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Cardiac resynchronization therapy (CRT) is an established class I level A biventricular pacing therapy in chronic heart failure patients with left bundle branch block and reduced left ventricular ejection fraction, but not all patients improved clinically. Purpose of the study was to evaluate electrical interatrial conduction delay (IACD) to interventricular conduction delay (IVCD) ratio with focused transesophageal left atrial and left ventricular electrocardiography.
Methods: Thirty eight chronic heart failure patients (age 63.4±10.2 years; 3 females, 35 males) with New York Heart Association (NYHA) functional class 3.0±0.2 and 171.71±36.17ms QRS duration were analysed using posterior left atrial and left ventricular transesophageal electrocardiography with hemispherical electrodes before CRT. Electrical IACD was measured between onset of P-wave in the surface ECG and onset of left atrial signal. Electrical IVCD was measured between onset of QRS complex in the surface ECG and onset of left ventricular signal.
Results: Electrical IACD and IVCD could be evaluated by transesophageal left atrial and left ventricular electrocardiography in all heart failure patients with correlation to 1.18±0.92 IACD-IVCD-ratio (r=-0.57, P<0.001; r=0.66, P<0.001). There were 32 CRT responder with reduction of NYHA class from 3.0±0.22 to 1.97±0.31 (P<0.001) during 16.5±18.9 month CRT with 75.19±33.49ms IACD, 78.91±24.73ms IVCD, 1.04±0.66 IACD-IVCD-ratio and correlation between IACD and IACDIVCD- ratio (r=0.84, P<0.001). There were 6 CRT nonresponder with no reduction of NYHA class from 3.0±0.3 to 2.9±0.5 during 14.3±13.7 month biventricular pacing, 50.0±28.26ms IVCD (P=0.014), 1.92±1.65 IACD-IVCD-ratio (P=0,029) and correlation between 67.0±24.9ms IACD and IACD-IVCD-ratio (r=0.85, P=0.031).
Conclusions: Focused transesophageal left atrial and left ventricular electrocardiography can be utilized to analyse electrical IACD and IVCD in heart failure patients. IACDIVDC- ratio may be a useful parameter to evaluate electrical left cardiac desynchronization in heart failure patients.
Cardiac resynchronization therapy (CRT) is an established biventricular pacing therapy in heart failure patients with left bundle branch block and reduced left ventricular ejection fraction, but not all patients improved clinically as CRT responder. Purpose of the study was to evaluate electrical left atrial conduction delay (LACD) with focused transesophageal electrocardiography in CRT responder and CRT non-responder.
Methods: Twenty heart failure patients (age 66.6±8.2 years; 2 females, 18 males) with New York Heart Association functional class 3.0±0.3 and 174.2±40.2ms QRS duration were analysed using posterior left atrial transesophageal electrocardiography with hemispherical electrodes. Electrical LACD was measured between onset and offset of transesophageal left atrial signal before implantation of CRT devices.
Results: Electrical LACD could be evaluated by bipolar transesophageal left atrial electrocardiography using TO Osypka electrode in all heart failure patients with negative correlation between 54.7±18.1ms LACD and 24.9±6.4% left ventricular ejection fraction (r=-0.65, P=0.002). There were 16 CRT responders with reduction of New York Heart Association functional class from 3.0±0.29 to 2.1±0.2 (r=0.522, P=0.038) during 9.41±10.96 month biventricular pacing and negative correlation between 49.6±14.2ms LACD and 26.0±6.2% left ventricular ejection fraction (r=-0.533, P=0.034). There were 4 CRT non-responders with no reduction of New York Heart Association functional class from 3.0±0.4 to 2.8±0.5 (r=0.816, P=0.184) during with 13.88±16.39 month biventricular pacing and no correlation between 75.25±19.17ms LACD and 20.75±6.4% left ventricular ejection fraction (r=-0.831, P=0.169).
Conclusions: Focused transesophageal left atrial electrocardiography can be utilized to analyse electrical LACD in heart failure patients. LACD correlated negative with left ventricular ejection fraction in CRT responders. LACD may be a useful parameter to evaluate electrical left atrial desynchronization in heart failure patients.
In der Wertanalyse ist die Methodik TRIZ (Theorie der Lösung erfinderischer Problemstellungen) seit vielen Jahren als Werkzeug zur Kostensenkung oder zur Steigerung der Funktionalität von Produkten bekannt. Seit ihrem ersten Bekanntwerden in Westeuropa hat sich auch TRIZ weiterentwickelt. So wurden Methoden zur Modellierung von Systemen inzwischen erweitert und um Werkzeuge zur schnellen Lösungsfindung, zur Fehlervoraussage und zur Produktplanung neu entwickelt. Durch den weltweiten wissenschaftlichen Fortschritt, die Verwendung unterschiedlicher Sprachen und neue Literatur ist andererseits auch die verwendete Terminologie angewachsen und nicht mehr eindeutig. Die neue VDI-Richtlinie 4521, von deren erstem Teil nun der Gründruck vorliegt, zielt deswegen auf eine Standardisierung der Terminologie und eine vereinheitlichte Beschreibung der Methoden ab. Mit ihrer Hilfe sollen das Studium der Methodik erleichtert, die Benutzung von Literatur vereinfacht und Inhalte der TRIZ klarer darstellbar werden.
Distribution of esophageal interventricular conduction delays in CRT patients and healthy subjects
(2015)
Additive Manufacturing and Reverse Engineering have increasingly been gaining in importance over the past years. This paper investigates the current status of the implementation of these new technologies in design education and also identifies current shortcomings. Then it develops two new approaches for the teaching of the necessary expertise for the design of 3D-printed components and illustrates these with case studies. First, a workshop is presented in which students gain a broad understanding for the functionalities of additive manufacturing and the creative possibilities and limits of this process, through the assembly and installation of a 3D-printer. A second new approach is the combination of reverse engineering and 3D-printing. Thereby, students learn how to deal with this complex process chain. The result of these new approaches can e.g. be seen in the design guidelines for Additive Manufacturing, which were developed by the students themselves. At the same time, the students are able to estimate opportunities and limits of both technologies. Finally, the success of the new course contents and form is reviewed by an evaluation by the students.
This paper presents a new approach for the teaching of competence in additive manufacturing to engineering students in product development. Particularly new to this approach is the combination of the students' autonomous assembly and commissioning of a 3D-printer, and the independent development of guidelines for this new technology regarding the design of components. This way the students will be able to gain first practical experiences with the data preparation, the additive manufacturing process itself and also the required post-treatment of the 3D-printed parts. To allow the students a significantly deeper insight into the functioning of 3D-printing, the workshop Rapid Prototyping developed a new approach in the course of which the students first assemble a construction kit for a 3D-printer themselves and then commission the printer. This enables the students to gain a better understanding of the functionality and configuration of additive manufacturing. In a next step, the students used the 3D-printers they constructed themselves to produce components which they take from a database. Finally, the experiences of the students in the course of the workshop will be evaluated to review the effectiveness of the new approach.
In addition to traditional methods in product development, the increasing availability of two new 3D digital technologies, namely digital manufacturing (3D-printing) and digitizing of surfaces (3D-scanning), offer new opportunities in product development processes today. With regard to the systematic implementation of these technologies in the education of students in the field of product development, however, only a small number of approaches exist so far. This paper explores several ways in which 3D digital technologies can productively be used in design education. The innovative aspects here include that the students assemble and install the 3D-printers themselves, and that they are introduced to an approach that combines 3D-scanning followed by 3D-printing.
Application of Polymer Plaster Composites in Additive Manufacturing of High-Strength Components
(2015)
Today, 3D-printing with polymer plaster composites is a common method in Additive Manufacturing. This technique has proven to be especially suitable for the production of presentation models, due to the low cost of materials and the possibility to produce color-models. But nowadays it requires refinishing through the manual application of a layer of resin. However, the strength of these printed components is very limited, as the applied resin only penetrates a thin edge layer on the surface. This paper develops a new infiltration technique that allows for a significant increase in the strength of the 3D-printed component. For this process, the components are first dehydrated in a controlled two-tier procedure, before they are then penetrated with high-strength resin. The infiltrate used in this process differs significantly from materials traditionally used for infiltration. The result is an almost complete penetration of the components with high-strength infiltrate. As the whole process is computer-integrated, the results are also easier to reproduce, compared to manual infiltration. On the basis of extensive material testing with different testing specimen and testing methods, it can be demonstrated that a significant increase in strength and hardness can be achieved. Finally, this paper also considers the cost and energy consumption of this new infiltration method. As a result of this new technology, the scope of applicability of 3D-printing can be extended to cases that require significantly more strength, like the production of tools for the shaping of metals or used for the molding of plastics. Furthermore, both the process itself and the parameters used are monitored and can be optimized to individual requirements and different fields of application.
The Effect of Gamification on Emotions - The Potential of Facial Recognition in Work Environmentsns
(2015)
Gamification means using video game elements to improve user experience and user engagement in non-game services and applications. This article describes the effects when gamification is used in work contexts. Here we focus on industrial production. We describe how facial recognition can be employed to measure and quantify the effect of gamification on the users’ emotions.
The quantitative results show that gamification significantly reduces both task completion time and error rate. However, the results concerning the effect on emotions are surprising. Without gamification there are not only more unhappy expressions (as to expect) but surprisingly also more happy expressions. Both findings are statistically highly significant.
We think that in redundant production work there are generally more (negative) emotions involved. When there is no gamification happy and unhappy balance each other. In contrast gamification seems to shift the spectrum of moods towards “relaxed”. Especially for work environments such a calm attitude is a desirable effect on the users. Thus our findings support the use of gamification.
Towards a gamification of industrial production: a comparative study in sheltered work environments
(2015)
Using video game elements to improve user experience and user engagement in non-game applications is called "gamification". This method of enriching human-computer interaction has been applied successfully in education, health and general business processes. However, it has not been established in industrial production so far.
After discussing the requirements specific for the production domain we present two workplaces augmented with gamification. Both implementations are based on a common framework for context-aware assistive systems but exemplify different approaches: the visualization of work performance is complex in System 1 and simple in System 2.
Based on two studies in sheltered work environments with impaired workers, we analyze and compare the systems' effects on work and on workers. We show that gamification leads to a speed-accuracy-tradeoff if no quality-related feedback is provided. Another finding is that there is a highly significant raise in acceptance if a straightforward visualization approach for gamification is used.
Design approaches for the gamification of production environments: a study focusing on acceptance
(2015)
Gamification is an ever more popular method to increase motivation and user experience in real-world settings. It is widely used in the areas of marketing, health and education. However, in production environments, it is a new concept. To be accepted in the industrial domain, it has to be seamlessly integrated in the regular work processes.
In this work we make the following contributions to the field of gamification in production: (1) we analyze the state of the art and introduce domain-specific requirements; (2) we present two implementations gamifying production based on alternative design approaches; (3) these are evaluated in a sheltered work organization. The comparative study focuses acceptance, motivation and perceived happiness.
The results reveal that a pyramid design showing each work process as a step on the way towards a cup at the top is strongly preferred to a more abstract approach where the processes are represented by a single circle and two bars.
With major intellectual properties there is a long tradition of cross-media value chains -- usually starting with books and comics, then transgressing to film and TV and finally reaching interactive media like video games. In recent years the situation has changed: (1) smaller productions start to establish cross media value chains; (2) there is a trend from sequential towards parallel content production. In this work we describe how the production of a historic documentary takes a cross media approach right from the start. We analyze how this impacts the content creation pipelines with respect to story, audience and realization. The focus of the case study is the impact on the production of a documentary game. In a second step we reflect on the experiences gained so far and derive recommendations for future small-scale cross media productions.
In this work we provide an overview of gamification, i.e. the application of methods from game design to enrich non-gaming processes. The contribution is divided into five subsections: an introduction focusing on the progression of gamification through the hype cycle in the recent years (1), a brief introduction to gamification mechanics (1) and an overview of the state of the art in established areas (3). The focus is a discussion of more recent attempts of gamification in service and production (4). We also discuss the ethical implications (5) and the future perspectives (6) of gamified business processes. Gamification has been successfully applied in the domains education (serious games) and health (exergames) and is spreading to other areas. In recent years there have been various attempts to “gamify” business processes. While the first efforts date back as far as the collection of miles in frequent flyer programs, we will portray some of the more recent and comprehensive software-based approaches in the service industry, e.g. the gamification of processes in sales and marketing. We discuss their accomplishments as well as their social and ethical implicatio. Finally a very recent approach is presented: the application of gamification in the domain of industrial production. We discuss the special requirements in this domain and the effects on the business level and on the users. We conclude with a prognosis on the future development of gamification.
This paper presents a practice and science orientated education approach for freshman students of interdisciplinary bachelor engineering degree programs. This approach is meant to enhance the motivation and success of freshman students during their whole study. The education approach is called Fit4PracSis (Fit for Practice and Sciences) It was started to develop, set up and establish an education approach, which is building a relationship to students' future profession and to scientific working during the introductory study phase. The freshman students will be trained early in important skills, which are necessary for achieving the final degree successfully and handling of future business and research activities.