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During pregnancy, regular medical check-ups provide information about the health and development of the pregnant person and the child. However, these examinations only provide snapshots of their state, which can be dangerous, especially in high-risk cases. To enable convenient and continuous monitoring during this sensitive phase, an international research consortium is planning to further develop the technology of smart textiles. A patch equipped with highly sensitive electronics is meant to collect and evaluate vital data. In addition, the sensors will be integrated into baby clothing in order to improve the future of medical monitoring for newborns with the highest level of data security.

The beginning of a pregnancy is accompanied by a period of intensive health monitoring of the baby and the pregnant person. Conventional prenatal examinations with ultrasound devices, however, only capture snapshots of the respective condition and require frequent visits to doctors, especially in high-risk pregnancies. With the help of novel wearables and smart textiles, researchers in the EU-funded project Newlife aim to enable continuous obstetric monitoring in everyday life.

One goal of the consortium, consisting of 25 partners, is the development of a biocompatible, stretchable, and flexible patch to monitor the progress of the pregnancy and the embryo. Similar to a band-aid, the patch will be applied to the pregnant person’s skin, continuously recording vital data using miniaturized sensors (e.g., ultrasound) and transmitting it via Bluetooth.

For some time now, modern medical technology has been relying on smart textiles and intelligent wearables to offer patients convenient, continuous monitoring at home instead of stationary surveillance. At the Fraunhofer Institute for Reliability and Microelectronics IZM, a team led by Christine Kallmayer is bringing this technology to application-oriented implementation, benefitting from the Fraunhofer IZM’s years of experience with integrating technologies into flexible materials. For the integrated patch, the researchers are using thermoplastic polyurethane as base materials, in which electronics and sensors are embedded. This ensures that the wearing experience is similar to that of a regular band-aid instead of a rigid film.

To ensure that the obstetric monitoring is imperceptible and comfortable for both pregnant individuals and the unborn child, the project consortium plans to integrate innovative MEMS-based ultrasound sensors directly into the PU material. The miniaturized sensors are meant to record data through direct skin contact. Stretchable conductors made of TPU material tracks will then transmit the information to the electronic evaluation unit and finally to a wireless interface, allowing doctors and midwives to view all relevant data in an app. In addition to ultrasound, the researchers are planning to integrate additional sensors such as microphones, temperature sensors, and electrodes.

Even after birth, the new integration technology can be of great benefit to medical technology: With further demonstrators, the Newlife team plans to enable the monitoring of newborns. Sensors for continuous ECG, respiration monitoring, and infrared spectroscopy to observe brain activity will be integrated into the soft textile of a baby bodysuit and a cap. "Especially for premature infants and newborns with health risks, remote monitoring is a useful alternative to hospitalization and wired monitoring. For this purpose, we must guarantee an unprecedented level of comfort provided by the ultra-thin smart textiles: no electronics should be noticeable. Additionally, the entire module has to be extremely reliable, as the smart textiles should easily withstand washing cycles," explains Christine Kallmayer, project manager at Fraunhofer IZM.

For external monitoring of the baby's well-being, the project is also researching ways to use camera data and sensor technology in the baby's bed. Once the hardware basis of the patch, the textile electronics, and the sensor bed is built and tested, the project partners will take another step forward. Through cloud-based solutions, AI and machine learning will be used to simplify the implementation for medical staff and ensure the highest level of data security.

The Newlife project is coordinated by Philips Electronics Nederland B.V. and will run until the end of 2025. It is funded by the European Union under the Horizon Europe program as part of Key Digital Technologies Joint Undertaking under grant number 101095792 with a total of 18.7 million euros.

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.

• After the corona shock, European SMEs are showing very high levels of debt, a considerable deterioration in profitability in some cases, and insufficient capitalization
• The Covid-19 pandemic is particularly affecting small and medium-sized enterprises (SMEs) in France and Italy
• Compared to its European counterparts, German SMEs have come through the crisis relatively well so far
• Already before the crisis 20% "zombies" among Italian SMEs, in France 11%, Germany 10%  

In France and Italy in particular, the Covid-19 pandemic is taking a toll on small and medium-sized enterprises (SMEs): they are currently lacking financial resources totaling an estimated EUR 100 billion - despite the extensive economic stimulus packages and after the exclusion of so-called "zombie" companies. In Germany too, SMEs lacking around EUR three billion of financial resources for a sufficient recapitalization. In view of the lack of EUR 70 billion in Italy and around EUR 29 billion in France, however, the local SMEs are in a much better position. This is the conclusion of a recent analysis by the world's leading credit insurer Euler Hermes.

"European SMEs have a very high level of debt, significantly deteriorated profitability and insufficient capitalization," Ron van het Hof, CEO of Euler Hermes in Germany, Austria and Switzerland says. "In the medium term, this is a very bad combination for the solvency of these companies. In Italy and France in particular, Covid-19 is making the situation increasingly acute, even if the numerous economic stimulus packages have at least avoided a short-term liquidity crisis. German SMEs have once again proven to be relatively robust and have so far come through the crisis relatively well compared to their European counterparts."

In this country too, debt has increased as a result of numerous liquidity measures. In France in particular, however, it is almost twice as high in relation to gross domestic product (81% of GDP) as in Germany (43% of GDP). In Italy, the debt of 65% of GDP is above average also in a European comparison (average: 63%).

In terms of profitability, French SMEs are at the bottom of the European league
"French small and medium-sized companies are now at the bottom of the European league in terms of profitability, even behind Italy," Ana Boata, Head of Macroeconomics at Euler Hermes says. "The profitability of French SMEs has fallen dramatically by 7 percentage points (pp) since the beginning of the year compared to -0.6 pp in Germany. In Italy, we estimate that profitability has also fallen by up to 3pp^[1]. With 33%, the equity ratio in Italy is the lowest and thus well below the 40% that is generally considered as being adequate. Accordingly, Italy is the country where the greatest need for additional funding for recapitalization exists."

In France, the equity ratio of SMEs is 37%, while in Germany, at 39%, only slightly below the recommended capital adequacy level. In their analysis, the economists have already deducted such companies that were already practically unviable before the Covid 19 pandemic.

"A majority of medium-sized companies are proving to be very robust even in the current crisis, especially in Germany, Van het Hof says. "This fact, however, must not hide the fact that there are numerous zombie companies in their shadow in Europe - even before the Covid-19 pandemic. In Italy, for example, even before the crisis, around one-fifth of the SMEs were no longer economically viable, while in France (11%) and Germany (10%) only about half as many were known. However, this number is likely to have increased dramatically with the current crisis, as have the financing requirements of SMEs. The situation will be particularly tight for companies and sectors that had little buffer before the crisis."

In Germany, the equity ratio before the pandemic was particularly low in the transportation industry: in shipping it was around 32%, in aviation 29%. With Covid-19 the existing financing gap has widened again. In France and Italy, companies in the hotel and restaurant industry as well as in mechanical engineering and trade had particularly bad starting positions and therefore have the greatest need for capital now.

The complete study can be found here: https://ots.de/lYcKea 

^[1] Figures are currently available for Germany and France until H1 2020, in Italy only for Q1 2020. The decline in profitability of up to 3pp in Italy is an expert estimate.

Euler Hermes is the world leader in credit insurance and a recognized specialist in bonding and guarantees, debt collection and protection against fraud or political risks. Every day, Euler Hermes monitors and analyzes the insolvency of more than 80 million small, medium and multinational companies through its proprietary monitoring system. Overall, the expert analyses cover markets that account for 92% of the global gross domestic product (GDP).

Please read the attached document for notes regarding forward-looking statements.