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Background:
Cardiac surgery patients represent a high-risk cohort in intensive care units (ICUs). Central venous pressure (CVP) measurement seems to remain an integral part in hemodynamic monitoring, especially in cardio-surgical ICUs. However, its value as a prognostic marker for organ failure is still unclear. Therefore, we analyzed postoperative CVP values after adult cardiac surgery in a large cohort with regard to its prognostic value for morbidity and mortality.
Methods:
All adult patients admitted to our ICUs between 2006 and 2019 after cardiac surgery were eligible for inclusion in the study (n = 11,198). We calculated the median initial CVP (miCVP) after admission to the ICU, which returned valid values for 9802 patients. An ROC curve analysis for optimal cut-off miCVP to predict ICU mortality was conducted with consecutive patient allocation into a (a) low miCVP (LCVP) group (≤11 mmHg) and (b) high miCVP (HCVP) group (>11 mmHg). We analyzed the impact of high miCVP on morbidity and mortality by propensity score matching (PSM) and logistic regression.
Results:
ICU mortality was increased in HCVP patients. In addition, patients in the HCVP group required longer mechanical ventilation, had a higher incidence of acute kidney injury, were more frequently treated with renal replacement therapy, and showed a higher risk for postoperative liver dysfunction, parametrized by a postoperative rise of ≥ 10 in MELD Score. Multiple regression analysis confirmed HCVP has an effect on postoperative ICU-mortality and intrahospital mortality, which seems to be independent.
Conclusions:
A high initial CVP in the early postoperative ICU course after cardiac surgery is associated with worse patient outcome. Whether or not CVP, as a readily and constantly available hemodynamic parameter, should promote clinical efforts regarding diagnostics and/or treatment, warrants further investigations.
OBJECTIVE: The aim of the study was to identify and systematically categorize musculoskeletal assessments used in quantitatively based studies about posture and movement in musicians playing high string instruments (violin, viola) in order to inform further research and help to identify gaps in knowledge.
METHODS: A systematic literature search was conducted in the databases Cochrane, CINAHL, and PubMed as well as the journal Medical Problems of Performing Artists. Additional studies were searched within the reference lists of relevant articles. Sixty-four studies conducted since 1999 until May 2017 were included according to predefined inclusion criteria.
RESULTS: Various biomechanical measurement instruments were used in 24 of the selected studies in order to collect two- and three-dimensional kinematic data: optoelectronic systems with active and passive markers, electromagnetic systems, ultrasonic motion analysis systems, and image-based analysis of posture. In 11 studies, kinetics were measured by optoelectronic systems, force sensors, and a posturographic device. Further studies used electromyography to evaluate muscle activity (19 studies) as well as instruments to measure range of motion (2 studies). Additionally, a broad range of clinical examination techniques (35 studies) and self-reports (36 studies) were used to assess the musculoskeletal system of high string players.
CONCLUSION: The identified assessments could be used both in further research and in practical work in order to evaluate posture and movement in high string players. For future research, qualitatively based studies as well as psychometrically tested quantitatively based self-report assessments are required.
rationale: Musculoskeletal problems are widespread in performing artists and are due to the special demands of instrument playing, singing or dancing. Additionally, various other factors might contribute to performance-related musculoskeletal problems. In order to provide a specific physiotherapeutic management for performing artists, it is important to gain information about the performing art, the individual (biomechanical) demands and contributing factors. The subjective examination is the basis of the clinical reasoning process and the hypothesis forming, which is important for goal setting in further clinical examination and biomechanical analysis. In the present protocol, the subjective examination consists of a questionnaire based section and an interview based section and is part of the evaluation process of the neuromusculoskeletal examination of a performing artist specific reference laboratory.
purpose: The aim of this study was to develop a standardized protocol for an interview based subjective examination of performing artists with musculoskeletal problems. The results of this section of the subjective examination will be combined with the results of the questionnaire based subjective examination , in order to gather as much relevant information as possible to specifically address the individual’s musculoskeletal health status.
methods: A common physiotherapeutic recording of findings which addresses the relevant questions of the subjective examination of musculoskeletal problems was used. In order to adapt the anamnesis to performing-related musculoskeletal problems, questions specific to instrument playing, singing and dancing were selected on the basis of a literature search and the expertise of the research group.
results: The protocol is based on the five aspects of clinical practice described by Maitland and the Musculoskeletal Clinical Translation Framework by Mitchell et al. (2017) .The performing art specific questions especially address (1) performing art specific considerations including style, genre, education and professional level, practice habits, repertoire, and external factors, e.g. concert conditions, (2) performing art specific physical and psychosocial contributing factors, and (3) performing art specific activities which trigger the musculoskeletal problems and help to form hypotheses for the following clinical examination. Individual tracks lead through the subjective examination so that irrelevant questions are skipped depending on the kind of musculoskeletal problem and the performing art practiced by the individual client.
conclusions: A pretest of this standardized anamnesis protocol is ongoing in a special physiotherapy clinic for performing artists since spring 2022. In an iterative approach, the protocol will be continuously improved based on patient feedback and clinical considerations.
Hintergrund und Zielsetzung:
Instrumentalistinnen und Instrumentalisten sind beim Spielen erheblichen psychischen und Instrument-spezifischen körperlichen Belastungen ausgesetzt. Häufig kommt es dabei zu Überlastungen des neuromuskuloskelettalen Systems, insbesondere der oberen Extremität. Welchen Beitrag kann eine musikerspezifische Physiotherapie zum Management von körperlichen spielbedingten Beschwerden leisten?
Methodik:
Es wurde eine Literaturrecherche zu Art und Prävalenz neuromuskuloskelettaler Beschwerden der oberen Extremität bei Instrumentalist/innen durchgeführt. Zusätzlich wurden retrospektiv Patient/innen-Akten aus einer physiotherapeutischen Musiker/innen-Sprechstunde gesichtet, um das Vorgehen bei der Untersuchung und Behandlung spielbedingter Beschwerden zu beschreiben.
Ergebnisse:
Studien berichten von einer Prävalenz spielbedingter neuromuskuloskelettaler Beschwerden der oberen Extremität bei Instrumentalist/innen von 47-52,8%. Häufige Ursachen sind Überlastungssyndrome durch wiederkehrende Belastung derselben anatomischen Strukturen, Hypo- oder Hypermobilität sowie (periphere) Neuropathien. Bei der physiotherapeutischen Anamnese bei Instrumentalist/innen spielen sowohl Beschwerde-bezogene Fragen als auch spezifische Fragen zum Instrument, zur Spielerfahrung und zum Übeverhalten eine wichtige Rolle. Insbesondere die funktionelle Demonstration der beschwerdeauslösenden Bewegung und die Haltungs-/Bewegungsanalyse am Instrument geben wichtige Hinweise für das weitere Vorgehen in der physiotherapeutischen Diagnostik und Behandlung. Die klinische Untersuchung kann durch eine apparative Untersuchung z.B. der Muskelaktivität und von Bewegungsabläufen ergänzt werden. Die physiotherapeutischen Behandlungsansätze beinhalten Manuelle Therapie, (Instrument-)spezifische therapeutische Übungen, Haltungs-/Bewegungsschulung am Instrument, neurodynamische Techniken und Patient/innen-Edukation sowie ergonomische Anpassungen des Instruments.
Schlussfolgerung:
Eine musikerspezifische physiotherapeutische Versorgung kann einen entscheidenden Beitrag zum multidisziplinären Management spielbedingter neuromuskuloskelettaler Beschwerden der oberen Extremität bei Instrumentalist/innen leisten.
Sängerinnen und Sänger gehören zu der Gruppe der sogenannten „Professional Voice User“ bzw. der BerufssprecherInnen. Diese Gruppe ist den höchsten Anforderungen hinsichtlich der Stimmqualität und der Stimmbelastung ausgesetzt. Deshalb haben SängerInnen ein hohes Risiko eine Stimmstörung zu entwickeln, die wiederum ihre Arbeitsfähigkeit und Lebensqualität beeinträchtigen kann. Neben Stimmstörungen mit organischen Ursachen gibt es funktionelle Stimmstörungen, die z.B. durch ein ungünstiges Atemmuster oder Hypertonus der Schulter-, Nacken- und Halsmuskulatur verursacht werden können. In diesem Vortrag werden die unterschiedlichen Risikofaktoren für die Entwicklung einer Stimmstörung bei SängerInnen aufgezeigt. Anschließend werden physiotherapeutische Behandlungsansätze vorgestellt, die als Teil eines multidisziplinären Managements von funktionellen Stimmstörungen bei SängerInnen eingesetzt werden können.
Ziel des Workshops ist es, das besondere Potential der Physiotherapie im multidisziplinären Management von Sängerinnen und Sängern mit funktionellen Stimmstörungen aufzuzeigen. Anhand eines Fallbeispiels aus der physiotherapeutischen Musikersprechstunde wird der physiotherapeutische Behandlungsansatz vorgestellt. Die Sängerin mit ärztlich diagnostizierter hyperfunktioneller Stimmstörung zeigte Symptome wie ein sternales Atemmuster und Hypertonus der Nacken-, Kiefer- und der äußeren Kehlkopf-Muskulatur. Basierend auf der aktuellen Evidenzlage und der Anatomie werden die theoretischen Überlegungen der klinischen Urteilsbildung erläutert. Das Vorgehen im Behandlungsprozess wird beschrieben und einige praktische Beispiele von Behandlungstechniken, z.B. manualtherapeutische Techniken am Kehlkopf, werden demonstriert.
Background: Singers belong to the group of professional voice users with the highest demands regarding voice quality and vocal load. Thus, they also have a high risk of developing a voice disorder, which in return has major impact on their ability to work. Besides voice disorders caused by organic changes, there are functional voice disorders caused by, e.g., a hypertonia of the larynx, shoulder and neck muscles or insufficient breathing patterns. In these cases, physiotherapy can be one component of a multidisciplinary approach to treatment.
The purpose of this presentation is, based on anatomical considerations and current evidence, to inform about and demonstrate physiotherapy techniques for treating singers with functional voice disorders.
Approach of Presentation: A case from a special physiotherapy outpatient clinic for vocalists will be described. Based on this example, information on the evidence of physiotherapy approaches for functional voice disorders will be provided. Afterwards, some practical hands-on techniques will be demonstrated for participants to try.
Content of Presentation: This workshop will focus on the physiotherapy treatment for a vocalist with functional voice disorders. The vocalist experienced changed pitch and hypertonia in both the muscles of the shoulder-neck region and the extrinsic laryngeal muscles. Paralaryngeal manual techniques, in addition to posture and breathing exercises, will be demonstrated with the purpose of mobilizing the larynx and relaxing the hypertonic muscles.
Conclusions and Practical Relevance: This workshop highlights the special potential of physical therapy in the treatment of functional voice disorders in singers.
In der ersten CCJ-Ausgabe 2021 werden sechs Aufsätze vorgestellt, die aus aktuellen Bachelor- und Masterarbeiten hervorgegangen sind. Sie zeigen erneut ausgewählte Themen, mit denen sich die Querschnittsdisziplin des Kommunikationsmanagement befasst.
Inhalt:
Editorial (Dagmar Schütte, Detlev Dirkers, Susanne Knorre)
Transformation lernen
Zur Bedeutung der Veränderungskommunikation bei der Implementierung digitaler Kollaborationstools (Carolin Scheibel)
Kann ‘Working Out Loud‘ zur kommunikativen Reifung eines Unternehmens beitragen?
– Eine qualitative Studie (Kim Reincke)
Welche Funktion haben Printmedien in der internen Kommunikation?
Eine Studie zu den veränderten Anforderungen an Mitarbeiterzeitungen m Kontext der digitalen Transformation (Tabea Specht)
Welche Rolle spielt die Frame-Semantik für die Markenidentität?
Ein Vergleich von Markenclaims und Selbstdarstellungen auf Unternehmenswebseiten (Henriette Resing)
Generation Z
- Sind die Unternehmen im Emsland bereit für den Generationswandel? (Kai Rabe)
Eine Frage der Kultur?
Weibliche Führungskräfte und ihre Karrierewege in PR- und Kommunikationsagenturen. (Anne Wunsch)
Der vorliegende Beitrag thematisiert die Bedeutung von Veränderungskommunikation bei der Implementierung eines digitalen Tools zur Kollaboration im Bereich des Customer Relationship Managements. Aus der Unternehmensperspektive eines Digitaldienstleisters wurde betrachtet, welche Rolle das Change Management in Kundenprojekten einnimmt und auf welche Aspekte hinsichtlich Emotionen, Widerständen und Lernverhalten beim Einsatz der Veränderungskommunikation geachtet werden sollte. Dazu sind im Rahmen einer qualitativen Erhebung elf problemzentrierte Experteninterviews mit Mitarbeitenden des Unternehmens und externen Sachkundigen durchgeführt worden. Im Fokus der halbstandardisierten Leitfadeninterviews standen die persönlichen Erfahrungen der Befragten mit der durch ein Digitalprojekt erzeugten Veränderungssituation. Als Ergebnis entstanden, aus der Kombination von theoretischen Grundlagen und Erkenntnissen aus der empirischen Untersuchung, Implikationen für die Praxis. Der Ausblick zeigt weiterführenden Forschungsbedarf im Bereich der Veränderungskommunikation beim Einsatz von Digitalisierungsprojekten auf.
With the increasing size and complexity of embedded systems, the impact of software on energy consumption is becoming more important. Previous research focused mainly on energy optimization at the hardware level. However, little research has been carried out regarding energy optimization at the software design level. This paper focuses on the software design level and addresses the gap between software and hardware design for embedded systems. This is achieved by proposing a framework for software design patterns, which takes aspects of power consumption and time behavior of the hardware level into account. We evaluate the expressiveness of the framework by applying it to well-known and novel design patterns. Furthermore, we introduce a dimensionless numerical efficiency factor to make possible energy savings quantifiable.
Due to the resource-constrained nature of embedded systems, it is crucial to support the estimation of their power consumption as early in the development process as possible. Non-functional requirements based on power consumption directly impact the software design, e.g., watt-hour thresholds and expected lifetimes based on battery capacities. Even if software affects hardware behavior directly, these types of requirements are often overlooked by software developers because they are commonly associated with the hardware layer. Modern trends in software engineering such as Model-Driven Development (MDD) can be used in embedded software development to evaluate power consumption-based requirements in early design phases. However, power consumption aspects are currently not sufficiently considered in MDD approaches. In this paper, we present a model-driven approach using Unified Modeling Language profile extensions to model hardware components and their power characteristics. Software m odels are combined with hardware models to achieve a system-wide estimation, including peripheral devices, and to make the power-related impact in early design stages visible. By deriving energy profiles, we provide software developers with valuable feedback, which may be used to identify energy bugs and evaluate power consumption-related requirements. To demonstrate the potential of our approach, we use a sensor node example to evaluate our concept and to identify its energy bugs.
Power consumption has become a major design constraint, especially for battery-powered embedded systems. However, the impact of software applications is typically considered in later phases, where both software and hardware parts are close to their finalization. Power-related issues must be detected in early stages to keep the development costs low, satisfy time-to-market, and avoid cost-intensive redesign loops. Moreover, the variety of hardware components, architectures, and communication interfaces make the development of embedded software more challenging. To manage the complexity of software applications, approaches such as model-driven development (MDD) may be used. This article proposes a power-estimation approach in MDD for software application models in early development phases. A unified modeling language (UML) profile is introduced to model power-related properties of hardware components. To determine the impact of software applications, we defined two analysis methods using simulation data and a novel in-the-loop concept. Both methods may be applied at different development stages to determine an energy trace, describing the energy-related behavior of the system. A novel definition of energy bugs is provided to describe power-related misbehavior. We apply our approach to a sensor node example, demonstrate an energy bug detection, and compare the runtime and accuracy of the analysis methods.