P04: Contactless monitoring of laboratory animals for the sake of home cage observation, refinement of anaesthesia and prediction of impending inflammation

The DFG research unit 2591 – a research consortium aims at defining a severity assessment framework for laboratory animals

Patients of the intensive care unit must be constantly monitored regarding their circulatory system and health status. Therefore, they are connected to necessary measuring instruments with the use of electrodes and derivations which takes time and severely narrows the patient’s ability to move. Even patient transport is thereby made more difficult. Through the development of reliable, contactless measurement methods the patients’ ability to move can in this regard stay unrestricted and clinical procedures can be optimized.

This study targets a contactless assessment of the health status of experimental animals. Remotely, vital signs (respiratory rate, pulse, temperature) can be measured, signs of inflammation can be checked and perfusion imaging can be performed with the help of video sequences, radar as well as infrared- and colour cameras.

Further information can be found on: severity-assessment.de

Cooperation partners

The DFG project is part of a DFG research group with the common title: “Severity Assessment in Animal-based Research” (FOR2591)

• P01 Prof. André Bleich, Phd, DipECLAM (Hannover Medical School, Institute for Laboratory Animal Science and Central Animal Facility, Hannover) und Dr. Christine Häger (Hannover Medical School, Institute for Laboratory Animal Science and Central Animal Facility, Hannover)
• P02 Univ.-Prof. Dr. med. René H. Tolba, MD, PhD (Institute for Laboratory Animal Science and Central Animal Facility RWTH Aachen University, Medical Faculty)
• P05 Prof. Peter Gass, MD (Central Institute of Mental Health, Mannheim, Mannheim Faculty / University of Heidelberg, Mannheim/Heidelberg)
• P08 Prof. Dr. Fabian Kiessling, M.D. (Chair of Experimental Molecular Imaging, RWTH Aachen University, Medical Faculty, Aachen)
• P10 Prof. Ute Lindauer, Dr. med. vet. (Translational Neurosurgery and Neurobiology, Department of Neurosurgery, RWTH Aachen University, Medical Faculty, Aachen)
• P11 Prof. Dr. Heidrun Potschka, DVM (Institute of Pharmacology, Toxicology, and Pharmacy, Faculty of Veterinary Medicine, Ludwig-Maximilians-University, Munich)
• P12 Prof. Kerstin Schwabe, Phd (Laboratories for Experimental Neurosurgery, Hannover Medical School, Department of Neurosurgery, Hannover)
• P14 Prof. Dr. Stefan Treue (German Primate Center, Head of the Cognitive Neuroscience Laboratory, Göttingen) und Prof. Dr. Alexander Gail (Sensorimotor Group, German Primate Center, Leibniz Institute for Primate Research, Göttingen)
• P15 Dietmar Zechner, PhD (Rostock University Medical Center, Institute for Experimental Surgery, Rostock University Medical Center, Rostock) und Prof. Dr. med. Brigitte Vollmar (Institute for Experimental Surgery, Rostock University Medical Center, Rostock)
• nP17 Dorit Merhof, Prof. Dr. Ing. (Institute of Imaging & Computer Vision, RWTH Aachen University, Aachen)
• nP18 Marion Bankstahl, Prof. Dr. (Institute for Laboratory Animal Science, Hannover Medical School, Hannover)

Contact

Dr.-Ing. Carina Barbosa Pereira (cbarbosapereukaachende)

Janosch Kunczik, M.Sc. (jkunczikukaachende)

Funding

Deutsche Forschungsgemeinschaft

Project duration: 10/2020 – 09 /2023

TeleSAN – The tele-senior EMS physician as a strategy for the future of disaster medicine – a study testing the feasibility of telemedicine in civil defense

Civil defense emergencies of national importance such as terror attacks, military conflicts, fires and natural disasters as well as local disaster situations are challenging for emergency personnel and executives. Initially, there is a lack of overview, resources for medical treatment are missing and new dangers for both the comrades’ and the own life are omnipresent. Available human and material resources are primarily used for basic life support. Depending on the severity resource balancing might take several days only then allowing individual medical treatment. Aside from the patient care CBRN incidents and terror attacks pose further challenges demanding the immediate support from special forces.

This feasibility study aims at assessing the employment of telemedicine in civil defense emergencies following the example of the telemedicine system established in Aachen. After an evaluation the emergency personnel will be equipped with technical devices allowing them to connect with the tele-senior EMS physician (TeleLNA) as well as other tele-EMS physicians by use of a Tele-SAN app. They are immediately available and able to consult the on-site emergency personnel from afar without losing time about triage, first-aid and individual medical treatment such as the analgesia in cases of thermal traumas. Further specialists like Chemists or Policemen are also able to log on to the system in order to give advice without needing to be on-site. Not least, the TeleSAN-App should be available for the own smartphone providing professionals as well as first responders with treatment guidelines and instructions allowing them to take action within their means and to the best of their knowledge.

Cooperation partners

• Docs in Clouds TeleCare GmbH, Aachen
• Malteser Bildungszentrum Euregio, Aachen
• Rechtsanwalt Prof. Dr. Dr. Karsten, Köln
• Berufsfeuerwehr Aachen
• Deutsches Rotes Kreuz gGmbH Städteregion Aachen 

Contact

Dr. med. Andreas Follmann (afollmannukaachende)

Dr. med. Tobias Imhof (timhofukaachende)

Funding

Bundesamt für Bevölkerungsschutz und Katastrophenhilfe (BBK)

Project duration: 05/2020 - 04/2023

OR.NET – secure dynamic networking in operation room and hospital

Integration and networking in medical IT have been a great subject since years. Several projects deal with the networking of IT systems within a medical institution as well as overall facilities. An increasingly important aspect is the integration und networking of medical devices among each other and with adjoining IT systems. The project OR.NET addresses especially this core topic.

Goals:

• The development of certifiable, dynamic, non-proprietary networking possibilities in consisting and future devices
• Plug&Play Networking in consideration of aspects for approval capability and risk management
• Development of operator models

Further information can be found on: http://ornet.med-design.net

Cooperation partners

• Providers of integrated operation rooms
• Manufacturers of medical devices and medical technological components
• (IT-) service providers for software and IT solutions for networking
• Research Institutes, especially:
  • Lehrstuhl für Medizintechnik (MediTec; Direktor: Univ.-Prof. Dr.-Ing. K. Radermacher)
  • Lehrstuhl für Medizinische Informationstechnik (MedIT; Direktor: Univ.-Prof. Dr.-Ing. Dr. med. Steffen Leonhardt)
• Specialist clinic
  • Klinik-IT-Abteilungen und Betreiber

Contact

Dr. Verena Voigt (vvoigtukaachende)

Funding

Bundesministerium für Bildung und Forschung

Project duration: 09/2012 – 08/2015

AUDIME – AUDIvisual medical information technology for complex emergency situations

Terrorist attacks, natural catastrophes and severe traffic accidents always bring serious challenges for rescue teams all over the world. Lack of information on number and severity of injured as well as information on available and necessary resources immensely impede the organisation of rescue operations and lead to relevant delays in patient transport and treatment.

The project AUDIME researches information technology-based decision and support systems including the relevant sighting algorithms for rescue procedures – from sighting up to the treatment at the treatment unit. Key requirements for the system are the usability in complex, supra-regional emergency situations, the integration capacity of existing and new support systems as well as a specific processing and provision of relevant information on the current situation. The technical project focus lies on the creation of an information-integration-system which, besides statistical data accumulation, enables the involvement and evaluation of continuous real-time data and telemedical aspects. In this way, relevant information is provided to the decision- and support system as well as all further networked users in real-time.

Cooperation partners

• Lehrstuhl für Informations-management im Maschinenbau (IMA) der RWTH Aachen
• Center for Security & Society, Institut für Soziologie Albert-Ludwigs-Universität Freiburg
• TECH2GO Mobile Systems GmbH
• GS Elektromedizinische Geräte G. Stemple GmbH

Contact

Dr. Andreas Follmann (afollmannukaachende)

Förderung

Bundesministerium für Bildung und Forschung (BMBF)

Projektträger VDI Technologiezentrum GmbH

Project duration: 12/2014 – 12/2017

Postoperative pain does not only constitute a high acute burden on patients but also impedes the recovery and leads to chronicity. Therefore, an early detection and treatment of pain conditions especially in monitoring and intensive care units is significant. However, pain is a high-sensitive experience and therefore difficult to grasp despite different technical concepts (analysis of skin conductance, evaluation of heart rate variability and others).

The research project “Mimik” develops a system solution for long time monitoring of postoperative pain and stress in intensive care units. With the help of IR-thermography dynamic contours and thermal profiles of a patient’s face are measured in a passive and contactless way in order to detect reactions on pain stimulus (difference in facial expression, lacrimation, perspiration). Regardless of environmental conditions and networked with the hospital information system including secured data and long-term archiving this system will lead to an improved remote monitorability of intensive care patients.

The project’s goals:

• Detection of face shape and condition as well es changes in 3D with the help of IR-thermography
• Detection of pain reactions (changes in facial expression, lacrimation, perspiration)
• Medical evaluation of pain und stress reaction with derivation of therapy options

Cooperation partners

• RWTH Aachen Philips Lehrstuhl für Medizinische Informationstechnik (MedIT)
• RWTH Aachen Lehrstuhl für Bildbearbeitung
• Infra Tec GmbH
• Pneumatik Berlin GmbH Medical Systems

Contact

Henriette Dohmeier (hdohmeierukaachende)

Funding

Bundesministerium für Wirtschaft und Technologie

Projektträger ZIM- Netzwerkförderung

Project duration: 03/2014 – 01/2017

Leitwart – SmartCareUnit

Being part of the Smart Care Unit projects, this project is dedicated for the development of a system solution for a central control room with data fusion and interpretation across all devices in an intensive care unit. For this purpose, a fusion of medical devices and laboratory data across all manufacturers as well as data of the hospital IT should be enabled for the generation of smart alarm and decision support systems. At the same time, a software condition to master great, heterogeneous volume of data (video, audio, text, images, measurements) is developed (multidimensional databases, big data evaluations). A contactless, intuitive handling, highly complex data interpretation with recommendation for actions, stationary and mobile available and situation adapted visualization, trend based early alerting, secure documentation and long-term archiving characterize the new level of patient care. In this context, a special value is attached to usability, good medical design, data security and quality standards. The smart networked system solution for the intensive care unit offers more efficiency, value and life quality for patient and personnel.

Goals:

• Fusion of medical devices, laboratory data and hospital IT across all manufacturers
• Software development to master big, heterogenous volume of data
• Situation adapted visualization, trend based early alerting and data security in patient care

Cooperation partners

• Conworx Technology GmbH
• Yacoub Automation GmbH
• G.punkt medical services
• Dr. Hornecker Softwareentwicklung und IT-Dienstleistungen
• Fraunhofer Heinrich-Hertz-Institut

Contact

Dr. med. Verena Voigt (vvoigtukaachende)

Funding

Bundesministerium für Wirtschaft und Technologie

Projektträger ZIM- Netzwerkförderung

Project duration: 12/2014 – 05/2017

Wundscanner (Development of a mobile system for early detection and monitoring of wound infection)

Wound infections belong to the most frequent complications of medical interventions and cover around 24% of all nosocomial infections in Germany. First, they constitute a serious risk, not only for the concerned patients but also for fellow patients if not the whole hospital. In case of healthcare wound infections after interventions pose a substantial cost factor causing an additional cost of around 3 billion euros for over 220.000 infections per year. Second, the sooner the infection is detected the better and more effective treatment can be provided. Studies have shown that the thermal pattern of a wound in case of an infection exhibits special features. With the help of an infrared-thermography, these patterns can be assessed in a passive and burden-free way even before the inflammation gets visible for the human eye.

This project’s goal is the development of a scanner system that merges optical data of an infrared camera and a camera working within visible light and uses smart algorithms for image evaluation to create interpreted gradients over time and space.

Cooperation partners

• SANTOX Gehäuse-Systeme GmbH (https://www.santox.com/)

All cooperation partners are members of the ZIM-Network “AmbuCare”: https://www.smart-care-unit.de

Contact

Henriette Dohmeier (hdohmeierukaachende)

Franziska Schollemann, M.Sc. (mschollemannukaachende)

Funding

Bundesministerium für Wirtschaft und Technologie

Projektträger ZIM- Netzwerkförderung

Project duration: 10/2017 - 03/2020

The DFG research unit 2591 – a research consortium aims at defining a severity assessment framework for laboratory animals

Patients of the intensive care unit must be constantly monitored regarding their circulatory system and health status. For that, they are connected to necessary measuring instruments with the use of electrodes and derivations which takes time and severely narrows the patient’s ability to move. Even patient transport is thereby made more difficult. Through the development of reliable, contactless measurement methods the patients’ ability to move can in this regard stay unrestricted and clinical procedures can be optimized.

This study targets a contactless assessment of the health status of experimental animals. In a wireless way, vital data (respiration, pulse, temperature) can be measured, signs of inflammation can be checked and perfusion imaging can be performed with the help of video sequences, radar as well as infrared- and colour cameras.

Further information can be found on: https://severity-assessment.de

Cooperation partners

The DFG project is part of a DFG research group with the common title: “Severity Assessment in Animal-based Research” (FOR2591)

• P01 Prof. André Bleich, Phd, DipECLAM (Hannover Medical School, Institute for Laboratory Animal Science and Central Animal Facility, Hannover) und Dr. Christine Häger (Hannover Medical School, Institute for Laboratory Animal Science and Central Animal Facility, Hannover)
• P02 Univ.-Prof. Dr. med. René H. Tolba, MD, PhD (Institute for Laboratory Animal Science and Central Animal Facility RWTH Aachen University, Medical Faculty)
• P05 Prof. Peter Gass, MD (Central Institute of Mental Health, Mannheim, Mannheim Faculty / University of Heidelberg, Mannheim/Heidelberg)
• P08 Prof. Dr. Fabian Kiessling, M.D. (Chair of Experimental Molecular Imaging, RWTH Aachen University, Medical Faculty, Aachen)
• P10 Prof. Ute Lindauer, Dr. med. vet. (Translational Neurosurgery and Neurobiology, Department of Neurosurgery, RWTH Aachen University, Medical Faculty, Aachen)
• P11 Prof. Dr. Heidrun Potschka, DVM (Institute of Pharmacology, Toxicology, and Pharmacy, Faculty of Veterinary Medicine, Ludwig-Maximilians-University, Munich)
• P12 Prof. Kerstin Schwabe, Phd (Laboratories for Experimental Neurosurgery, Hannover Medical School, Department of Neurosurgery, Hannover)
• P14 Prof. Dr. Stefan Treue (German Primate Center, Head of the Cognitive Neuroscience Laboratory, Göttingen) und Prof. Dr. Alexander Gail (Sensorimotor Group, German Primate Center, Leibniz Institute for Primate Research, Göttingen)
• P15 Dietmar Zechner, PhD (Rostock University Medical Center, Institute for Experimental Surgery, Rostock University Medical Center, Rostock) und Prof. Dr. med. Brigitte Vollmar (Institute for Experimental Surgery, Rostock University Medical Center, Rostock)
• nP17 Dorit Merhof, Prof. Dr. Ing. (Institute of Imaging & Computer Vision, RWTH Aachen University, Aachen)
• nP18 Marion Bankstahl, Prof. Dr. (Institute for Laboratory Animal Science, Hannover Medical School, Hannover)
• nP19 Nils Hoppe, Prof. Dr. (Centre for Ethics and Law in the Life Sciences, Gottfried Wilhelm Leibniz Universität Hannover, Hannover) und Rebecca Knabb, PhD (Centre for Ethics and Law in the Life Sciences, Gottfried Wilhelm Leibniz Universität Hannover, Hannover)

Contact

Dr.-Ing. Carina Barbosa Pereira (cbarbosapereukaachende)

Janosch Kunczik, M.Sc. (jkunczikukaachende)

Funding

Deutsche Forschungsgemeinschaft

Project duration: 03/2017 - 02/2020

MoVE – Modular Validation Environment for medical device networks

The integration and network of medical devices became an indispensable component of modern operating rooms during the last years. Especially big international manufacturers provide different monolithic solutions as overall systems. These systems though show a difficult to implement integrability with third party devices due to the necessity of conformity assessment of medical devices with the Medical Product Act as well as the risk management of networked medical products. Therefore, the market access for smaller and average manufacturers of medical devices is limited.

For the open networking of medical devices, adapted procedures and implements are absolutely required to support the approval process for manufacturers as well as the operation process for operators. The conception, implementing, validating and operation of such test areas for medical devices is complex and usually can’t be realised with reasonable costs by smaller and average manufacturers. These surroundings though prospectively are a significant component for a successful development of innovative products and their approval as well as their successful placement in the market.

Goals of this project:

• The development of a technical-strategical approach to support the approval and certification procedure and the risk management of networked medical devices in an integrated surgical surrounding
• The development of a test environment including appropriate protocols, scenarios and test areas as well as relevant approval strategies which are able to test the networking of medical devices and software components in different simulated scenarios and validate them regarding several parameters
• Further development of approval strategies for open networked medical products

Cooperation partners

• SurgiTAIX AG
• Localite GmbH
• Steute Schaltgeräte GmbH & Co. KG
• Fritz Stephan GmbH Medizintechnik
• Synagon GmbH
• Ilara GmbH
• Healthcare Consulting GmbH
• UTK Lübeck
• Lehrstuhl für Medizintechnik der RWTH Aachen (mediTEC Aachen)
• Institut für Angewandte Mikroelektronik und Datentechnik (IMD) der Universität Rostock
• Institut für Medizinische Informatik der Universität Lübeck
• Innovation Center Computer Assisted Surgery der Universität Leipzig (ICCAS)

Ansprechpartner

Dr. med. Verena Voigt (vvoigtukaachende)

Marian Ohligs, M.Sc. (mohligsukaachende)

Förderungen

Bundesministerium für Bildung und Forschung (BMBF)

Project duration: 05/2018 – 09/2019

Large-scale disasters, such as terrorist attacks, major fire incidents or mass casualty incidents (MCI), always pose serious challenges to emergency personnel and incident commanders: Initially there is a lack of overview of the situation biasing the perception. It is often the overall perspective that incident commanders miss in order to determine lacking resources and available potentials.

In order to counter this problem, VirtualDisaster involves a tele-mission management, based on the model of the Aachen TeleMedic. Drones using 360° cameras and laser based distance meters (LiDAR) transmit three dimensional reconstructions of the scene. The use of virtual reality (VR) gives a quick overview of the scene even in difficult, inaccessible locations. The cooperation between the tele-mission management and the mission management (or the senior EMS physician) on site ensures a more efficient approach to the situation. This inevitably reduces delays in rescue and treatment of the injured, as well as in large-scale disasters.

Cooperation partners

• Berufsfeuerwehr Aachen
• TEMA Technologie Marketing AG
• RWTH Aachen, Institut für Flugsystemdynamik
• RWTH Aachen, Lehrstuhl für Informatik 8 (Computergrafik und Multimedia)

Contact:

Dr. med. Andreas Follmann (afollmannukaachende)

Marian Ohligs (mohligsukaachende)

Funding:

Bundesministerium für Bildung und Forschung (BMBF)

Project duration: 07/2019 - 12/2021

FALKE (Aircraft assisted management of complex emergency operations)

In the case of an MCI (mass casualty incident), the emergency personnel’s main task contains the division of all injured into different sighting categories. Though many of the emergency personnel know the applicable sighting categories, it is often misapplied in an emergency operation. Reasons are among other things distraction and a psychological pressure in an acute situation.

To improve the sighting quality, this procedure is semi-automated within project FALKE. For that, different sensor systems (radar, IRT-camera, RGB-camera) are installed on an unmanned flying object to collect vital data and movement profiles as quickly as possible. Existent sighting algorithms are then adapted to the given data situation and corrected or confirmed by a telemedical attached senior emergency physician (Tele-LNA). Through a quickly developed situation image, the difficult sighting task gets semi-automated and further leads to early, focused and lifesaving immediate measures.

Further information can be found on: https://www.projekt-falke.org

Cooperation partners

• Docs in Clouds GmbH
• Lehrstuhl und Institut für Flugsystemdynamik, RWTH Aachen
• flyXdrive GmbH
• Lehr­stuhl In­te­grier­te Sys­te­me, Ruhr-Universität Bochum
• IMST GmbH

Contact

Dr. med. Andreas Follmann (afollmannukaachende)

Lucas Mösch (lmoeschukaachende)

Funding

Bundesministerium für Bildung und Forschung (BMBF)

Project duration: 08/2018 – 02/2022

hOspItal – Location-based information services in hospitals

Modern medicine is characterized by numerous diagnostic and therapy processes that interlock and require complex planning. In order to optimally take into account the socio-economic aspects of medical action, these processes should at the same time be organized and carried out as smoothly as possible. To achieve this goal, communication is required not only among medical personnel, but also between the personnel and the medical devices and objects in the hospital.

The hoSpItal research project wants to address this situation and improve the treatment processes in clinics with location-based information. In the project, an acoustic localization platform is to be researched, developed and used in a test environment, which solves the following tasks:

• Scheduling of the staff
  • Localization of beds (for intra-hospital transports)
  • Dynamic adaptability of the route graph
  • Real-time calculation of arrival times
  • Notify staff of arrival times
  • Interactive treatment plan (e.g. replacement appointments in the event of non-appearance)
•      Finding medical devices
  • Positions of devices
  • Number of free devices
  • Predicting availability times
•      Smart analysis
  • Utilization of devices
  • Capacity calculations (outlook)

Cooperation partner

• IT4process GmbH
• contagt GmbH
• Telocate GmbH
• Kinderklinik Universitätsklinikum Freiburg (associated partner)

Contact Person

dr.med. Milos Bogovac (mbogovac@ukaachen.de)

Grant

federal Ministry of Education and Research

Funding period: 01/2020-04/2022

As part of the PriMed project, there is a (further) development of concepts for the open networking of medical devices in the operating room and in the clinic with the aim of improving the perioperative processes. Based on the preliminary work of the OR.NET project, a flexible, context-adaptive process and treatment management system is to be created for the different anesthesiological workplaces.

Aims:

• Development of concepts for process optimization in the OR using integrated medical technology
• Expansion of an anesthesia workstation and application of the SDC open communication standard based on the results of the OR.NET project
• Contextual and situational presentation of information including the perioperative standard procedures, the different therapists and treatment centers
• Integration of decision support logic

• Application of innovative human-machine interaction possibilities

Further information can be found at: http://primed.med-design.net

Cooperation partners

• SurgiTAIX AG
• Lehrstuhl für Medizintechnik der RWTH Aachen (mediTEC)
• Docs in Clouds GmbH
• IT4process GmbH
• Beger Design
• Localite GmbH
• Klinik für Neurochirurgie der Uniklinik RWTH Aachen
• OP-Management der Uniklinik RWTH Aachen

Contact

Dr. med. Verena Voigt (vvoigtukaachende)

Funding

EFRE NRW 2014-2020

Förderungszeitraum: 04/2019-04/2022

AIDA - Work development in elderly care through the introduction of a telemedical emergency service concept

Due to demographic change and the simultaneously prevailing shortage of skilled workers, across both nursing and medical professions, medical care in geriatric care facilities grows increasingly challenging. In case of a deterioration in condition, the attending general practitioner often is not instantly available for a home visit. Usually the following emergency call ends immediately in a hospital admission, even if the patients could often be treated further on an outpatient basis in their care facility.

In addition to the costs of hospitalization, this leads to far-reaching health-economic but also patient-related consequences, especially when demented patients are torn from their familiar surroundings.

In the AIDA project, a telemedical application (medical roll stand system TeleDoc) is used in the context of geriatric care in order to connect the general practitioners in charge of routine visits and emergency consultations via telemedicine, and to set up a 24/7 telemedical emergency service bridging the time the attending general practitioners is not available. The aim of AIDA is to make the medical and nursing staff capacities more effectively usable, to evaluate the changes in elderly care from an ergonomic point of view and to guarantee holistic patient care. The model project AIDA is intended to pioneer the broad practical introduction of teleconsultation in geriatric care facilities as basic and regular care.

Cooperation partners

• Uniklinik RWTH Aachen A.ö.R
• Docs in Clouds TeleCare GmbH, Aachen
• MA&T Sell & Partner GmbH, Würselen
• Stiftung Evangelisches Alten- und Pflegeheim Gemünd
• St. Gereon Seniorendienste GmbH, Hückelhoven
• Hausärztin Dr. Karidas-Moitzheim, Schleiden
• Hausärzte Dres. Schneider/Ferber/Kochs, Hückelhoven
• AOK Rheinland/Hamburg

Contact

Dr. med. Andreas Follmann (afollmannukaachende)

Dr. med. Sarah Veldeman (sveldemanukaachende)

Funding

Europäischer Fonds für regionale Entwicklung (EFRE) 2014-2020 „Investitionen in Wachstum und Beschäftigung“

Project duration: 11/2019 – 10/2022