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Patients with severe respiratory or lung diseases require intensive treatment and their lung function needs to be monitored on a continuous basis. As part of the Pneumo.Vest project, Fraunhofer researchers have developed a technology whereby noises in the lungs are recorded using a textile vest with integrated acoustic sensors. The signals are then converted and displayed visually using software. In this way, patients outside of intensive care units can still be monitored continuously. The technology increases the options for diagnosis and improves the patient’s quality of life.

For over 200 years, the stethoscope has been a standard tool for doctors and, as such, is a symbol of the medical profession. In television hospital dramas, doctors are seen rushing through the halls with a stethoscope around their neck. Experienced doctors do indeed use them to listen very accurately to heartbeats and the lungs and, as a result, to diagnose illnesses.

Now, the stethoscope is getting some help. As part of the Pneumo.Vest project, researchers of the Fraunhofer Institute for Ceramic Technologies and Systems IKTS at the Berlin office have developed a textile vest with integrated acoustic sensors, presenting a high-performance addition to the traditional stethoscope. Piezoceramic acoustic sensors have been incorporated into the front and back of the vest to register any noise produced by the lungs in the thorax, no matter how small. A software program records the signals and electronically amplifies them, while the lungs are depicted visually on a display. As the software knows the position of each individual sensor, it can attribute the data to its precise location. This produces a detailed acoustic and optical picture of the ventilation situation of all parts of the lungs. Here is what makes it so special: As the system collects and stores the data permanently, examinations can take place at any given time and in the absence of hospital staff. Pneumo.Vest also indicates the status of the lungs over a period of time, for example over the previous 24 hours. Needless to say, traditional auscultation can also be carried out directly on the patients. However, instead of carrying out auscultation manually at different points with a stethoscope, a number of sensors are used simultaneously.

“Pneumo.Vest is not looking to make the stethoscope redundant and does not replace the skills of experienced pneumologists. However, auscultation or even CT scans of the lungs only ever present a snapshot at the time of the examination. Our technology provides added value because it allows for the lungs to be monitored continuously in the same way as a long-term ECG, even if the patient is not attached to machines in the ICU but has instead been admitted to the general ward,” explains Ralf Schallert, project manager at Fraunhofer IKTS.

Machine learning algorithms aid with diagnosis
Alongside the acoustic sensors, the software is at the core of the vest. It is responsible for storing, depicting and analyzing the data. It can be used by the doctor to view the acoustic events in specific individual areas of the lungs on the display. The use of algorithms in digital signal processing enables a targeted evaluation of acoustic signals. This means it is possible, for example, to filter out heartbeats or to amplify characteristic frequency ranges, making lung sounds, such as rustling or wheezing, much easier to hear.

On top of this, the researchers at Fraunhofer IKTS are developing machine learning algorithms. In the future, these will be able to structure and classify complex ambient noises in the thorax. Then, the pneumologist will carry out the final assessment and diagnosis.

Discharge from the ICU
Patients can also benefit from the digital sensor alternative. When wearing the vest, they can recover without requiring constant observation from medical staff. They can transfer to the general ward and possibly even be sent home and move about more or less freely. Despite this, the lungs are monitored continuously, and any sudden deterioration can be reported to medical personnel straight away.

The first tests with staff at the University Clinic for Anesthesiology and Intensive Therapy at the University of Magdeburg have shown that the concept is successful in practice. “The feedback from doctors was overwhelmingly positive. The combination of acoustic sensors, visualization and machine learning algorithms will be able to reliably distinguish a range of different lung sounds,” explains Schallert. Dr. Alexander Uhrig from Charité – Universitätsmedizin Berlin is also pleased with the technology. The specialist in infectiology and pneumology at the renowned Charité hospital was one of those who initiated the idea: “Pneumo.Vest addresses exactly what we need. It serves as an instrument that expands our diagnostic options, relieves the burden on our hospital staff and makes hospital stays more pleasant for patients.”

The technology was initially designed for respiratory patients, but it also works well for people in care facilities and for use in sleep laboratories. It can also be used to train young doctors in auscultation.

Increased need for clinical-grade wearables
With Pneumo.Vest, the researchers at Fraunhofer IKTS have developed a product that is cut out for the increasingly strained situation at hospitals. In Germany, 385,000 patients with respiratory or lung diseases require inpatient treatment every year. Over 60 percent are connected to a ventilator for more than 24 hours. This figure does not account for the current increase in respiratory patients due to the COVID-19 pandemic. As a result of increasing life expectancy, the medical industry also expects the number of older patients with breathing problems to increase. With the help of technology from Fraunhofer IKTS, the burden on hospitals and, in particular, costly ICUs can be relieved as their beds will no longer be occupied for quite as long.

It should be added that the market for such clinical-grade wearables is growing rapidly. These are compact medical devices that can be worn directly on the body to measure vital signs such as heartbeat, blood oxygen saturation, respiratory rate or skin temperature. As a medical device that can be used flexibly, Pneumo.Vest fits in perfectly with this development. But do not worry: Doctors will still be using the beloved stethoscope in the future.

Fraunhofer “M³ Infekt” cluster project
Pneumo.Vest is just one part of the extensive M³ Infekt cluster project. Its objective is to develop monitoring systems for the decentralized monitoring of patients. The current basis of the project is the treatment of COVID-19 patients. With the SARS-CoV2 virus, it is common for even mild cases to suddenly deteriorate significantly. By continuously monitoring vital signs, any deterioration in condition can be quickly identified and prompt measures for treatment can be taken.

M3 Infekt can also be used for a number of other symptoms and scenarios. The systems have been designed to be modular and multimodal so that biosignals such as heart rate, ECG, oxygen saturation, or respiratory rate and volume can be measured, depending on the patient and illness.

A total of ten Fraunhofer institutes are working on the cluster project under the leadership of the Fraunhofer Institute for Integrated Circuits IIS in Dresden. Klinikum Magdeburg, Charité – Universitätsmedizin Berlin and the University Hospitals of Erlangen and Dresden are involved as clinical partners.

The fashion industry is massively influenced by the change in social values. Which trends can be observed and in which direction is the fashion future developing - an excerpt from the Retail Report 2023¹ by Theresa Schleicher.

The fashion industry has been slowed down by the global health pandemic and further affected by the measures taken in the wake of the Ukraine war: Fragile supply chains, increased transportation and energy costs, and rising prices are having an impact on the globalized fashion industry. Those who were moving the fastest are being hit the hardest. Fast fashion based on the principle of "faster and faster, cheaper and cheaper, more and more" - which has been in the fast lane for years - is now experiencing an unprecedented crash. Even without these momentous events, the fashion system would have reached its limits. What could have developed evolutionarily is now being revolutionized. Now and in the future, it will be particularly difficult for brands and retail companies that do not have a sharp profile or that have lost many customers in the attempt to offer mass-produced goods at prices that are still lower than those of their competitors.

New value paradigm in society - also for fashion
While fashion retailers and fashion brands are focusing on expanding online and have been putting their foot on the gas pedal since the corona pandemic at the latest, a parallel change in values is taking place in society. Many behaviors that have been practiced, tested and lived for months will continue to shape our consumer behavior and lifestyles in the future. The uncertainty in society as well as a shrinking economy and rising consumer prices as a result of the Ukraine war will further contribute to this shift in values.

The old paradigm was "primarily shaped by pragmatic factors such as price, quantity, safety and convenience, so consumer behavior was predominantly based on relatively simple cost-benefit calculations." The new value paradigm, on the other hand, is more strongly influenced by "soft factors". For example, the quality of a product is defined more holistically. In addition to price, "ecological, [...] ethical and social aspects are also taken into account. It is about positive or negative experiences that one has had with producers and about the visions that they pursue with their companies". This new value paradigm is forcing the large chain stores in particular to rethink. They have to develop their business models further in the direction of sustainability, transparency and responsibility - and show attitude. The influence of the neo-ecology megatrend combined with the push towards the sense economy is reshuffling the cards in the fashion industry.

The most important driver for the change in consumer behavior is climate protection, which is also becoming personally more important to more and more people because they are feeling the effects of climate change themselves in their everyday lives. The transition to a sustainable, bio-based and circular economy is accompanied by fundamental changes in the technical, economic and social environment.

Circular fashion as an opportunity for fast fashion
The development of the fashion industry - especially the fast fashion industry - towards a more circular economy is not a short-term trend, but one of the most long-term and at the same time forward-looking trends in retailing of all.

Even before the pandemic, a growing proportion of consumers placed value on sustainably produced clothing instead of constantly shopping the latest trends. A reset is needed, but the fashion industry faces a difficult question: How can it respond to the demand for new trends without neglecting its responsibility for the environment?

The solution for reducing emissions and conserving raw materials and resources seems obvious: produce less. On average, 2,700 liters of water are needed to produce a T-shirt - that much drinking water would last a person for two and a half years. In Europe, each person buys an average of 26 kilograms of textiles per year - and disposes eleven kilograms. Of this, almost 90 percent is incinerated or ends up in landfills. Overproduction, precarious working conditions during production and the use of non-sustainable materials are the major problems of the fast fashion industry. It is time to slow down fast fashion.

Fashion recycling by Design & Recycling as a Service
A first step towards keeping fashion and textiles in the cycle for longer is to recycle materials properly. In the future, recycling must be considered as early as the design stage - not only for sustainably produced fashion, but also for fast fashion. The H&M Group, for example, developed the Circulator for this purpose: The digital evaluation tool guides the designer through materials, components and design strategies that are best suited for the product depending on its purpose, and evaluates them in terms of their environmental impact, durability and recyclability.

However, more and more young companies are specializing in offering recycling for textiles as a service. They work directly with fashion retailers or fashion brands to enable the best possible recycling, re-circulation or even upcycling. Until now, it has not been worthwhile for large textile companies to invest in their own recycling systems. But Recycling as a Service is a market of the future, led by innovative start-ups such as Resortecs that are tackling previous hurdles in our recycling system. In the future, more and more new service providers will pop up around returns and recycling and help fashion retailers to align their material cycles more sustainably.

Secondhand conquers the fast fashion market
Another way to extend the life of clothing is to pass it on to new users. We are witnessing the triumph of vintage, retro and more - chic secondhand stores and chains like Resales and Humana are popping up everywhere. The renaming of secondhand to pre-owned or pre-loved also illustrates the increased appreciation of worn clothing. The trend toward secondhand also pays off economically for companies: The number of platforms whose business model revolves around the resale of clothing is increasing, and secondhand fashion is arriving in the middle of society. The luxury segment and especially vintage fashion are stable in price because the availability of these unique pieces is limited. Fast fashion, on the other hand, is available in sufficient quantities and is particularly interesting for price-sensitive customers, as secondhand is considered one of the most sustainable forms of consumption - meaning that fashion can be shopped with a clear conscience - and is usually even offered at a lower price than new goods. The second-hand market will continue to professionalize and become more socially acceptable. As a result, the fast fashion industry will also be forced to produce higher quality clothing in order to become or remain part of the circular system.

Slow fashion gains momentum thanks to technology
The development and orientation of fast fashion towards circular processes is also changing sustainable fashion. In the future, fast fashion and slow fashion can learn from each other to fully exploit their potential: fast fashion will become more sustainable, while slow fashion will focus on faster availability and delivery and make the customer experience as pleasant as possible. Fast and slow fashion are no longer compelling opposites - because the sustainable fashion movement can also benefit from technological innovations that are being established above all by the fashion platforms, and lift slow fashion to a new level.

At the same time, Sustainable Luxury is a new form of luxury consumption - especially in the field of designer fashion, sustainability is becoming the all-important criterion. Sustainability as a means of distinction for true luxury and sustainability as a basic prerequisite for a functioning fashion industry are increasingly converging. This is where the transition between a slowdown of fast fashion and an acceleration of slow fashion takes place.

Trend Sustainable Luxury
Luxury is defined less and less by the object and its possession and is increasingly becoming an expression of one's own lifestyle and values. Consumers' understanding of premium and luxury has changed - not least driven by the neo-ecology megatrend. In the future, it will no longer be just about owning something as expensive and ostentatious as possible. What began as a rebellion against careless consumption of luxury brands that promise high-end products but accept unfair and environmentally damaging manufacturing conditions in the process has increasingly become accepted as a value attitude. Luxury products have no less a claim than to improve the world.

Sustainable and ethical products and services made from innovative materials that have the power to solve problems and make the world a better place. At the same time, this highly ethically and morally charged form of sustainability is turning into a means of distinction: For the materials are so new, the manufacturing processes still so experimental, that the products are unique and often only available in very small quantities or on order. And this exclusive sustainability naturally comes at a price. After all, a company that pursues a mission is not concerned with simply cutting costs - certainly not at the expense of others or the environment. Instead of leather and fur, luxury fashion is now made from oranges, pineapples, hemp, cacti: there are more and more new, innovative and sustainable materials from which unique garments and accessories can be made.

Predictive, Pre-Order & Made-to-Order
Artificial intelligence and Big Data analysis can help predict fashion demand. Fast fashion leaders like Shein are characterized by agile production which is supported by AI algorithms for trend prediction fed with data from TikTok and other social media services. This could sustainably reduce overproduction and unsaleable goods in the future. As critical as Shein's practices are, the automation of processes also offers immense opportunities for a more sustainable fashion industry, as production only starts when goods are in demand.

AI support in the design process can be used to produce more sustainable fashion - and make it available more quickly. In a future of an avatar economy and in the world of virtual influencers, it may even be possible to dispense with part of the production process: Fashion will remain virtual - and thus more resource-efficient. Digital fashion will become increasingly important as the metaverse is built.

5 Key Takeaways on the Future of Fashion

1. The current crisis in the fashion industry is an opportunity to move more in the direction of circular fashion. Above all, the new value paradigm in society, understanding quality more holistically and consuming more mindfully, is providing a push towards fairer, more ecological and more social fashion. Fast fashion and sustainability are not mutually exclusive.
2. There are already first approaches to keep fast fashion in the cycle longer or to return it to the cycle. One important development is to consider recycling or reuse as early as the design and manufacturing process - known as recycling by design. In addition, there is a growing number of start-ups specializing in the optimized recycling of textiles and cooperating with major fashion players.
3. Above all, the booming online trade in used fashion, often communicated as the pre-loved or pre-owned category, is making secondhand respectable for the mainstream. Such fashion, with a story and an aura of uniqueness, is also a cost-effective but more sustainable alternative to fast fashion.
4. But slow fashion is also changing, especially due to the dominance of new technologies. Slow fashion can also benefit from processes that are currently manifesting themselves in the online fashion market, such as fast delivery or pre-order services. Slow fashion thus becomes more convenient, better and faster available. It will be easier for sustainably oriented fashion enthusiasts to consume according to their values and attitudes.
5. The trend toward sustainable luxury continues: Sustainability as a means of distinction for a new form of luxury enables alternative manufacturing processes and innovative materials in the luxury fashion market. These are being showcased by an avant-garde and, if they prove successful, adapted by fast fashion.

¹https://onlineshop.zukunftsinstitut.de/shop/retail-report-2023/