation of procedures in times of scarce resources for patients with colorectal and pancreatic cancer. Method(s): The CancerCOVID consortium conducted qualitative and quantitative studies on ethical challenges and psychosocial stress of patients and health care professionals in cancer care. For empirical analyses we obtained data from AOK Plus, the main health insurance in Saxony, AIO (Arbeitsgemeinschaft internistische Onkologie) cancer centers, the institute of Pathology Bochum, the ColoPredict Registry and data of outpatient care from the BNHO (Berufsverband der Hamatologen und Onkologen) and Onkotrakt AG. A selective literature review of international data and guidelines focussing on the effects of the pandemic on cancer care and allocation of resources was conducted. Structured group discussions on justified criteria for prioritisation were held with experts from oncology, ethics, law and health research. Recommendations for prioritisation were formulated as S1 guideline with approval of 9 AWMF Medical Societies, 22 multidisciplinary experts and patient representatives. Result(s): The main principle for decisions on prioritisation in times of scarce resources is the minimisation of individual and aggregated harm. In case of relevant risk of harm from a possible low priority classification or postponement prioritization decisions should be made individually for the respective patients according to the multiple-eyes principle. Decision making should involve different disciplines and professions depending on local infrastructure. We concretised recommendations for 5 areas in cancer care. Conclusion(s): Guidelines based on a broad multidisciplinary consensus can give ethically and empirically based support in medical decision making when resources are scarce. This can provide relief for decision-makers and facilitate transparency and trust of patients and population.
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Purpose: CRC prognosis has improved through guideline-based care. COVID-19 pandemic lead to re-allocation of health care resources potentially putting sections of cancer care at a disadvantage. We compared enrollment and clinical subgroups into our registry before and during the first (fw) and second wave (sw) of the COVID-19 pandemic. Method(s): CPP assembles clinical, histo-pathological and molecular data of pts. with resected CRC. Prospectively enrolled pts. during the fw (4-6/2020) and the sw (10-12/2020) were analyzed, focusing on total numbers, age and sex compared to corresponding pre-pandemic intervals of 2019. Due to site expansion (70 to 161) of CPP we calculated quarterly counts per site and in relation to total enrollment. Result(s): 2221 pts. enrolled into CPP during 2019 and 2020 were included, 47 % female (F) /53 % male (M). Mean age in 2019 was 71.9 years (y) vs 71.6 y in 2020. Mean number of pts. enrolled in CPP with primary diagnosis of CRC per site 2019/2020: fw 8,5/6.9 and sw 6.2/5.8. Evaluation for age showed: 2019%/2020% fw >70 y was 52.5/53.5 and <=70 y 47.5/ 46.5 respectively;for the sw > 70 y was 45.6/ 53.5;<=70 y 54.4/46.5. M vs F in fw 2019%/2020% M 50.5/61;F 49.5/39;in sw M 57.6/56;F 42.4/44. Discussion(s): CPP did not detect substantial differences in total counts of enrolled patients or distribution of age and sex. We detected a slight dip in enrollment together with a small shift toward men in fw as well as to elderly pts. in sw. Enrollment of pts. into registries seems to be feasible even in pandemic situation. Potentially, a possible data bias as preference of registry enrollment over randomized controlled trials. Conclusion(s): Real world data from CPP must be complemented by additional data for comprehensive assessment of colon cancer care and will be complemented for final data presentation in 2022 with data collected during the third and omicron wave.
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Background: The focus on treatment of COVID-19 patients during the Sars-CoV-2 outbreak, lockdown measures and individuals' anxiety regarding potential infection when seeing a healthcare provider have likely implications on the extent of diagnosis and quality of treatment of non-COVID-19 patients. This hypothesis has been evaluated exemplarily for the early detection, diagnosis and treatment of colorectal cancer in Saxony within the framework of the CancerCOVID project. Method(s): The situation during 2020 was compared with the situation before the Sars-CoV-2 pandemic (i.e., 2019). The evaluation is based on pseudonymised routine statutory health insurance data for Saxony including more than 50% of the population. Result(s): A main finding was the drop in the number of diagnosis of new colorectal cancer cases between 2019 and 2020 (i.e., 1797 versus 1352). Furthermore, the per-patient rate of surgeries for incident colorectal cancer cases increased slightly (2.4 to 2.5), as did the rate of intravenous (IV) cytostatics administration (2.2 to 2.4) and radiation therapy (1.1 to 1.4). The per-patient rate of surgeries for prevalent colorectal cancer patients remained constant (0.3), as did the rate of radiation therapy (0.2). However, the per-patient rate of IV cytostatics for prevalent colorectal cancer patients decreased from 1.7 to 1.4. The results of analyses pertaining to cancer screenings and mortality are available as well. Discussion(s): It is likely that reduced screenings and fewer contacts with healthcare providers due to the pandemic led to the drop in new diagnosis. The reasons for the small numeric increases in the rates of procedures per incident patient versus the largely flat trajectory in the rate of health care services for prevalent cases require further exploration. Conclusion(s): COVID-19 was associated with changes in the provision of health care especially for cancer patients, which should be taken into consideration in the resource planning when preparing for another pandemic or public health emergency.
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Background: The COVID-19 pandemic has led to deviations in all sectors of cancer care. We present multidisciplinarily approved recommendations for ethically and empirically based prioritisation of procedures in times of scarce resources for patients with colorectal and pancreatic cancer. Methods: The CancerCOVID consortium conducted qualitative and quantitative studies on ethical challenges and psychosocial stress of patients and health care professionals in cancer care. For empirical analyses we obtained data from AOK Plus, the main health insurance in Saxony, AIO (Arbeitsgemeinschaft internistische Onkologie) cancer centers, the institute of Pathology Bochum, the ColoPredict Registry and data of outpatient care from the BNHO (Berufsverband der Hämatologen und Onkologen) and Onkotrakt AG. A selective literature review of international data and guidelines focussing on the effects of the pandemic on cancer care and allocation of resources was conducted. Structured group discussions on justified criteria for prioritisation were held with experts from oncology, ethics, law and health research. Recommendations for prioritisation were formulated as S1 guideline with approval of 9 AWMF Medical Societies, 22 multidisciplinary experts and patient representatives. Results: The main principle for decisions on prioritisation in times of scarce resources is the minimisation of individual and aggregated harm. In case of relevant risk of harm from a possible low priority classification or postponement prioritization decisions should be made individually for the respective patients according to the multiple-eyes principle. Decision making should involve different disciplines and professions depending on local infrastructure. We concretised recommendations for 5 areas in cancer care. Conclusions: Guidelines based on a broad multidisciplinary consensus can give ethically and empirically based support in medical decision making when resources are scarce. This can provide relief for decision-makers and facilitate transparency and trust of patients and population. Legal entity responsible for the study: The authors. Funding: Bundesministerium für Bildung und Forschung;Germany Förderkennzeichen: 01KI20521A-C. Disclosure: A. Reinacher-Schick: Financial Interests, Personal, Invited Speaker: Amgen, Roche, Merck Serono, Bristol-Myers Squibb, MSD, MCI Group, AstraZeneca;Financial Interests, Personal, Advisory Board: Amgen, Roche, Merck Serono, Bristol-Myers Squibb, MSD, AstraZeneca, Pierre Fabre;Financial Interests, Personal, Other, Travel support: Roche;Financial Interests, Institutional, Research Grant: BNT, Roche, Ipsen. O. Schoffer: Financial Interests, Personal, Advisory Role: Novartis. A. Kraeft: Financial Interests, Personal, Writing Engagements: Astra. A. Tannapfel: Financial Interests, Institutional, Research Grant: Roche, Biontech. J. Schmitt: Financial Interests, Institutional, Funding: Sanofi, Pfizer, Novartis. All other authors have declared no conflicts of interest.
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Background: CRC still is one of the leading causes of cancer related death though prognosis has improved through guideline based management. The COVID-19 pandemic lead to re-allocation of resources subordinating all sections of care for CRC patients. We present data on changes of CRC care during the pandemic from 22 German AIO CC and our high volume Institute of Pathology (pathology). Methods: Data was collected retrospectively comparing the months (mo) of the first wave (fw) (4-6/2020) and second wave (sw) (11-12/2020) of the pandemic with corresponding periods (cp) in 2019 focusing on the number of precancerous (ICD-O/0+2) and malignant (ICD-O/ 3+6) colorectal lesions (CRL) diagnosed by our pathology, the number/stage of primary diagnoses (PD) and the number of surgeries (surg) at AIO CC. There, quality criteria of CRC care were also assessed (number of PD discussed within a multidisciplinary tumor board (tb), received social service (soc)/ psychological (psy) counseling or recruited into a clinical trial). Statistical analysis was performed using students t-test for paired data. Results: Numbers of CRL detected upon histology (row 1-3), number of cases, surg and quality criteria from AIO CC (row 4-9) are displayed in the table. We saw a dip in diagnosed CRL and number of surg (p=0.007) only during fw, whereas PD dipped significantly in both waves. A significant reduction in diagnosis of stage III CRC was detected for 2019 vs. 2020 (p=0.001), not for other stages. Quality criteria showed a significant reduction in clinical trial inclusion, a small dip in soc/psy counseling and persistently high tb presentation. Conclusions: We detected a significant decrease of premalignant lesions and primary cancers during the first year of the pandemic which may impact cancer mortality in the future. Certified German CC provided CRC care with significant reduction in clinical trial inclusion only, suggesting high stability of established certified cancer care infrastructure.
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We report the case of a 25-year-old woman who with suicidal intent jumped from an approx. seven metres high bridge. Computed tomography revealed a fracture of the lumbar vertebrae and fractures of both ankle joints. Although no direct chest trauma existed, radiography revealed a pneumomediastinum as an additional finding. Pneumomediastinum is characterised by the presence of air in the mediastinum and is also called mediastinal emphysema. While its occurrence is rare, cases are most commonly self-limiting and the outcome is good. Some reports emphasise that it may occur more often than it is diagnosed. Thus, if a usual diagnosis for chest pain or dyspnoea could not be found, pneumomediastinum should be considered as well. Pneumomediastinum is also seen in patients with COVID-19-infection. It is assumed that a higher vulnerability of the lung is more likely the reason for the higher incidence in those patients than mechanical ventilation. In this case report, we also describe the pathology of pneumomediastinum to consider it as a potential differential diagnosis in patients without trauma as well. © 2022 DIOmed Verlags GmbH. All rights reserved.
ABSTRACT
Introduction: All restrictions and social isolation imposed by the COVID-19 pandemic did not prevent the evolution of non-infectious diseases, interfering in the diagnosis and the beginning of the treatment for other pathologies. This study aims to measure the impact caused by the pandemic on the diagnosis and staging of lung cancer in patients who underwent lung resection (LR) in 2020 compared to 2019, as well as to describe the epidemiological profile of these patients. Methods: In this retrospective study, data from patients who underwent LR (lobectomy, segmentectomy, wedge resection, and pneumonectomy) by PUCRS’s Sao Lucas Hospital Thoracic Surgery team in Brazil within 2019 and 2020 were collected from medical records in March 2021. Only primary lung cancer patients were included. A descriptive analysis was performed. Results: There were 144 LR analyzed, 80 in 2019 and 66 (45.83%) in 2020. The number of LR due to primary lung cancer was 42 (52.5%) in 2019 and 30 (45.45%) in 2020. The comparison between years indicates a reduction of 28.57% in the number of LR. Of the 30 surgeries in 2020, 23 were lobectomies (76.66%), 3 segmentectomies (10%), 1 wedge resection, and 3 pneumonectomies. The incidence of lobectomies in men decreased 35.29% (17 in 2019;11 in 2020) and remained stable in women (13 in 2019;12 in 2020). The average age of patients who were subjected to LR was 61.57 in 2019 and 57.9 in 2020. In cancer patients, the average age was 59.9 (61.9 in 2019;57.98 in 2020). The incidence of adenocarcinoma was 29 in 2019 (69%) and 19 in 2020 (63.3%), being the most prevalent histological type. According to our review, clinic staging (CS) for lung cancer with the highest incidence in the two years analyzed was IA2, with 26.6% of cases in 2020 and 28.5% in 2019. CS IIA corresponded to 20% in 2020 and 9.5% in 2019, IIB 16.6% in 2019 and 6.6% in 2020, IA1 16.6% in 2020 and 2.38% in 2019, IA3 19% in 2019 and 13.3 % in 2020. Of the 42 patients who were performed LR for primary cancer in 2019, 17 (40.47%) underwent video-assisted thoracoscopic surgery (VATS), and from 29 (55.17) in 2020, 16 were VATS. Conclusion: In general, the pandemic and its restrictions of access to tertiary diagnostic and treatment centers decreased the number of patients. There was a reduction of 28.57% in the number of procedures performed for primary lung. Most patients continued to receive a CS IA2 diagnosis, however, the percentage of diagnosis in CS IIA had grown. This percentage is worrying, as it shows that patients took longer to receive adequate treatment or were unable to make an early diagnosis. On the other hand, the average age of diagnosis decreased in 2020, which may indicate early diagnosis perhaps related to incidental findings in COVID19 CT scans. Our lower number of VATS is related to the lack of endoscopic staples in public healthcare system. Keywords: lung cancer, public healthcare, Surgery
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Background At the beginning of the Covid-19 pandemic in spring 2020, governments around the world issued curfews and other stay at home orders ('lockdown') to limit the spread of the SARS-CoV19 virus. This may have forced people to decrease their physical activity. Physical inactivity as well as social stress is known to be especially deleterious for heart failure (HF) patients. The BIO;STREAM.HF study enrolled such HF patients into a prospective registry with Home Monitoring. Purpose: We aimed to evaluate the impact of the lockdown during the first Covid-19 pandemic wave on physical activity and arrhythmia burden of heart failure patients. Methods: We analysed daily transmitted data of patients enrolled into a large international registry (BIO;STREAM.HF) being implanted with a cardiac resynchronization therapy (CRT) devices. Patients with NYHA ≥ II and LVEF ≤ 40% before CRT implantation were selected. Intra-individual weekly mean and median values were calculated for the following daily transmitted parameters: physical activity (measured as % of the day during which the patient moves), atrial arrhythmia burden, mean heart rate (at rest), PP variability, PVC burden, and rate of biventricular pacing. Values were calculated for 12 weeks before and 12 weeks after the country-specific effective date of most rigorous restrictions in spring 2020 to visualize the general trend of parameter changes. Moreover, values for intra-individual changes between three 28-days periods (before, during, and after the lockdown) were calculated. Results: Of 444 patients, 76% were male. They had a mean age of 69 ± 10 years and LVEF of 28.2 ± 6.7%. HF was of ischemic etiology in 42% of cases and they were in NYHA class II (47.5%), III (50.0%) or IV (2.5%). On average, patients were active for 9% of the day (2 h 10 min). The physical activity decreased by approx. 10% with the onset of the lockdown (figure 1) and recovered within the following eight weeks. Comparison of the 28-days periods before, during and after the lockdown showed a statistically significant intra-individual decrease in physical activity (mean decrease 9 min per day) during the lockdown compared to pre- and post-lockdown values and a trend toward reduced mean heart rates. In parallel, a significant increase in device detected atrial arrhythmia burden (mean increase 17 min per day) was observed. All other parameters did not change significantly. Conclusion Our results show that patients reduced their physical activity during the Covid-19 related lockdown in spring 2020. This was associated with an increase in atrial arrhythmia burden and a reduction of the mean heart rate. Prognostic implications of these results will further be analysed.