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Institute
Methods: Systematic review of randomized controlled trials (RCT). Searches were conducted in five electronic databases. Studies were selected if they included patients with NP over 18 years old treated with aerobic exercise (AE) (e.g., cycling, running, hiking, and walking). The main outcome of interest was pain intensity. Qualitative and quantitative data were extracted. The risk of bias (RoB) was determined using the Cochrane RoB Tool-2 and the overall certainty of the evidence with the GRADE recommendations.
Results: Out of 21,585 initial records screened, a total of six individual studies published in ten manuscripts were included. There was a great heterogeneity between protocols, comparisons, and studies’ results (different magnitudes and directions). When looking at the effect of aerobic exercise versus control groups or other interventions on pain intensity measured with the VAS, not statistically (nor clinical) significant differences between aerobic exercise and control groups (MD [95%CI] 5.16 mm [-6.38, 16.70]) were identified. The combined effect of AE plus other interventions seems to be effective. Strength exercise obtained better effects than aerobic exercises (MD [95%CI]: -11.34 mm [-21.6, -1.09]).
Conclusions: Aerobic exercise presented positive results to reduce pain intensity, and improving disability, and physical and emotional functioning. However, the evidence is restricted, low quality, and heterogeneous.
The production of food-grade substances and complex biocatalysts used as additives or active ingredients – mainly for food applications – can be achieved in the eukaryotic expression system of Aspergillus niger. Food proteins or food enzymes e.g., casein, ovalbumin, phytase or glucoamylase are highly complex polymers. Most of them could be used as nitrogen or energy source for animals and humans, while others are industrial relevant biomass-degrading enzymes used for biological waste processing and food production.
However, the successful production of novel recombinant proteins can be challenging, resource- and time consuming. Therefore, A. niger mutant libraries are needed to understand the “adjusting screws” to produce high yields of recombinant proteins, preferably even in a kind of generic, transferable system. In order to establish a universal and multipurpose expression platform, there is the need to overcome the lack of high throughput assays first.
To tackle this problem, we designed a modular, quantitative and feasible high-throughput screening system to express and screen recombinant proteins regarding their stability and functionality in A. niger. For this purpose a dual-luciferase reporter gene system, which is applicable in small scale will be established for A. niger. After the generation of an A. niger secretion mutant library, the system will be transferred and tested to other proteins of interest. The technology can be integrated into bio-regenerative life support systems for the autonomous production of e.g., food, food additives and food enzymes on earth as well as in deep-space.
Smart city applications in the Big Data era require not only techniques dedicated to dynamicity handling, but also the ability to take into account contextual information, user preferences and requirements, and real-time events to provide optimal solutions and automatic configuration for the end user. In this paper, we present a specific functionality in the design and implementation of a declarative decision support component that exploits contextual information, user preferences and requirements to automatically provide optimal configurations of smart city applications. The key property of user-centricity of our approach is achieved by enabling users to declaratively specify constraints and preferences on the solutions provided by the smart city application through the Decision Support component, and automatically map these constraints and preferences to provide optimal responses targeting user needs. We showcase the effectiveness and flexibility of our solution in two real usecase scenarios: a multimodal travel planner and a mobile parking application. All the components and algorithms described in this paper have been defined and implemented as part of the Smart City Framework CityPulse.
When the ECLAS Conference took place in 1972 western societies were undergoing profound change: They transformed from industrial to postindustrial societies – the so-called service societies. 50 years later, the knowledge society is emerging: Knowledge is considered the key resource of this era. Digitalization and widespread dissemination of ICT allow information to be obtained anywhere anytime. This has severe implications for individual lifestyles and everyday practices. Different aspects of living, learning and working are no longer bound to physical limitations but can be enhanced by or even transferred to the virtual space. So being on the move today means travelling in hybrid spaces. We call this the space and practice “en route”.
At the University of Applied Sciences Osnabrück we explore the following questions:
What does “en route” mean and look like in landscapes of higher education?
How is it perceived individually?
(How) can landscape architecture shape it?
Our transdisciplinary research project EN ROUTE aims to meet current challenges at universities (e.g. digitalisation, sustainable development) with a comprehensive understanding of space and practices “en route”. In a transdisciplinary process, researchers from various disciplines – landscape architecture, geography, urban planning, business administrations and marketing, energy technology and computer science – develop concepts and strategies for sustainable and digital mobility in the higher education sector. New “EN ROUTE” types provide insights into the individual production and utilization of spaces “en route”.
The campuses of the University of Applied Science Osnabrück as well as the virtual and physical space network of its members serve as research example. Initial findings will be presented at the conference. While the ECLAS conference in 1972 focused on physical scales, landscape architecture has to reflect them critically and ask: What could be an innovative understanding of spaces “en route”?
This paper provides a discourse based upon the key development of nursing in response to the emerging 4Ds of health technology re-design. Building informatics capability among health professionals is a workforce issue necessitated through the increasing prevalence of information technology and digitization of healthcare affecting the entire health workforce, specifically front-line nurses. The key concepts will be explored of Digitization, Distribution, Disruption and Diversity, a framework recognising the tsunami of technology such as Big Data analytics, comprehensive decision support systems for nursing, nanobots, robotics, and pharmacogenomics and the impact these have upon the nursing workforce.
Patient handovers are cognitively demanding, crucial for information continuity and patient safety, but error prone. This study investigated the effect of an electronic handover tool, i.e. the handoverEHR, on the memory and care planning performance of nurse students (n=32) in a randomised, controlled cross-over design with the factors handover task and handover role. On a descriptive level, handover recipients could improve their memory performance with electronic support, handover givers their performance of writing care plans. Statistically meaningful differences occurred, however, only when the participants were givers. Without handover experience and with low fluency to word problems, givers performed badly in the most demanding of the handover tasks. Final recommendations, however, can only be made after replicating this study in a clinical setting with mixed groups.
Innovations are typically characterised by their relative newness for the user. In order for new eHealth applications to be accepted as innovations more criteria were proposed including “use” and “usability”. The handoverEHR is a new approach that allows the user to translate the essentials of a clinical case into a graphical representation, the so-called cognitive map of the patient. This study aimed at testing the software usability. A convenience sample of 23 experienced nurses from different healthcare organisations across the country rated the usability of the handoverEHR after performing typical handover tasks. All usability scales of the IsoMetricsL questionnaire showed positive values (4 “I agree”) with the exception of “error tolerance” (3 “neutral statement”). A significant improvement was found in self-descriptiveness as compared to an initial usability testing prior to this study. Different subgroups of users tended to rate the usability of the system differently. This study demonstrated the benefits of formative evaluations in terms of improving the usability of an entirely new approach. It thus helps to transform a novel piece of software towards becoming a real innovation. Our findings also hint at the importance of user characteristics that could affect the usability ratings.
Restricted Versus Unrestricted Search Space : Experience from Mining a Large Japanese Database
(2015)
The aim of this study was to investigate whether standard Big Data mining methods lead to clinically useful results. An association analysis was performed using the apriori algorithm to discover associations among co-morbidities of diabetes patients. Selected data were further analyzed by using k-means clustering with age, long-term blood sugar and cholesterol values. The association analysis led to a multitude of trivial rules. Cluster analysis detected clusters of well and badly managed diabetes patients both belonging to different age groups. The study suggests the usage of cluster analysis on a restricted space to come to meaningful results.
Health IT systems are employed to support continuity of care via information continuity, while management continuity is often neglected. This study aims at investigating issues of management continuity when developing a collaborative decision support system for chronic wounds. Thirty-three experts from a variety of professions and disciplines discussed problems and possible solutions in four workshops. The following topics emerged from the discussion: existing networks involving payers, responsibilities as well as good discharge management. These topics clearly address management continuity and are also relevant for the scenario of inter-professional wound care across different settings.
Background:
Midwifery care in Germany is a legal right for every woman (SGB V). Midwives work employed or freelance in hospitals or in community services, providing maternal care from pregnancy until the end of breastfeeding (Sayn-Wittgenstein 2007). Increasingly, a shortage of midwifery care has been observed, forcing hospitals to understaff or to close their birth units, leaving women and their families without care (Sander et al. 2018). At the same time, birth rates are rising, thus leading to an increasing demand of midwifery care (Destatis 2019). As off today there is no central register for midwives across Germany’s 16 states. Therefor the exact number of registered midwives as well as the scope of services provided by midwives are not known (Niedersächsisches Landesgesundheitsamt 2019). Given the present situation, it seems to be imperative to establish effective midwifery workforce planning.
The aim of this poster is to identify already existing health workforce planning approaches and to determine the extent to which those can be transferred to the German system of midwifery care.
Methods:
Health workforce planning approaches, already being used on a national and international level, have been analysed, focusing their applicability to midwifery services in Germany.
Results:
Particular elements of the workforce planning approaches already being used in Germany for registered physicians seem to be adoptable. However, they need to be adjusted and enhanced to ensure the characteristics of midwifery in the German public health services. Internationally used approaches are not readily transferable due to systemic differences in health care systems.
Conclusions:
The development of new specific workforce and service planning approaches for midwifery care in Germany is crucial to meet present and future needs of women and their families during the childbirth period.
Background: Crowding in emergency departments (ED) has a negative impact on quality of care and can be averted by allocating additional resources based on predictive crowding models. However, there is a lack in effective external overall predictors, particularly those representing public activity.
Objectives: This study, therefore, examines public activity measured by regional road traffic flow as an external predictor of ED crowding in an urban hospital.
Methods: Seasonal autoregressive cross-validated models (SARIMA) were compared with respect to their forecasting error on ED crowding data.
Results: It could be shown that inclusion of inflowing road traffic into a SARIMA model effectively improved prediction errors.
Conclusion: The results provide evidence that circadian patterns of medical emergencies are connected to human activity levels in the region and could be captured by public monitoring of traffic flow. In order to corroborate this model, data from further years and additional regions need to be considered. It would also be interesting to study public activity by additional variables.
Use of Emergency Departments by Frail Elderly Patients : Temporal Patterns and Case Complexity
(2019)
Emergency department (ED) care for frail elderly patients is associated with an increased use of resources due to their complex medical needs and frequently difficult psycho-social situation. To better target their needs with specially trained staff, it is vital to determine the times during which these particular patients present to the ED. Recent research was inconclusive regarding this question and the applied methods were limited to coarse time windows. Moreover, there is little research on time variation of frail ED patients’ case complexity. This study examines differences in arrival rates for frail vs. non-frail patients in detail and compares case complexity in frail patients within vs. outside of regular GP working hours. Arrival times and case variables (admission rate, ED length of stay [LOS], triage level and comorbidities) were extracted from the EHR of an ED in an urban German teaching hospital. We employed Poisson time series regression to determine patterns in hourly arrival rates over the week. Frail elderly patients presented more likely to the ED during already high frequented hours, especially at midday and in the afternoon. Case complexity for frail patients was significantly higher compared to non-frail patients, but varied marginally in time only with respect to triage level and ED LOS. The results suggest that frailty-attuned emergency care should be available in EDs during the busiest hours. Based on EHR data, hospitals thus can tailor their staff needs.
Frequent users of emergency departments (ED) pose a significant challenge to hospital emergency services. Despite a wealth of studies in this field, it is hardly understood, what medical conditions lead to frequent attendance. We examine (1) what ambulatory care sensitive conditions (ACSC) are linked to frequent use, (2) how frequent users can be clustered into subgroups with respect to their diagnoses, acuity and admittance, and (3) whether frequent use is related to higher acuity or admission rate. We identified several ACSC that highly increase the risk for heavy ED use, extracted four major diagnose subgroups and found no significant effect neither for acuity nor admission rate. Our study indicates that especially patients in need of (nursing) care form subgroups of frequent users, which implies that quality of care services might be crucial for tackling frequent use. Hospitals are advised to regularly analyze their ED data in the EHR to better align resources.
This paper describes the development and test of a novel LiDAR based combine harvester steering system using a harvest scenario and sensor point cloud simulation together with an established simulation toolchain for embedded software development. For a realistic sensor behavior simulation, considering the harvesting environment and the sensor mounting position, a phenomenological approach was chosen to build a multilayer LiDAR model at system level in Gazebo and ROS. A software-in-the-loop simulation of the mechatronic steering system was assembled by interfacing the commercial AppBase framework for point cloud processing and feature detection algorithms together with a machine model and control functions implemented in MATLAB/ Simulink. A test of ECUs in a hardware-in-the-loop simulation and as well as HMI elements in a driver-in-the-loop simulation was achieved by using CAN hardware interfaces and a CANoe based restbus simulation.
This article proposes the concept of a simulation framework for environmental sensors with multilevel abstraction in agricultural scenarios. The implementation case study is a simulation of a grain-harvesting scenario enabled by LiDAR sensors. Environmental sensor models as well as kinematics and dynamic behavior of machines are based on the robotics simulator Gazebo. Models for powertrain, machine process aggregates and peripheral simulation components are implemented with the help of MATLAB/ Simulink and with the robotics middleware Robot Operating System (ROS). This article deals with the general concept of a multilevel simulation framework and in particular with sensor and environmental modeling.
Apps have been attested to empower patients regarding disease self-management through numerous studies. However, it is still unclear what factors determine the perception of patients whether an app is a useful tool for this purpose. A multiple regression model that was informed by the Technology Acceptance Model (TAM 2) was tested based on the answers of 235 app users with Diabetes type 1 or 2. The model accounted for 59.2% of the variance of the perceived degree of self-management. Factors belonging to the relevance-usefulness-quality complex as well as factors reflecting the patient’s self-control were found to be significant in the model. Patient demographics, i.e. age, gender, app experience and type of Diabetes did not play any significant role. In conclusion, this study raises the question whether apps should be designed to strengthen self-management in the sense of self-control (e.g. own measurements, diary) as opposed to guiding and advice giving.
Wood fibers can contribute to replacing peat in growing media and thus help to protect peatlands. As domestic, renewable raw materials, they represent a sustainable option for this purpose. To date, however, wood fibers are usually used as a peat substitute at a maxi-mum of 30% (v/v). A main reason for this limitation is the insufficient microbial stability of wood fibers, which favors nitrogen immobilization and can thus impair nitrogen supply of plants. To address this drawback, in this study wood fibers were subjected to different thermal or thermal-hydrolytic treatments. Seedling tests with napa cabbage were conducted to determine whether treated wood fibers were free of phytotoxic substances. Mixtures with 50% (v/v) wood fiber and white peat each were used. In addition, three wood fiber varieties were evaluated in the cultivation of petunia. Two wood fiber proportions (30 and 60% v/v) and two nitrogen fertilization rates (common and increased supply) were included in each case. In the seedling trial with napa cabbage, no phytotoxic effects were detectable in any of the wood fiber variants investigated. However, when cultivating petunias, both shoot mass growth and number of flowers decreased with increasing wood fiber content. In substrates with a wood fiber content of 60% (v/v), plant development was inhibited so severely that the petunias no longer achieved marketable quality. Increased nitrogen fertilization was able to compensate for this negative effect only in few cases. This suggests that other factors than nitrogen limited plant growth in wood fiber-rich substrates. Among others, physical proper-ties such as the lower water capacity of wood fibers may be a cause. More in-depth investigations are still required in this regard.
Currently, soil nutrient analysis involves two separate processes for soil sampling and nutrient analysis: 1. field soil sampling and 2. laboratory analysis. These two - separate - main work processes are combined and conceptualised for a mobile field laboratory so that soil sampling and analysis can be carried out simultaneously in the field. The module-based field laboratory "soil2data" can carry out these two main work processes in parallel and consists of 5 different task-specific modules that build on each other: app2field, field2soil, app2liquid, liquid2data and data2app. The individual modules were designed and built for the sub-process steps and adapted to the special features of the mobile field laboratory "soil2data". The biggest advantage is that the analysis results are available immediately, and a fertiliser recommendation can be generated instantly. For further analyses, the results are stored in the data cloud. The soil material remains in the field. In the ongoing project "Prototypes4soil2data", the mobile field laboratory soil2data is being further developed into a prototype with a modular structure.
Optimised Nutrient Recovery from Biogas Digestate by Solid/Liquid Separation and Membrane Treatment
(2019)
Anaerobic digestion products of agricultural biogas plants are characterised by high nitrogen, phosphorus, and potassium content. In three scale-up steps, a membrane based digestate treatment process of solid-liquid-separation, ultrafiltration, and reverse osmosis for nutrient recovery was investigated. Lab-scale trials delivered a very good understanding of fluid properties and subsequent ultrafiltration performance, which is the limiting process step in terms of energy demand and operation costs. In semi-technical experiments, optimisation, and design parameters were developed, which were subsequently applied to pilot-scale tests at two full-scale biogas plants. The process optimisation resulted in 50 % energy reduction of the ultrafiltration step. About 36 % of the sludge volume was recovered as dischargeable water, 20 % as solid N/P-fertiliser, and 44 % as liquid N/K-fertiliser.
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.
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.
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.
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.
Bamboo is an environmentally friendly alternative to conventional materials in mechanical engineering such as steel or aluminium. Bamboo is the fastest growing plant in the world. Instead of releasing CO2 during the manufacturing process, bamboo absorbs CO2 as it grows.
In addition to the sustainability aspect, bamboo tubes also offer excellent properties as a lightweight construction material, which have been optimised through evolution. Bamboo tubes have high strength and stiffness at low weight when used as tension-compression bars or bending beams. Bamboo has strong, high-density fibres at the boundary area, where bending stresses are greatest. Towards the inside, where the stresses are lower, the bamboo becomes porous to optimise weight. This, together with knots arranged in regular intervals, counteracts buckling.
In mobile applications such as cars and bicycles, lightweight construction is sought for energy efficiency reasons. Because of its excellent lightweight properties, the project investigated whether bamboo could be used in mobile, automotive or agricultural engineering. For example, a bamboo bicycle frame has been developed with the aim to be as light as possible. There are bamboo bicycles on the market, but they can only be made one at a time by hand. The bamboo tubes are joined together and functional elements such as the bottom bracket and headset are integrated by wrapping them in resin-impregnated natural or carbon fibres. This makes the joints very heavy. A different approach is taken here: the bamboo tubes are drilled out slightly to achieve a defined internal diameter, and then short aluminium tubes are glued into the bamboo canes from the inside. To prevent the cane from breaking in the circumferential direction, i.e. perpendicular to the fibre direction, the bamboo tubes are wrapped in a thin layer of natural or carbon fibre impregnated with synthetic resin. The aluminium tubes and functional elements are welded or soldered together beforehand.
The design of the bicycle frame, i.e. the dimensioning of the bamboo tubes and joints, was based on extensive bending and tensile tests to determine the strength properties of the natural material bamboo. The bonding between the bamboo cane and the aluminium tube was also investigated experimentally. Finally, several prototype bicycle frames were made and tested for durability according to DIN-EN-14764. The frames passed the tests.
The result is a bamboo bicycle that is manufactured with standardised connectors and joints. The assembly concept developed allows both fully automated and semi-automated series production of bamboo bicycles.
Aims: This study examines the relationship between the time, students spent abroad, personality traits and circumstances during this time with the student’s intercultural competence and integration performance in the target culture. Design and sample: The study had a correlative cross-sectional design. 202 academic subjects were surveyed. The average age was 22 years. There was one measuring time, to which 58 % of the participants stated that they have had a stay abroad. Measurements: Metacognitive, cognitive, motivational and behavioural intercultural competence were measured with the Cultural Intelligence Scale. The personality traits involvement, discipline, social competence, cooperation, dominance and stability were captured with the "Bochum inventory for job-related personality description-6F". Work-related attitudes as patterns of behaviour and experience were measured using the "Work-related Behaviour and Experiencing Pattern 44" (Geman: Arbeitsbezogene Verhaltens- und Erlebensmuster; AVEM). In addition, the demographic factors and characteristics of stays abroad as well as the integration into the target culture based on the Sociocultural Adaption Scale were examined. The data was tested for relationships and differences by tests for mean differences, variance and regression analyses. Results: There was a positive correlation between duration and cognitive, motivational and behavioural intercultural competence. The motivational competence is higher in subjects who have no risk pattern in the AVEM. The different types of competence influence each other at diverse times. Moreover, the suggested structural equation model could be confirmed. This showed the effect of the AVEM pattern on intercultural competence, moderated by the stay abroad and the social competence.
Although national eHealth strategies have existed now for more than a decade in many countries, they have been implemented with varying success. In Germany, the eHealth strategy so far has resulted in a roll out of electronic health cards for all citizens in the statutory health insurance, but in no clinically meaningful IT-applications. The aim of this study was to test the technical and organisation feasibility, usability, and utility of an eDischarge application embedded into a laboratory Health Telematics Infrastructure (TI). The tests embraced the exchange of eDischarge summaries based on the multiprofessional HL7 eNursing Summary standard between a municipal hospital and a nursing home. All in all, 36 transmissions of electronic discharge documents took place. They demonstrated the technical-organisation feasibility and resulted in moderate usability ratings. A comparison between eDischarge and paper-based summaries hinted at higher ratings of utility and information completeness for eDischarges. Despite problems with handling the electronic health card, the proof-of-concept for the first clinically meaningful IT-application in the German Health TI could be regarded as successful.
The contribution follows the hypothesis that the concept of transformative resilience can be a driver in transdisciplinary processes bringing together landscape planning and landscape design. Combining processes of generating, structuring and spatializing knowledge on landscape functions and designing visions for sustainable landscapes on different scales benefits from the creative use of mappings.
Taking the transdisciplinary research study “Green fingers for a climate resilient city”, funded by the German Ministry of education and research (BMBF), as an example, this paper follows the hypothesis that processes of landscape planning and designing multifunctional green spaces and processes of co-creation need to be combined to stimulate climate resilient city transformation. The findings are that efforts to combine these processes benefit from making complex climate-resilient city planning accessible for people of different professional backgrounds. The paper showcases how storytelling (Schmidt 2019), mapping (Langner 2009) and guided walks (Schultz 2019) are means to mutually engage with, perceive and understand multifunctional green spaces, inspire ownership, and build capacity for the city’s climate-resilient transformation.
Taking the transdisciplinary research study “Green fingers for a climate resilient city”, funded by the German Ministry of education and research (BMBF), as an example, this paper follows the hypothesis that processes of landscape planning and designing multifunctional green spaces and processes of co-creation need to be combined to stimulate climate resilient city transformation. The findings are that efforts to combine these processes benefit from making complex climate-resilient city planning accessible for people of different professional backgrounds. The paper showcases how storytelling (Schmidt 2019), mapping (Langner 2009) and guided walks (Schultz 2019) are means to mutually engage with, perceive and understand multifunctional green spaces, inspire ownership, and build capacity for the city’s climate-resilient transformation.
Artificial intelligence (AI) and human-machine interaction (HMI) are two keywords that usually do not fit embedded applications. Within the steps needed before applying AI to solve a specific task, HMI is usually missing during the AI architecture design and the training of an AI model. The human-in-the-loop concept is prevalent in all other steps of developing AI, from data analysis via data selection and cleaning to performance evaluation. During AI architecture design, HMI can immediately highlight unproductive layers of the architecture so that lightweight network architecture for embedded applications can be created easily. We show that by using this HMI, users can instantly distinguish which AI architecture should be trained and evaluated first since a high accuracy on the task could be expected. This approach reduces the resources needed for AI development by avoiding training and evaluating AI architectures with unproductive layers and leads to lightweight AI architectures. These resulting lightweight AI architectures will enable HMI while running the AI on an edge device. By enabling HMI during an AI uses inference, we will introduce the AI-in-the-loop concept that combines AI's and humans' strengths. In our AI-in-the-loop approach, the AI remains the working horse and primarily solves the task. If the AI is unsure whether its inference solves the task correctly, it asks the user to use an appropriate HMI. Consequently, AI will become available in many applications soon since HMI will make AI more reliable and explainable.
Transition road maps – an investigative approach to map the daily life consumption of individuals
(2014)
The present paper aims at investigating an innovative approach to guide consumers’ daily life choices in Germany towards a more sustainable way of acting. This should be achieved by introducing a new concept: transition road maps. Transition road maps bear the capability of illustrating courses of consumption behaviour without being prohibitive. These schemes foster self-determined behaviour and encourage the consumer to rethink and restructure his or her habits of consumption, with a focus on sustainability. The innovative thought is, not to simply stick to the usual triad of spheres of activity, consisting of nutrition, mobility and housing. Instead further aspects of consumers’ daily routines are considered, such as leisure activities, time usage or financial activities. Moreover the transition road maps are based on a new ideology of combining and connecting the qualitative algorithm of time use, financial spending and resource impact of social practices in the area of private consumption. In the long-term, the transition road maps could e.g. be used in sustainability communication or consumer counselling.
Workshop: “‘Sciatica’: neuropathic or not and does it matter? Outcomes from a NeuPSIG working group”
(2023)
The identification of neuropathic pain in persons with spine-related leg pain is important as this information guides treatment and management, including self-management. The NeuPSIG neuropathic pain grading system was developed to assist clinicians and researchers in determining whether patients have neuropathic pain and the level of confidence associated with that decision. Based on clinical and laboratory examination findings, patients are classified as having no neuropathic pain, possible, probable or definite neuropathic pain. Whereas this grading system works nicely in people with systemic neuropathies where sensory findings and diagnostic tests are mostly present, its application in patients with spine-related leg pain, particular in radicular pain, can be challenging. For example, in the absence of sensory changes and MRI findings, patients with radicular pain would at best reach a classification of possible neuropathic pain according to the current neuropathic pain grading system.
In this presentation I will explain the adaptations to the neuropathic pain grading system for spine-related leg pain recommended by the NeuPSIG working group. I will demonstrate its application in clinical practice using case studies and provide clarity for how the system can be incorporated in clinical trials. This will be an interactive session with audience participation.
Differentiating nociceptive and neuropathic components of clinical pain presentations matters!
(2016)
Background and Aims
Early identification of nerve lesions and associated neuropathic pain in spine-related pain disorders is important for tailored treatment. Management may consist of surgical intervention for compressive neural lesions.
With a growing waitlist for public surgical outpatient clinics in Western Australia and wait times exceeding the recommended wait time for initial assessment (Category 1 – assessment within 1 months, Category 2 within 3 months, category 3 within 12 months), a call to support new models of care has been made1, including the evaluation and expansion of workforce models supporting advanced skills in allied health.1
An Advanced Scope Physiotherapy (ASP) led Neurosurgery Spinal Clinic operates at Sir Charles Gairdner Hospital in Western Australia. The ASPs (2FTE) examine patients from the neurosurgery waitlist for their suitability for spinal surgery. Recommendation of either further investigation and possible assessment by a neurosurgeon or appropriate non-surgical management of the patients’ pain condition is suggested. Patient assessment is conducted either ‘in person’ at the hospital or via telehealth due to the remoteness of some rural patients. Patient cases are discussed with a neurosurgery consultant on a weekly basis. The aim of this project is to evaluate the ASP service in the year 2022.
Method
A retrospective descriptive analysis of patient data captured in 2022 was performed.
Results
In 2022, 1337 new patient referrals were managed plus 267 follow-ups from the previous year. Category 1 patients (n=81) waited on average 31 days for their first appointment, Category 2 patients (n=394) waited 76 days and Category 3 patients (n=854) waited 376 days.
287 (18%) referrals were discharged without physical assessment of the patient (DNA, cancellations, declined). Of the 1317 patients physically assessed by the ASPs (57%) were discharged directly after assessment, for 290 patients (22%) their outcome was still pending at time of analysis (March 2023) and 281 (22%) patients were referred for review with a neurosurgeon. Of the 229 patients assessed by a neurosurgeon (including patients from 2022), 103 patients (45%) were offered surgery, 52 (23%) were not offered surgery, 46 ( 20%) patients had to be reviewed, and for the remaining (n=18) their outcome was unknown.
Conclusion
Of the 1604 patients managed in the Neurosurgery Spinal Clinic, only 17% needed to see a neurosurgeon. The conversion rate to surgery of 45% is higher compared to an estimated 5%-10% in a non-triaged clinic.
The ASP model of care has proved invaluable to (i) provide access of patient care within the recommended wait times (ii) optimize neurosurgeons’ time, (iii) educate patients and, in case of non-suitability for surgery, advise and refer them for alternative appropriate management.
Relevance for Patient Care
The Advanced Scope Physiotherapy model of care at the Neurosurgery Spinal Clinic allows timely assessment of patients with spine-related disorders and supports targeted management of their condition.
Ethical Permissions
This project is registered as a Quality Improvement Project at Sir Charles Gairdner Hospital (QI35728) and as per the National Statement on Ethical Conduct in Human Research was exempt from review by the Sir Charles Gairdner Hospital Human Research and Ethics Committee
References
1Sustainable Health Review (2019). Sustainable Health Review: Final report to the Western Australian Government of Health, Western Australia
Purpose
Sedentary behaviour (SED) and low level of physical activity (PA) might be associated with the development or worsening of pain. Still, studies assessing physical behaviours by accelerometry in individuals with orofacial pain are limited. This study aims to assess whether women with temporomandibular disorders (TMD) present different patterns of physical behaviours in days with (DWP) or without pain (DWoP).
Methods
Twenty-nine out of forty-four women (mean age 29.21 sd 7.96) were diagnosed with TMD and monitored over seven days using a thigh-worn accelerometer. DWP was determined when subjects presented pain in one of the craniocervical regions (head, jaw and neck) with intensity of at least 3 in the numerical rating scale. To be considered a DWoP, the individual presented less than 3 points in the three regions. Daily time-use compositions were described in terms of SED in short (<30 min) and long (≥30 min) bouts, light PA (LPA), moderate-to-vigorous PA (MVPA), and time-in-bed. Isometric log-ratios (ilr) were calculated to express the ratio of time-in-bed to time spent awake, SED relative to LPA and MVPA, SED in short relative to long bouts, and LPA relative to MVPA. Differences between DWP and DWoP were examined using MANOVA, followed by univariate post-hoc tests of pairwise differences.
Results
During DWP, women with TMD spent more time in SED in short (239 min) and long bouts (419 min), less time in LPA (245 min), MVPA (68 min), and in bed (468 min) compared with DWoP (235, 378, 263, 70 and 493 min, respectively). The MANOVA showed that all sets of ilrs did not differ statistically (ηp2 = 0.19, p = 0.25). Still, the post-hoc tests showed a trend that time spent SED relative to LPA and MVPA was larger in DWP than in DWoP (Cohen’s d = 0.36, p = 0.05).
Conclusions
Women with TMD did not show different patterns of physical behaviours in DWP or DWoP. However, there is a trend of more sedentary behaviour and less physical activity in DWP compared to DWoP. Future studies should consider other pain intensity cut-offs, isolated pain locations, and larger sample sizes to confirm these results.
Informatics competencies of the health care workforce must meet the requirements of inter-professional process and outcome oriented provision of care. In order to help nursing education transform accordingly, the TIGER Initiative deployed an international survey, with participation from 21 countries, to evaluate and prioritise a broad list of core competencies for nurses in five domains: 1) nursing management, 2) information technology (IT) management in nursing, 3) interprofessional coordination of care, 4) quality management, and 5) clinical nursing. Informatics core competencies were found highly important for all domains. In addition, this project compiled eight national cases studies from Austria, Finland, Germany, Ireland, New Zealand, the Philippines, Portugal, and Switzerland that reflected the country specific perspective. These findings will lead us to an international framework of informatics recommendations.