Andreas Werner

Hybrid Twin: Stress Level Detection using Machine Learning The increasing complexity of workplaces raises the level of stress, necessitating the adaptation of occupational health examinations. Previous rigid procedures should be expanded by continuously evaluating data in the workplace. This approach has become possible with the use of smart textiles, which can employ “machine learning” to create a hybrid twin that provides valuable occupational health findings throughout the entire occupational period.

Objective: This study evaluates the suitability of cerebral oximetry using near-infrared spectroscopy (NIRS) compared to traditional pulse oximetry (SpO2) for measuring cerebral oxygen saturation during hypoxia testing, aiming to enhance safety during flight operations and training. Material and Methods: The study included 106 participants aged 18–60 years at the Aerospace Medicine Training Center in Königsbrück. Cerebral oxygen saturation (rSO2) and peripheral oxygen saturation (SpO2) were measured using the INVOS™ 5100C cerebral oximeter and Masimo™ MS5 pulse oximeter, respectively. Measurements were taken at baseline, during hypoxia at 25,000 feet, and post recovery. Data analysis included regression analysis, Bland–Altman plots, and concordance correlation coefficients (CCC). Ethical approval was obtained from the Hannover Medical School. Data from 100 participants were analyzed. Results: Baseline SpO2 was 97.5 ± 1.5%, and baseline rSO2 was 77.25 ± 6.4%. During hypoxia, SpO2 dropped significantly, while rSO2 showed higher values. SpO2 recovered faster than rSO2. Deviations in rSO2 between the right and left sides during hypoxia were minimal. Lin’s CCC indicated moderate to substantial concordance. NIRS measurements were more stable and less prone to disturbances, with 95 disruptions in pulse oximetry, 25 of which were potentially critical. Conclusions: NIRS is a reliable method for detecting cerebral oxygen saturation, offering significant advantages over traditional pulse oximetry in stability and reliability during hypoxia testing. NIRS is less error-prone, supporting its use for continuous monitoring in aviation settings and enhancing flight safety by providing more accurate hypoxia detection.

Collecting and recording physiological parameters and forwarding this data via telemedicine or remote surveys may significantly increase the health and safety of people working under extreme environmental conditions, like firefighters, mountain rescuers, disaster control employees, military personnel, etc. First, ruggedized systems, as small, lightweight, and flexible as possible, are needed to optimize the goal of increasing occupational health and safety of persons at risk and maximizing their performance during missions. Previous systems could only record a very limited number of parameters, and a few could forward the data online to return information to the user. Therefore, in order to record several meaningful, valid, and reliable physiological parameters synchronized, an extension of existing systems is required. This review highlights this problem and gives an overview of the historical development. The actual status of the systems available was listed and described comparatively. In the end, a proven, promising, and innovative solution is presented that can solve the problem and allow people to work more safely in extreme environments, which may represent the future.

Collecting and recording physiological parameters and forwarding this data via telemedicine or remote surveys may significantly increase the health and safety of people working under extreme environmental conditions, like firefighters, mountain rescuers, disaster control employees, military personnel, etc. First, ruggedized systems, as small, lightweight, and flexible as possible, are needed to optimize the goal of increasing occupational health and safety of persons at risk and maximizing their performance during missions. Previous systems could only record a minimal number of parameters, and a few could forward the data online to return information to the user. Therefore, an extension of existing systems is required to record several meaningful, valid, and reliable physiological parameters synchronized. This review highlights this problem and gives an overview of the historical development and the actual status of the physiological systems available. In the end, a proven and promising solution is presented that can solve the problem and allow people to work more safely in extreme environments in the future. Keywords Performance; Prevention; Online monitoring; Smart textiles; Telemedicine; E-health

ZUSAMMENFASSUNG: Telemedizin (eHealth) ist aus der heutigen Welt nicht mehr wegzudenken. In manchen Bereichen geht es ohne diese Übertragung gar nicht – im Weltraum. Die modernsten und neuesten Informations- und Kommunikationssysteme werden im Gesundheitssystem eingesetzt; in Kliniken schon lange zum Monitoring von Patienten verwendet. Beim US-amerikanischen „soldier of the future“ soll ein Onlinemonitoring die Performancedaten während eines Einsatzes übertragen. Zukünftig sollen nicht nur Vitalparameter erfasst werden, sondern der kognitive, metabolische und „Combat-ready-Status“ zur Verfügung gestellt werden. Diese könnten operationell als situative Erkenntnisse für den Kommandeur oder für den Mediziner im Fall eines Patientenmonitorings zugänglich gemacht werden. Insgesamt ist überall die Absicht zu erkennen, dass es zukünftig möglich sein soll, ein Individuum über eine digitale, gesundheitsförderliche Plattform zu monitoren, um seine Gesundheit und Leistungsfähigkeit zu erhalten oder zu erhöhen.

Ferngesteuerte, unbemannte Luftfahrtsysteme (UAV), auch Drohnen genannt, sind die neue Dimension des Fliegens. Militärisch wurden sie in der Vergangenheit intensiv in den Konflikten im Irak und in Afghanistan eingesetzt, mittlerweile jedoch auch weltweit und stellen den ergänzenden, zukünftigen Weg in der Kriegsführung dar. Es ist seit Langem bekannt, dass das militärische Personal während und nach Einsätzen psychische Störungsbilder entwickeln kann, Militärpiloten beziehungsweise das fliegende Personal sind davon nicht ausgenommen (15,9 / 1000 Personenjahre). Vor dem Hintergrund, das Drohnenoperateure weniger gefährdet sein sollen, weil sie physisch nicht direkt in das Kriegsgeschehen involviert sind und ihre Einsätze weit weg vom Geschehen durchführen, kommen zunehmend Berichte aus den USA, dass es wohl doch Anhaltspunkte hierfür zu geben scheint. Während der letzten Jahre wurden typische Symptome auch des posttraumatischen Belastungssyndroms (PTBS) bei solchen Personen beschrieben, die eine starke Beeinträchtigung der Gesundheit darstellen (25,0 pro 1000 Personenjahre). Soweit bekannt, gibt es bei der U.S. Air Force (USAF) die einzigen UAV-Operateure, die direkt in kriegerische Auseinandersetzungen mit zerstörenden Waffensystemen eingreifen. Besonders bei diesen Personen konnte ein starker Anstieg von psychischem Stress, Müdigkeitssymptomen und mentalen Erkrankungen diagnostiziert werden. Jedoch konnte kein signifikanter Unterschied von PTBS, Depressionen oder Angstzustände zwischen den Operateuren und Piloten gezeigt werden. Die deutsche Luftwaffe hat ebenfalls begonnen, solche Luftfahrtsysteme zu nutzen, bislang werden sie allerdings nur zu Aufklärungszwecken eingesetzt. Nach derzeitigem Kenntnisstand konnte bei deutschen Operateuren bisher kein Anstieg von mentalen Erkrankungen gefunden werden, Ein solcher ist aber zu vermuten, wenn die Technologie mit seinen Möglichkeiten weiter genutzt wird, gegebenenfalls auch zu Kampfeinsätzen. Daher sollte sowohl in der Politik als auch in der Medizin eine verstärkte Aufmerksamkeit auf die Entstehung psychischer Erkrankungen infolge des zunehmenden Einsatzes von Drohen – insbesondere bei deren Nutzung als Waffensystem – gerichtet sein. Remotely piloted aircraft (RPA; also called drones) is a new dimension in aviation. Militarily, RPA's have been used in the past extensively in the conflicts in Iraq and Afghanistan, but meanwhile worldwide, which illustrate the new way of future complementary military warfare. It is well known that military personal evolve mental health disorders (MHD) during their military services or after deployments even in military pilots or flight personal (15.9 per 1,000 person-years). Based on the fact operators of drones compared to pilots are not vulnerable to MHD, because they are not physically involved and far away from combat operations and the battlefield, it becomes apparent that there is evidence. During the last years, typical symptoms of PTSD occurred in such individuals and obtained a serious disturbance of health (25.0 per 1,000 person-years). Currently, to our best knowledge, only in the U.S. Air Force (USAF) RPA operators participate directly in the act of war also using destructive weapons. Especially in this population, it were found increasing and high levels of psychological stress, fatigue, and rates of MH diagnoses, without significant difference in the rates of post-traumatic stress disorder, depressive disorders, and anxiety disorders between RPA operators and flying pilots. The German Air Force has begun using drones up to now exclusively for reconnaissance. According to empiric observation, there was not seen a progress in developing MHD by German RPA's, but it is to adopt that we will also find this illnesses if we proceed with this technology. Hence, it should be of a high sensibility to military policymakers and clinicians that RPA operators have also a high probability to develop mental health disorder particular by using remoted aircrafts as a weapon.

Ein 37-jähriger, bisher gesunder und leistungsfähiger militärischer Luftfahrzeugführer eines agilen, strahlengetriebenen Luftfahrzeugs mit einer Wehrfliegerverwendungsfähigkeit (WFV) seit 2004 und mit über 1200 Flugstunden, synkopierte 2013 während eines akuten Magen-Darm-Infekts.