AI-Based Learning Approach with Consideration of Safety Criteria on Example of a Depalletization Robot

AbstractRobotic systems need to achieve a certain level of process safety during the performance of the task and at the same time ensure compliance with safety criteria for the expected behaviour. To achieve this, the system must be aware of the risks related to the performance of the task in order to be able to take these into account accordingly. Once the safety aspects have been learned from the system, the task performance must no longer influence them. To achieve this, we present a concept for the design of a neural network that combines these characteristics. This enables the learning of safe behaviour and the fixation of it. The subsequent training of the task execution no longer influences safety and achieves targeted results in comparison to a conventional neural network.</jats:p

Using system dynamics for collaborative design: a case study

<p>Abstract</p> <p>Background</p> <p>In order to facilitate the collaborative design, system dynamics (SD) with a group modelling approach was used in the early stages of planning a new stroke unit. During six workshops a SD model was created in a multiprofessional group.</p> <p>Aim</p> <p>To explore to which extent and how the use of system dynamics contributed to the collaborative design process.</p> <p>Method</p> <p>A case study was conducted using several data sources.</p> <p>Results</p> <p>SD supported a collaborative design, by facilitating an explicit description of stroke care process, a dialogue and a joint understanding. The construction of the model obliged the group to conceptualise the stroke care and experimentation with the model gave the opportunity to reflect on care.</p> <p>Conclusion</p> <p>SD facilitated the collaborative design process and should be integrated in the early stages of the design process as a quality improvement tool.</p

Sildenafil attenuates pulmonary arterial pressure but does not improve oxygenation during ARDS

OBJECTIVE: Pulmonary hypertension is a characteristic feature of acute respiratory distress syndrome (ARDS) and contributes to mortality. Administration of sildenafil in ambulatory patients with pulmonary hypertension improves oxygenation and ameliorates pulmonary hypertension. Our aim was to determine whether sildenafil is beneficial for patients with ARDS. DESIGN: Prospective, open-label, multicenter, interventional cohort study. SETTING: Medical-surgical ICU of two university hospitals. PATIENTS: Ten consecutive patients meeting the NAECC criteria for ARDS. INTERVENTIONS: A single dose of 50 mg sildenafil citrate administered via a nasogastric tube. MAIN RESULTS: Administration of sildenafil in patients with ARDS decreased mean pulmonary arterial pressure from 25 to 22 mmHg (P = 0.022) and pulmonary artery occlusion pressure from 16 to 13 mmHg (P = 0.049). Systemic mean arterial pressures were markedly decreased from 81 to 75 mmHg (P = 0.005). Sildenafil did not improve pulmonary arterial oxygen tension, but resulted in a further increase in the shunt fraction. CONCLUSION: Although sildenafil reduced pulmonary arterial pressures during ARDS, the increased shunt fraction and decreased arterial oxygenation render it unsuitable for the treatment of patients with ARD

Multi-capillary column-ion mobility spectrometry (MCC-IMS) as a new method for the quantification of occupational exposure to sevoflurane in anaesthesia workplaces: an observational feasibility study

BACKGROUND: Occupational exposure to sevoflurane has the potential to cause health damage in hospital personnel. Workplace contamination with the substance mostly is assessed by using photoacoustic infrared spectrometry with detection limits of 10 ppbv. Multi-capillary column-ion mobility spectrometry (MCC-IMS) could be an alternative technology for the quantification of sevoflurane in the room air and could be even more accurate because of potentially lower detection limits. The aim of this study was to test the hypothesis that MCC-IMS is able to detect and monitor very low concentrations of sevoflurane (<10 ppbv) and to evaluate the exposure of hospital personnel to sevoflurane during paediatric anaesthesia and in the post anaesthesia care unit (PACU). METHODS: A MCC-IMS device was calibrated to several concentrations of sevoflurane and limits of detection (LOD) and quantification (LOQ) were calculated. Sevoflurane exposure of hospital personnel was measured at two anaesthesia workplaces and time-weighted average (TWA) values were calculated. RESULTS: The LOD was 0.0068 ppbv and the LOQ was 0.0189 ppbv. During paediatric anaesthesia the mean sevoflurane concentration was 46.9 ppbv (8.0 - 314.7 ppbv) with TWA values between 5.8 and 45.7 ppbv. In the PACU the mean sevoflurane concentration was 27.9 ppbv (8.0 – 170.2 ppbv) and TWA values reached from 8.3 to 45.1 ppbv. CONCLUSIONS: MCC-IMS shows a significantly lower LOD and LOQ than comparable methods. It is a reliable technology for monitoring sevoflurane concentrations at anaesthesia workplaces and has a particular strength in quantifying low-level contaminations of sevoflurane. The exposure of the personnel working in these areas did not exceed recommended limits and therefore adverse health effects are unlikely

Simulation zur Erstellung von Benchmarks für Outcomes

Following the early experiences in aviation, medical simulation has rapidly evolved into one of the most novel educational tools of the last three decades. In addition to its use in training individuals or teams in crisis resource management, simulation has been studied as a tool to evaluate technical and non-technical skills of individuals as well as, more recently, entire medical teams. It is usually fairly difficult to obtain clinical reference data from critical events to refute claims that the management of actual events fell below what could reasonably be expected and we demonstrated the use of rank order statistics to calculate quantiles with confidence limits for management times of critical obstetrical events using data from realistic simulation. This approach could be used to describe the distribution of treatment times in order to assist in deciding what performance may constitute an outlier. It can also identify particular challenges of clinical practice and allow the development of educational curricula. While the information derived from simulation has to be interpreted with a high degree of caution for a clinical context, it may represent a further ‘added value’ or important step in establishing simulation as a training tool and to provide information that could be used in an appropriate clinical context for adverse events. Large amounts of data (such as from a simulation registry) would allow the calculation of acceptable confidence intervals for the required outcome parameters as well as actual tolerance limits.Es ist auf Grund der Rarität von vielen Notfällen normalerweise nicht möglich genug klinische Daten zur Auswertung zur Verfügung zu haben, um sagen zu können, ob das Management eines bestimmten Falles innerhalb von ‚normalen’ Grenzwerten fällt. In dieser wissenschaftlichen Arbeit zeigten wir das ‚Rank Order Statistiks’ dafür benutzt werden könnten, die Resultate von simulierten Notfällen in der Geburtshilfe als Bandbreite von ‚normalen’ klinischen Leistungen darzustellen. Dieses Vorgehen würde es erlauben, eine klinische Leistung mit einer Datenbank von vergleichbaren simulierten Zwischenfällen abzugleichen, um entscheiden zu können, ob die klinische Leistung innerhalb von ‚normalen’ Werten ausgefallen ist. Dieses Vorgehen verschafft außerdem Einblick, welche Probleme besondere Schwierigkeiten bereiten sodass ggf. gezielte Fortbildungen vorbereitet werden könnten. Obwohl die Daten der Simulation mit gewisser Vorsicht zu interpretieren sind, repräsentiert dieses Vorgehen eine neue Anwendung von Simulation, die für die Auswertung von klinischen Notfällen von großer Bedeutung sein könnte. Es wird in diesem Zusammenhang allerdings notwendig sein, relativ große Datenbanken von vielen simulierten Notfällen zu erstellen und auszuwerten, um die gesuchten Werte mit genug Genauigkeit kalkulieren zu können

Simulation to Establish Benchmark Outcome Measures

Following the early experiences in aviation, medical simulation has rapidly evolved into one of the most novel educational tools of the last three decades. In addition to its use in training individuals or teams in crisis resource management, simulation has been studied as a tool to evaluate technical and non-technical skills of individuals as well as, more recently, entire medical teams. It is usually fairly difficult to obtain clinical reference data from critical events to refute claims that the management of actual events fell below what could reasonably be expected and we demonstrated the use of rank order statistics to calculate quantiles with confidence limits for management times of critical obstetrical events using data from realistic simulation. This approach could be used to describe the distribution of treatment times in order to assist in deciding what performance may constitute an outlier. It can also identify particular challenges of clinical practice and allow the development of educational curricula. While the information derived from simulation has to be interpreted with a high degree of caution for a clinical context, it may represent a further ‘added value’ or important step in establishing simulation as a training tool and to provide information that could be used in an appropriate clinical context for adverse events. Large amounts of data (such as from a simulation registry) would allow the calculation of acceptable confidence intervals for the required outcome parameters as well as actual tolerance limits

Biological Principles and Physiology of Bone Regeneration under the Schneiderian Membrane after Sinus Lift Surgery: A Radiological Study in 14 Patients Treated with the Transcrestal Hydrodynamic Ultrasonic Cavitational Sinus Lift (Intralift)

Introduction. Sinus lift procedures are a commonly accepted method of bone augmentation in the lateral maxilla with clinically good results. Nevertheless the role of the Schneiderian membrane in the bone-reformation process is discussed controversially. Aim of this study was to prove the key role of the sinus membrane in bone reformation in vivo. Material and Methods. 14 patients were treated with the minimal invasive tHUCSL-Intralift, and 2 ccm collagenous sponges were inserted subantrally and the calcification process followed up with CBCT scans 4 and 7 months after surgery. Results. An even and circular centripetal calcification under the sinus membrane and the antral floor was detected 4 months after surgery covering 30% of the entire augmentation width/height/depth at each wall. The calcification process was completed in the entire augmentation volume after 7 months. A loss of approximately 13% of absolute augmentation height was detected between the 4th and 7th month. Discussion. The results of this paper prove the key role of the sinus membrane as the main carrier of bone reformation after sinus lift procedures as multiple experimental studies suggested. Thus the importance of minimal invasive and rupture free sinuslift procedures is underlined and does not depend on the type of grafting material used