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In this paper, we evaluate the application of Bayesian Optimization (BO) to discrete event simulation (DES) models. In a first step, we create a simple model, for which we know the optimal set of parameter values in advance. We implement the model in SimPy, a framework for DES written in Python. We then interpret the simulation model as a black box function subject to optimization. We show that it is possible to find the optimal set of parameter values using the open source library GPyOpt. To enhance our evaluation, we create a second and more complex model. To better handle the complexity of the model, and to add a visual component, we build the second model in Simio, a commercial off-the-shelf simulation modeling tool. To apply BO to a model in Simio, we use the Simio API to write an extension for optimization plug-ins. This extension encapsulates the logic of the BO algorithm, which we deployed as a web service in the cloud.
The fact that simulation models are black box functions with regard to their behavior and the influence of their input parameters makes them an apparent candidate for Bayesian Optimization (BO). Simulation models are multivariable and stochastic, and their behavior is to a large extent unpredictable. In particular, we do not know for sure which input parameters to adjust to maximize (or minimize) the model’s outcome. In addition, the complex models can take a substantial amount of time to run.
Bayesian Optimization is a sequential and self-learning algorithm to optimize black box functions similar to as we find them in simulation models: they contain a set of parameters for which we want to identify the optimal set, they are expensive to evaluate, and they exhibit stochastic noise. BO has proven to efficiently optimize black box functions from varius disciplines. Among those, and most notably, it is successfully applied in machine learning algorithms to optimize hyperparameters.
SimBO is a flexible framework for optimizing discrete event-driven simulations (DES) using sequential optimization algorithms. While specifically designed for Bayesian Optimization (BO) in the context of DES, SimBO can be applied to any black-box problem with other optimization algorithms. The framework consists of four encapsulated components - the black-box problem, the sequential optimization algorithm, a database for experiment configuration and results, and a web-based graphical user interface - that communicate via well-defined interfaces. Each component can be run in different environments, allowing for cooperation between different hardware- and software configurations. In our research context, SimBO’s architecture enabled BO algorithms to be run on a high-performance cluster with GPU support, while the simulation is executed on a local Windows machine using the Simio simulation software. The framework’s flexibility also makes it suitable for evolving from a research-focused tool to a production-ready, cloud-based optimization tool for modern algorithms.
Rationale: Three-dimensional (3D) motion analysis has proved helpful in the diagnosis of different musculoskeletal syndromes and identifying injurious movement patterns in high string players. Furthermore, an optoelectronic 3D motion capture system allows an accurate and objective assessment of upper body posture and motion during violin and viola performance. However, no reference upper body model of high string players has been proposed as yet. Moreover, a more physiological shoulder model that separates the joints of the shoulder complex has not been reported. Especially in view of given the role of the scapula in the normal movement of the humerus, it cannot be disregarded when evaluating musculoskeletal strain in the shoulder.
The International Society of Biomechanics recommends definitions of joint coordinate systems for the report of upper body joint motion using anatomical landmarks as reference for the placement of surface markers. Using markers on the skin for some of the proposed locations is, however, inappropriate when an instrument is being played. There are skin movement artifacts, e. g. caused by the movement of the scapula underneath the skin, whereas some markers interfere with the instrument on the shoulder or might be occluded by the bowing arm in motion.
Purpose: The aim of this study was to develop a marker-based method for quantifying 3D upper body kinematics of high string players and to demonstrate its clinical feasibility in violin and viola performance. The method is intended to provide an objective evaluation of high string players’ motor strategies, especially in the shoulder complex, while minimizing skin movement artifacts, marker occlusions and limitations in instrument placement.
Methods: A custom marker set was developed consisting of thirty-one single markers to define the anatomical coordinate systems of sixteen upper body segments including the pelvis, thorax, spine and head, as well as both scapulae, upper arms, forearms and hands. Twenty-one of these markers as well as two pre-built and four custom-made rigid marker clusters were used for tracking the segment motions.
Twelve professional violinists without history of musculoskeletal or neurological problems were recruited for assessing the clinical feasibility of the method. They were asked to perform a single sequence of two consecutive musical notes on each of two adjacent strings (G- and D-string) in real time, played at 50 bpm with tempo audibly regulated by a metronome, and using a standardized violin and bow. The participants played up- and down-bow alternately using the whole length of the bow.
A custom biomechanical model was applied to the motion capture data and the rotation angles of fifteen joints were calculated. The location of each glenohumeral joint rotation center was computed by upper arm movements with respect to the scapula based on a functional method. For a description of the motion patterns, minimum, maximum and range of angular motion were averaged across participants for each string and rotation. Inter-subject variability was assessed by calculating the standard deviation (SD) at each sample of the angle-time series between participants for each rotation and for both strings. Then SD was averaged over sequences for each rotation and string. For comparing mean rotation angles between strings over time, random effect models were used.
Results: The highest range of motion was observed in the right elbow flexion and right wrist flexion/extension. Also, high ranges of motion (> 10°) were found in all right glenohumeral rotations and right wrist deviation and pronation/supination. In conclusion, lumbar and thoracic spine, thorax, neck, and left upper limb were quite static, while large motion occurred in the right upper limb during up and down bowing.
Most rotation angles showed a reasonable inter-subject variability except for left and right glenohumeral plane of elevation as well as left glenohumeral internal/external rotation, and left and right wrist pronation/supination (> 10°).
Significant differences in the rotation angles between G- and D-string bowing were detected especially in the left wrist and right shoulder joints.
Conclusions: This is the first study that used quantitative 3D analysis to explore the upper body kinematics of high string players during performance, providing a detailed view of the motor control in the shoulder as well as in the lumbar and thoracic spine. The biggest advantage over previously published methods is the more physiological shoulder and spine models while providing a simple application.
The method was found to give consistent motion patterns across participants and to be sensitive to differences between adjacent strings. Although the method appears to be valid, more rigorous validation is necessary. Since there is no gold standard with which we could compare results, we were only able to assess the clinical feasibility. We believe that our method represents a good compromise between accuracy and practicability for clinical application.
Due to the inclusion of multi-segmented shoulder and spine models, it will improve understanding of the motor strategies adopted by high string players and may contribute to injury prevention, diagnosis and treatment.
Rationale:
Instrumentalists often suffer from playing-related (neuro-)musculoskeletal disorders (PRMDs). Most common PRMDs in string players are related to upper-body regions. Motion analysis has proven to be helpful in the evaluation of functional disorders. It was already shown that it is a valid and clinically feasible tool for accurate, repeatable, and objective assessments of functional movement in string players. Thus, it may guide clinicians to improvements in injury prevention, diagnosis, and treatment. Nevertheless, its application in clinical consultation is still very uncommon. For this reason, there is a lack of well-established motion analysis protocols for the examination of PRMDs in string players using advanced biomechanical instruments in clinical settings.
Purpose:
To demonstrate the development and application of a motion analysis protocol for the evaluation of functional upper-body movements in violinists, violists, and cellists in a clinical setting for the investigation of PRMDs.
Approach:
The protocol was to be integrated into a clinical reasoning process for testing clinical hypotheses and evaluating treatment outcomes in physiotherapy. As a starting point, a primary clinical question was defined, and then, specific upper-body symptom regions as well as measurement parameters (relative rotation angles and muscle activities over time) were identified. Subsequently, involved segments, joints, and muscles were assorted. For quantification of upper-body kinematics a novel, marker-based method was used which provides multi-segmented shoulder and spine models while providing simple application. Based on that, a comprehensive mechanical model of the upper body as well as the associated coordinate systems and rotation sequences were specified. This further guided both, the definition of a custom-made marker set as well as the selection and placement of surface electrodes. Furthermore, required static and functional calibration trials as well as movement tasks for functional assessment were specified. Finally, advanced approaches, such as a comprehensive kinematic model and functional determination of joint centers and axes were established for extraction. Then, outcome parameters and their form of representation were determined for further analysis and interpretation.
The application of the method first includes the selection of segments, joints, and muscles to examine – originating from one or more clinical (working) hypotheses or symptom regions. This drives the configuration and placement of required surface markers and electrodes. Then, the required calibration and functional movement trials are executed. After measurement, the outcome parameters get extracted and analyzed. Based on the results the hypothesis is discarded or verified.
Content:
The method was applied to a violinist (female; 18 years old; 13 years of experience; practicing 2 to 3 hours per day, 7 days per week) with playing-related demands in the left cervical-shoulder-arm region.
Subjective findings indicated that the pain regularly occurred after 30 minutes of playing fast or difficult musical pieces. Physical examination showed that strength testing of left serratus anterior muscle caused pain, lower trapezius muscles seemed weak, forearm muscles were sensitive to pressure, movement of the cervical spine to the left was reduced, and upper limb neural tension test was noticeable.
This led to the following working hypothesis: Neck-related arm pain with neurodynamic component and motor control problem in the scapulothoracic region. Thus, left-sided cervical-shoulder-arm region was selected for functional examination.
Optoelectronic motion capture system and surface electromyography were used for data collection. Static and function calibration trials as well as functional assessment trials (chromatic scale with different tempi) were conducted. Afterwards, data was further processed, and outcome parameters were extracted.
Results showed that greater tempo and pain had an impact on the rotation angles and muscle activities. They led to less overall joint movement and range of motion, to less muscle activity in the forearm muscles, and to greater activity inputs in the scapulothoracic muscles. Overall, greater tempo and pain led to a different motor program which verified the working hypothesis.
The procedure was repeated after treatment (four appointments over one week) with manual therapy, training, and education. The pre-/post-interventional comparison showed changes in the motor program. There was noticeable higher mean activity in upper trapezius and deltoid muscles and simultaneously less in the remaining ones. In addition, only marginal differences in ranges of motion and muscle activity inputs were found between tempi. The playing style appeared to be more stable now. Overall, it appeared that nearly the same motor program was used for each tempo.
Clinical Implications:
Potential applications are intraindividual evaluations of simultaneously joint and muscular function in string players during clinical consultation. It is intended to contribute to the diagnosis of PRMDs in terms of an objective, comprehensive and yet clinically feasible diagnostic assessment as well as pre-post-intervention outcome evaluation.
Nonetheless, motion analysis must be used with care in clinical decision making. Motion data is subject to both, intraindividual variations, and measurement errors. In addition, the smallest clinically relevant changes are not clear yet. Therefore, results should only be interpreted together with other clinical findings.
Climate change is the biggest social challenge facing the globalised world. The aim of this paper is to investigate the requirements for governance structures in regional sustainability programmes against climate change.
The study is an explorative case study. It is based on a literature review and expert interviews. It also involves the participatory observation of working groups meetings, and a design thinking workshop.
In spite of their enormous importance, little is known about the institutional conditions of the regional governance of climate change projects in Germany.
For this reason, the research project focuses on the important aspect of networking and governance structures. Consequently, the investigation will contribute to answering the question of which institutional framework conditions can raise the likelihood of climate change projects having a sustainable effect.
The outcomes of the application
This research has not only practical implications for the single case. The exploration of the critical factors of success also offers other regions important food for thought in shaping their governance structures. In particular, the design thinking process and the business network in the District of Steinfurt offer valuable points of reference.
Purpose
Attracting skilled students is an important aim of many cities in a knowledge-based society. This paper focuses on urban factors of attractiveness from a student's perspective and analyses their influence on locational choices of students. The criteria found were also used to evaluate how the City of Osnabrück, Germany, is rated in terms of these criteria and to reveal the greatest discrepancies.
Design / Methodology / Approach
The paper is based on a multi-level empirical research concept, including qualitative and quantitative approaches. A survey of 2,300 students was conducted in Osnabrück on the basis of focus group discussions with students and interviews with various experts such as a neighbourhood manager, an urban planner, a district mayor, a college president, a real estate manager.
Originality/value
To date, little research has been undertaken to empirically examine the specific requirements that German students look for in a place to live and study. According to the author’s present state of knowledge (January 2018), a comparable study has not been done.
The main contribution of this paper is the empirical analysis of what makes cities attractive to students. In contrast to the findings of Richard Florida about the Creative Class, the cleanliness of a city, beautiful city scenery, and attractive apartments are more important to students than cultural offers, interesting job opportunities, or a multicultural population.
Practical Implications
Insights from the empirical survey can both help to analyse important factors in students' decision-making process and provide possible measures that the city stakeholders can take.
Keywords
1. Knowledge-based urban development
2. Mobility decisions by students and skilled professionals
3. Location factors
4. Place branding
Proposed paper: Academic Research Paper
Iron deficiency is a global issue and can lead to a variety of clinical pictures. The biofor-tification of vegetables with iron could complement the existing portfolio of iron-rich products, thus improving iron supply in the long term. In order to determine whether the iron-biofortified vegetables could meet this demand and would address appropriate target groups, a quantitative online survey was conducted in Germany. Based on 1000 consumer responses, a cluster analysis was performed. The results showed a four-cluster solution. The first cluster was holistically engaged, the second was fitness-affine but health unconcerned, the third cluster consists frugal eaters with a focus on medical prevention, and the fourth cluster are hedonists. No cluster focused its consumption on iron-enriched products, but instead all developed an individual mix of the three product groups.
Perceptions of German consumers regarding methods for fortifying foods with iodine (Abstract)
(2022)
Health IT adoption research is rooted in Rogers' Diffusion of Innovation theory, which is based on longitudinal analyses. However, many studies in this field use cross-sectional designs. The aim of this study therefore was to design and implement a system to (i) consolidate survey data sets originating from different years (ii) integrate additional secondary data and (iii) query and statistically analyse these longitudinal data. Our system design comprises a 5-tier-architecture that embraces tiers for data capture, data representation, logics, presentation and integration. In order to historicize data properly and to separate data storage from data analytics a data vault schema was implemented. This approach allows the flexible integration of heterogeneous data sets and the selection of comparable items. Data analysis is prepared by compiling data in data marts and performed by R and related tools. IT Report Healthcare data from 2011, 2013 and 2017 could be loaded, analysed and combined with secondary longitudinal data.
The usage of high-level synthesis (HLS) tools for FPGAs has increased significantly over the last years since they matured and allow software programmers to take advantage of reconfigurable hardware technology.
Most HLS tools employ methods to optimize for loops, e. g. by unrolling or pipelining them. But there is hardly any work on the optimization of while loops. This comes at no surprise since most while loops have loop-carried dependences involving the loop condition which result in large recurrence cycles in the dataflow graphs. Therefore typical while loops cannot be parallelized or pipelined.
We propose a novel transformation which allows to optimize while loops nested within a for loop. By interchanging the two loops, it is possible to pipeline (and thereby parallelize) the inner loop, resulting in a reduced execution time. We present two case studies on different hardware platforms and show the speedup factors - compared to a host processor and to an unoptimized hardware implementation - achieved by our while loop optimization method.
Artificial intelligence (AI) promises transformative impacts on society, industry, and agriculture, while being heavily reliant on diverse, quality data. The resource-intensive "data
problem" has initialized a shift to synthetic data. One downside of synthetic data is known as the "reality gap", a lack of realism. Hybrid data, combining synthetic and real data, addresses this. The paper examines terminological inconsistencies and proposes a unified taxonomy for real, synthetic, augmented, and hybrid data. It aims to enhance AI training datasets in smart agriculture, addressing the challenges in the agricultural data landscape. Utilizing hybrid data in AI models offers improved prediction performance and adaptability.
The PosiThera project focuses on the management of chronic wounds, which is multi-professional and multi-disciplinary. For this context, a software prototype was developed in the project, which is intended to support medical and nursing staff with the assistance of artificial intelligence. In accordance with the user-centred design, national workshops were held at the beginning of the project with the involvement of domain experts in wound care in order to identify requirements and use cases of IT systems in wound care, with a focus on AI. In this study, the focus was on involving nursing and nursing science staff in testing the software prototype to gain insights into its functionality and usability. The overarching goal of the iterative testing and adaptation process is to further develop the prototype in a way that is close to care.
This paper introduces and empirically illustrates a pedagogical approach to teaching Public Relations (PR) in higher education. The approach is based on the Communities of Practice theory (Wenger, 1998). Based on this theory and for the purposes of this paper, learning is perceived as (1) a participation in a practice of (2) a social community and (3) the understanding of this practice. The pedagogical approach to teaching PR entails the facilitation of these three elements. The approach is illustrated through a case study. The authors conducted an international undergraduate course to teach students how to conduct a social media campaign to raise engagement for social issues. Twenty students from Netherlands and Germany enrolled. The paper offers an integrated understanding of theory and practice (see Wenger, 1998, p. 48). It contrasts many current approaches in PR education, which tend to differentiate between PR theory and practice. PR educators are encouraged to facilitate an equal negotiation between theory and practice and to enable students to match whatever is theorised with practice and whatever is practiced with theory.
This paper presents an optimized algorithm for estimating static and dynamic gait parameters. We use a marker- and contact-less motion capture system that identifies 20 joints of a person walking along a corridor.
Based on the proposed gait cycle detection basic metrics as walking frequency, step/stride length, and support phases are estimated automatically. Applying a rigid body model, we are capable to calculate static and dynamic gait stability metrics. We conclude with initial results of a clinical study evaluating orthopaedic technical support.
he development of context-aware applications is a difficult and error-prone task. The dynamics of the environmental context combined with the complexity of the applications poses a vast number of possibilities for mistakes during the creation of new applications. Therefore it is important to test applications before they are deployed in a life system. For this reason, this paper proposes a testing tool, which will allow for automatic generation of various test cases from application description documents. Semantic annotations are used to create specific test data for context-aware applications. A test case reduction methodology based on test case diversity investigations ensures scalability of the proposed automated testing approach.
Due to the emerging evidence of health IT as opportunity and risk for clinical workflows, health IT must undergo a continuous measurement of its efficacy and efficiency. IT-benchmarks are a proven means for providing this information. The aim of this study was to enhance the methodology of an existing benchmarking procedure by including, in particular, new indicators of clinical workflows and by proposing new types of visualisation. Drawing on the concept of information logistics, we propose four workflow descriptors that were applied to four clinical processes. General and specific indicators were derived from these descriptors and processes. 199 chief information officers (CIOs) took part in the benchmarking. These hospitals were assigned to reference groups of a similar size and ownership from a total of 259 hospitals. Stepwise and comprehensive feedback was given to the CIOs. Most participants who evaluated the benchmark rated the procedure as very good, good, or rather good (98.4%). Benchmark information was used by CIOs for getting a general overview, advancing IT, preparing negotiations with board members, and arguing for a new IT project.
As health IT supports processes along the entire patient trajectory and involves different types of professional groups, eHealth is inter-professional by nature. The aim of this study, therefore, is to investigate which competencies are at the intersection of the individual groups of health professionals. 718 international experts provided relevance ratings of eHealth competencies for different professional roles in an online survey. Communication and leadership proved to be important competencies across all professions, not only for executives. None or very little differences between professions were found between physicians and nurses, between IT experts at different levels and between IT experts and executives. However, there were a number of competencies rated differently when contrasting direct patient care specialists with executives. These findings should encourage organisations issuing educational recommendations to specify areas of shared competencies more extensively.
Background: IT is getting an increasing importance in hospitals. In this
context, major IT decisions are often made by CEOs who are not necessarily IT
experts. Objectives: Therefore, this study aimed at a) exploring different types of IT
decision makers at CEO level, b) identifying hypotheses if trust exists between these
different types of CEOs and their CIOs and c) building hypotheses on potential
consequences regarding risk taking and innovation. Methods: To this end, 14
qualitative interviews with German hospital CEOs were conducted to explore the
research questions. Results: The study revealed three major types: IT savvy CEOs,
IT enthusiastic CEOs and IT indifferent CEOs. Depending on these types, their
relationship with the CIO varied in terms of trust and common language. In case of
IT indifferent CEOs, a potential vicious circle of lack of IT knowledge, missing trust,
low willingness to take risks and low innovation power could be identified.
Conclusion: In order to break of this circle, CEOs seem to need more IT knowledge
and / or greater trust in their CIO.
Health IT and communication systems are indispensable in German hospitals for clinical as well as administrative process support. However, IT is often regarded as a “black box” for hospital CEOs. Thus, the question arises how can CEOs decide if they do not know what is in the box? In order to answer this question, half-structured interviews with 14 German hospital CEOs were conducted. They revealed three principle decision processes: the supported decision, the joint decision and the corporate level decision. In all cases, the hospital CEO and the CIO interacted to reach the final decision, most strongly in the joint decision mode and least strongly in the corporate decision mode. Only the joint decision mode definitely forced the CEO to open the “black box” of IT. In the era of digitalisation, however, CEOs must develop better competencies to decide over complex matters.
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.
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.
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
Differentiating nociceptive and neuropathic components of clinical pain presentations matters!
(2016)
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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”?
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.
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.
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.
Methods: The searches were conducted on five electronic databases. RCTs or CTs with patients over 18 years old of both sexes with OFP diagnoses were targeted. The intervention of interest was AE (i.e., walking, cycling, and running), compared to any other conservative and non-conservative therapy. The primary outcome was pain intensity. Risk of bias (RoB) was done with the Cochrane RoB tool (RoB 2). The overall certainty of the evidence was evaluated with GRADE.
Results: Out of 21,585 initial records found in the initial database search, only one study (reported on three manuscripts) was included. The diagnosis of interest was headache plus temporomandibular disorders (TMD). Three treatment groups (strengthening (Str) exercise + manual therapy (MT) (G1); AE + MT + Str exercises (G2); AE (G3)) were compared. The main outcome was pain; the secondary outcomes included disability, strength, anxiety, and quality of life. The combined treatment (AE+MT+Str exercises) had the strongest effect to decrease pain and headache intensity in patients with OFP (SMD: 9.99 [95%CI: 7.19, 12.80].
Conclusions: a multimodal treatment strategy achieved the greatest positive effects on pain and other outcomes in the short/medium term. AE seems to be an important component of this strategy. However, the scientific evidence supporting AE’s isolated effect is limited, indicating a research gap in this scientific field.
Management of agricultural processes is often troubled by disconnections and data transfer failures. Limited cellular network coverage may prevent information exchange between mobile process participants.
The research projects KOMOBAR and ISOCom designed, implemented und field-tested a delay tolerant platform for robust communication in rural areas and challenging environments. An adaptable combination of infrastructure-based cellular networks and infrastructure-free multihop ad hoc communication (WLAN) leads to a variety of new communication opportunities. Temporal storage and forwarding of data on mobile farm machinery as well as dynamic platform configurations during process runtime strongly enhance reliability and robustness of data transfers.
Process modeling languages help to define and execute processes and workflows. The Business Process Model and Notation (BPMN) 2.0 is used for business processes in commercial areas such as banks, shops, production and supply industry. Due to its flexible notation, BPMN is increasingly being used in non-traditional business process domains like Internet of Things (IoT) and agriculture. However, BPMN does not fit well to scenarios taking place in environments featuring limited, delayed, intermittent or broken connectivity. Communication just exists for BPMN - characteristics of message transfers, their priorities and connectivity parameters are not part of the model. No backup mechanism for communication issues exists, resulting in error-prone and failing processes. This paper introduces resilient BPMN (rBPMN), a valid BPMN extension for process modeling in unreliable communication environments. The meta model addition of opportunistic message flows with Quality of Service (QoS) parameters and connectivity characteristics allows to verify and enhance process robustness at design time. Modeling of explicit or implicit, decision-based alternatives ensures optimal process operation even when connectivity issues occur. In case of no connectivity, locally moved functionality guarantees stable process operation. Evaluation using an agricultural slurry application showed significant robustness enhancements and prevented process failures due to communication issues.
For Delay-Tolerant Networks (DTNs) many routing algorithms have been suggested. However, their performance depends heavily on the applied scenario. Especially heterogeneous scenarios featuring known and unknown node movements as well as different kinds of data lead to either poor delivery ratios or exhausted network resources.
To overcome these problems this paper introduces Data-Driven Routing for DTNs. Data is categorized according to its requirements into priority queues. Each queue applies an appropriate DTN routing algorithm that fits the data requirements best. Simulation results show that Data-Driven Routing allows high delivery ratios for time-critical data while saving network resources during the transfer of less time-critical data at the same time.
Personal health records (PHR) are instruments to compile, store and present health and wellness related data digitally with proven effects on self-management of diseases. The aim of this study was to investigate whether there were differences in the intention to use (ITU) and perceived usefulness (PU) of two technologies allowing users to access the PHR, i.e. a kiosk system and a smart phone based app (access as usual). The study also aimed at modelling ITU and PU with multiple linear regressions. A total of 46 subject participated in the study who were randomly assigned to one of the two experimental groups (nkiosk = 22; napp = 24). The task for both groups was to digitise their “Medikationsplan” (medical record) and upload it to the PHR. There was no significant difference in ITU and PU between the two technologies. ITU could only be significantly explained by PU (R2 = .55, p < 0.001), while PU was determined by perceived ease of use and psychological factors (R2 = .64, p < 0.001). Severity of disease did not play any significant role. The German “Terminservice- und Versorgungsgesetz” underpins the importance and timeliness of this study. The assumption that both – the publicly accessible kiosk and the app – are equally acceptable for people of different gender, age and technology background demonstrates the opportunity to master a potential digital divide among the population and allows users to get access to their PHR in multiple ways.
This prospective longitudinal study aims at better understanding eHealth success factors in different European nations, esp. the role of eHealth-legislation in Switzerland and Germany. Qualitative interviews with 39 matched experts from a large variety of institutions in both nations were conducted. The individual statements in the interviews and the overall satisfaction rating indicate a clear trend for a more optimistic attitude towards the law in Switzerland than in Germany. This result is not surprising given the history of a telematics infrastructure in Germany. Cross-country learning topics for German politicians are the inclusion of the inpatient sector and the focus on one major application. In a next step, interview results from Austria will be included and with that the scope of study findings enriched.
Despite similar policy goals, the adoption of eHealth practices took different paths in Austria (AT), Switzerland (CH), and Germany (GER). We seek to provide a rigorous analysis of the current state of hospitals by focusing on three key eHealth areas: electronic patient records (EPR), health information exchange (HIE), electronic patient communication. For validation and in order to gain better contextual insight we applied a mixed method approach by combining survey results from clinical directors with qualitative interview data from eHealth experts of all three countries. Across countries, EPR adoption rates were reported highest (AT: 52%, CH: 78%, GER: 50%), HIE-rates were partly lower (AT: 52%, CH: 14%, GER: 17%), and electronic patient communication was reported lowest overall (AT: 17%, CH: 8%, GER: 19%). Amongst others, results indicate patient awareness about eHealth to be equally weak across countries, which thus may be an important focal point of future policy initiatives.
Today's development of client-side web applications is based on one of the JavaScript-frameworks, such as Angular or React. The excessive dependencies that arise in the ecosystem from the Node-Package-Manager increase the security risk and the dependency of your own web application on third-party packages. Moreover, the frameworkless approach proposes a renaissance of classic web development, because it strives to avoid external dependencies as far as possible and to fall back on the standards. Whether the implementation achieves maintainability and security of frameworks is questionable. Therefore, it makes sense to research which core concepts of the frameworks meet the requirements for maintainability and security and how these are implemented. The novelty is that the concepts to be explored are moved to a standard in order to ensure the developer efficiency, security, performance and maintainability in the long term. This allows existing approaches to focus on other essential features.
Rationale
Playing the trombone can lead to playing-related musculoskeletal disorders (PRMD). Previous research suggests that professional trombonists predominantly struggle with PRMD on the left body side. An increasing volume leads to an increasing contact pressure on the mouthpiece of the trombone, but it is still unclear how the muscle activity relates to this and whether it differs in musicians with PRMD from those without PRMD.
Purpose
The purpose of this study was to investigate the relationship between the activity of different muscles of the left body side, the contact pressure on the mouthpiece and the volume level in healthy trombonists.
Methods
Six male healthy tenor trombonists were included in this study and run through a standardized protocol which consisted of playing a b-flat major scale with three different volume levels (pianissimo, mezzoforte, fortissimo). Analyzed parameters were (1) the activity of several muscles of the left body side (measured with surface electromyography), (2) the contact pressure on the mouthpiece (measured with a force sensor) and (3) the different volume levels.
Results
Analysis of variance reveals significant differences of the muscle activity for the three volume levels. Depending on the volume level and the selected muscle, results show very weak to moderate correlations between contact pressure on the mouthpiece and muscle activity (Spearman´s rho between .11 and .58). The strongest correlation across all muscles occurs during fortissimo playing.
Conclusions
These results show a relationship in healthy trombonists between volume level, contact pressure on the mouthpiece and muscle activity when playing a b-flat major scale. Future research should include trombonists with PRMD to enable comparison between PRMD and non-PRMD musicians.
Educational Objectives:
At the end of the presentation, the participants will be able to…
1. understand the relationship between muscle activity, contact pressure on the mouthpiece and volume when playing the trombone
2. recognize that there are different muscle activity patterns on the left body side when playing the trombone
3. understand that a comprehensive functional diagnosis is important in the management of musicians
Introduction: Hamstring injuries are among the most common injuries in soccer players. Especially the danger of hamstring injuries increases in the final third of each half, with the biceps femoris muscle being highly susceptible, but currently there is no supporting evidence in soccer players. It is important to investigate to provide a basis for further clinical investigations in order to reduce the risk of hamstring injuries.
Objective: To investigate a soccer-specific muscle fatigue protocol has an effect on the activation patterns of the biceps and semitendinosus muscles and correlates with the subjectively perceived exertion of the soccer players.
Methods: 19 healthy soccer players aged 19 - 35 years were included and underwent a standardized procedure that included: (1) performance of the nordic hamstring curls (NHC) and a 10m sprint (pre-test), (2) a soccer-specific muscle fatigue loading protocol for 30 minutes with subsequent rating of perceived exertion (RPE), (3) re-assessed like pre-assessment (post- test). Electromyography (EMG) data were recorded the biceps and
semitendinosus muscles of both legs. Two parameters were analyzed: the peak amplitude during the NHC and the mean amplitude during the 10m sprint.
Results: The RPE score (9.5, p<0.001) and 10m sprint shows significant differences between pre- and post- test for the biceps (standing leg: -82.45, kicking leg: -81.77; p<0.01) and semitendinosus muscle (standing leg: -60.08, p=0.001); kicking leg: -65.30, p=0.03). Significant correlation exists between RPE score and biceps muscles at posttest (standing leg: r=-0.54, kicking leg: r=-0.51; p<0.05).
Conclusion: Muscle fatigue leads to significant changes in the activation behavior of the hamstring muscles. In particular, the biceps muscle shows a correlation with perceived exertion, the higher the exertion, the lower the muscle activity. This may help explain the higher prevalence of the biceps muscle in hamstring injuries and offers a basis for further clinical investigations
Rationale:
Biomechanical analyses are capable of capturing and evaluating human motions. In addition to the major biomechanical fields of kinetics and kinematics, electromyography (EMG) provides a reliable way to analyse neuromuscular activities, e.g. inter- and intramuscular coordination, fatigue behavior or timing. Based on these parameters it is possible to conclude to clinically relevant parameters such as motor control, muscular coordination or compensation strategies with different loads. In addition to this, EMG can be used in treatment itself, e.g. biofeedback-training with an EMG is an effective and evidenced based tool to improve neuromuscular control.
Purpose:
To show the importance of EMG in musicians´ health and to demonstrate additional therapy and diagnostic options.
Educational Objectives:
At the end of the workshop, the participants will be able to…
1. understand and describe the basic principles of EMG
2. understand and describe the importance of EMG in the context of musicians´ health, physical therapy and the clinical reasoning process
3. use EMG on musicians in the performance process
Content of Presentation:
This workshop briefly introduces the theoretical principles of EMG and the clinical applications in the context of musicians´ health. It explains why EMG provides an additional value in the clinical reasoning process and supports the therapist, but decision making in the clinical reasoning process should never be based on EMG solely.
In the further course of the workshop the use of EMG in diagnostics and therapy (biofeedback) with musicians is practically demonstrated and discussed with the participants.
Approach of Presentation:
1. Short presentation: introduction and understanding of EMG (educational objective 1)
2. Short case presentation of a musician to introduce EMG in the field of musicians´ health and the clinical reasoning process (educational objective 2)
3. Interactive practical demonstration (diagnosis and biofeedback-training) as the central part of the workshop. Questions and comments will be discussed directly throughout the group (educational objective 3)
Clinical Significance:
EMG based functional neuromuscular diagnostics and biofeedback-training provides both the therapist as well as the musician with additional value in their clinical work.
Rationale:
Biomechanical analyses are capable of capturing and evaluating human motions. In addition to the major biomechanical fields of kinetics and kinematics, electromyography (EMG) provides a reliable way to analyse neuromuscular activities, e.g. inter- and intramuscular coordination, fatigue behavior or timing. Based on these parameters it is possible to conclude to clinically relevant parameters such as motor control, muscular coordination or compensation strategies with different loads. In addition to this, EMG can be used in treatment itself, e.g. biofeedback-training with an EMG is an effective and evidenced based tool to improve neuromuscular control.
Purpose:
To show the importance of EMG in musicians´ health and to demonstrate additional therapy and diagnostic options.
Educational Objectives:
At the end of the workshop, the participants will be able to…
1. understand and describe the basic principles of EMG
2. understand and describe the importance of EMG in the context of musicians´ health, physical therapy and the clinical reasoning process
3. use EMG on musicians in the performance process
Content of Presentation:
This workshop briefly introduces the theoretical principles of EMG and the clinical applications in the context of musicians´ health. It explains why EMG provides an additional value in the clinical reasoning process and supports the therapist, but decision making in the clinical reasoning process should never be based on EMG solely.
In the further course of the workshop the use of EMG in diagnostics and therapy (biofeedback) with musicians is practically demonstrated and discussed with the participants.
Approach of Presentation:
1. Short presentation: introduction and understanding of EMG (educational objective 1)
2. Short case presentation of a musician to introduce EMG in the field of musicians´ health and the clinical reasoning process (educational objective 2)
3. Interactive practical demonstration (diagnosis and biofeedback-training) as the central part of the workshop. Questions and comments will be discussed directly throughout the group (educational objective 3)
Clinical Significance:
EMG based functional neuromuscular diagnostics and biofeedback-training provides both the therapist as well as the musician with additional value in their clinical work.
Rationale:
Biomechanical analyses are capable of capturing and evaluating human motions. In addition to the major biomechanical fields of kinetics and kinematics, electromyography (EMG) provides a reliable way to analyse neuromuscular activities, e.g. inter- and intramuscular coordination or fatigue behavior. Based on these parameters it is possible to conclude to clinically relevant parameters such as motor control, muscular coordination or compensation strategies with different loads. In addition to this, EMG can be used in treatment itself, e.g. biofeedback-training with an EMG is an effective and evidenced based tool to improve neuromuscular control.
Purpose:
To show the advantages of implementing EMG in performing artists´ health and to demonstrate additional therapy and diagnostic options.
Educational Objectives:
At the end of the workshop, the participants will be able to…
1.understand and describe the basic principles of EMG
2.understand and describe the importance of EMG in the context of performing artists´ health, physical therapy and clinical reasoning
3.use EMG on performing artists in the performance process
Content of Presentation:
This workshop briefly introduces the theoretical principles of EMG and the clinical applications in the context of performing artists´ health. It explains why EMG provides an additional value in the clinical reasoning process and supports the therapist, but decision making in the clinical reasoning process should never be based on EMG solely.
In the further course of the workshop the use of EMG in diagnostics and therapy (biofeedback) with performing artists is practically demonstrated and discussed with the participants.
Approach of Presentation:
1.Short presentation: introduction and understanding of EMG (educational objective 1)
2.Short case presentation of a performing artist to introduce EMG in the field of performing artists´ health and clinical reasoning (educational objective 2)
3.Interactive practical demonstration (diagnosis and biofeedback-training) as the central part of the workshop. Questions and comments will be discussed directly throughout the group (educational objective 3)
Clinical Significance:
EMG based functional neuromuscular diagnostics and biofeedback-training provides both the therapist as well as the performing artist with additional value in their clinical work.
Rationale:
Dance as an intense kind of performance is associated with high loads on the musculoskeletal system. In particular, the lower limb is exposed to these high loads, which is reported by a high prevalence. Most dancers are affected by injuries during their careers, most in the lower limb. Typical risk factors for dancers include the compensatory turnout, hypermobility, and core stability. The correlation between these factors and lower limb injuries is not fully understood.
Purpose:
The aim of this study was to evaluate the correlation between lower limb injuries and the risk factors compensated turnout, hypermobility and core stability. Based on these results, hypotheses can be generated for further studies.
Methods:
This explorative pilot study was conducted at Osnabrück University of Applied Sciences. All eligible participants were scheduled for a single research appointment if they fulfilled the inclusion criteria of dance experience (ballet, modern, contemporary or jazz) at least one year with dance lessons of at least 5 hours per week. Parameters for the correlation analysis were (1) core stability, measured by the motor control tests battery proposed by Luomajoki, (2) hypermobility, measured by the Beighton Score (3) compensated turnout, measured by the difference between functional turnout and external rotation of both hips, (4) dance hours per week, (5) dance experience in years, (6) professional dance experience in years and (7) dance style (ballet, modern, contemporary, jazz). These parameters were correlated with the numbers of lower limb injuries. Significance level was set at 90% because of the explorative character of the study with the purpose to generate hypotheses.
Results:
Sixteen female dancers with different levels of dance experience (mean 11.3 years) and dance lessons per week (mean 17.6 hours) fulfilled the inclusion criteria and participated in this study. Significant correlations with the numbers of lower limb injuries were found at core stability (rs=0.489, p=0.034, medium effect), dance hours per week (rs=0.459, p=0.048, medium effect) and professional dance experience in years (rs=0.396, p=0.093, medium effect). Two dance styles (modern dance: rs=0.388, p=0.101 and contemporary dance: rs=0.385, p=0.104) were close to the significance level.
Conclusions:
These results show correlations between core stability, dance hours per week, professional dance experience in years and lower limb injuries in dancers.
Due to the limitations of a small and heterogeneous sample size as well as the medium effects, these results should be interpreted with caution, but may provide a basis for further research to this topic in the field of dance research and can be helpful in generating research hypotheses.
Background: Muscle fatigue has been reported as a risk factor for the
development of performance-related musculoskeletal disorders (PRMD) in
musicians. However, little research exists to support this claim. The aim of
this study was to investigate whether changes occur in muscle activity
patterns during high string performance over a prolonged playing period, and
whether this is influenced by PRMD.
Methods: High string musicians were divided into a PRMD and a non-PRMD
group. They played a chromatic scale pre and post and a self-chosen “hard”
(Borg scale 16-17) piece of music for one hour. Electromyography data
recorded from arm, shoulder and trunk muscles was analyzed: the amplitude
to measure muscle activity characteristics and the lower frequency to
measure muscle fatigue. Differences between and within groups and the
frequency spectrum were analyzed using linear mixed models.
Results: Fifteen musicians participated (7 PRMD: 22.8 years, 2 male/5 female
and 8 non-PRMD: 34.3 years, 2 male/6 female). Changes in muscle activation
patterns were observed between and within both groups, however changes
varied significantly depending on group affiliation. Significant low frequency
spectrum changes between groups were observed in overall muscles of the
right arm (p=0.04) and left forearm flexors (p=0.05) following one hour of
playing.
Conclusions: Muscle activity and frequency spectrum shifts differ in high
string musicians with and without PRMD, suggesting possible differential
muscle fatigue effects between the groups.
Rationale:
Performing artists are exposed to high strains during their performance. These strains are similar to the ones of professional athletes, but in contrast to athletes there is a comprehensive undersupply of care regarding preventive and rehabilitative therapy offers.
Purpose:
The purpose of RefLabPerform is to develop a reference laboratory for the assessment of neuromusculoskeletal disorders using physiotherapeutic assessment methods in combination with biomechanical motion analysis. This includes the automatized integration of the physiotherapeutic assessments with the technical biomechanical analysis for an individual treatment recommendation with decentralized health care recommendations for a home-based therapy based on evidence-based prevention and rehabilitation strategies.
Methods:
Several work packages are processed systematically, whereby according to the requirements in the course of the project an overlapping of work packages occurs. First, the component planning of the innovative reference laboratory structure is carried out, on which the clinical and technical development of the reference laboratory is based. The next steps are the development of individual clinical assessment protocols, prevention and rehabilitation strategies as well as the setup of the laboratory and the development of technical routines. Parallel to this, various analysis tools are being developed for biomechanical data as well as for physiotherapeutic diagnostics and merged at the end of this work package for individual results for different groups of performing artists. Overlapping with the previous work packages, the reference laboratory will be tested for application and manageability. Clinical and technical data are brought together and checked by means of individual case trials on various groups of artists. In terms of an agile software development process, the results flow back into the previous work packages in order to optimize them and then test them again.
Results:
At the end of the project a functional and proven reference laboratory for the comprehensive analysis of performing artists will be developed.
Conclusions:
This reference laboratory is specialized to the diagnosis and treatment of playing- and performance-related dysfunctions with a focus on clinical findings and biomechanical movement analysis.
Educational Objectives:
At the end of the presentation, the participants will be able to…
1. describe the innovative content of the project RefLabPerform
2. understand the advantages of merged analysis strategies by physiotherapeutic and biomechanical examinations
3. understand the complex interdisciplinary process to develop a reference laboratory for performing artists
Rationale:
Performing artists are exposed to high strains during their performance. These strains are similar to the ones of professional athletes, but in contrast to athletes there is a comprehensive undersupply of care regarding preventive and rehabilitative therapy offers.
Purpose:
The purpose of RefLabPerform is to develop a reference laboratory for the assessment of neuromusculoskeletal disorders using physiotherapeutic assessment methods in combination with biomechanical motion analysis. This includes the automatized integration of the physiotherapeutic assessments with the technical biomechanical analysis for an individual treatment recommendation with decentralized health care recommendations for a home-based therapy based on evidence-based prevention and rehabilitation strategies.
Methods:
Several work packages are processed systematically, whereby according to the requirements in the course of the project an overlapping of work packages occurs. First, the component planning of the innovative reference laboratory structure is carried out, on which the clinical and technical development of the reference laboratory is based. The next steps are the development of individual clinical assessment protocols, prevention and rehabilitation strategies as well as the setup of the laboratory and the development of technical routines. Parallel to this, various analysis tools are being developed for biomechanical data as well as for physiotherapeutic diagnostics and merged at the end of this work package for individual results for different groups of performing artists. Overlapping with the previous work packages, the reference laboratory will be tested for application and manageability. Clinical and technical data are brought together and checked by means of individual case trials on various groups of artists. In terms of an agile software development process, the results flow back into the previous work packages in order to optimize them and then test them again.
Results:
At the end of the project a functional and proven reference laboratory for the comprehensive analysis of performing artists will be developed.
Conclusions:
This reference laboratory is specialized to the diagnosis and treatment of playing- and performance-related dysfunctions with a focus on clinical findings and biomechanical movement analysis.
Educational Objectives:
At the end of the presentation, the participants will be able to…
1. describe the innovative content of the project RefLabPerform
2. understand the advantages of merged analysis strategies by physiotherapeutic and biomechanical examinations
3. understand the complex interdisciplinary process to develop a reference laboratory for performing artists
Biomechanical analyses are capable of capturing and evaluating human motions. In addition to the major biomechanical fields of kinetics and kinematics, electromyography (EMG) provides a reliable way to analyse neuromuscular activities, e.g. inter- and intramuscular coordination or fatigue behavior. Based on these parameters it is possible to conclude to clinically relevant parameters such as motor control, muscular coordination or compensation strategies with different loads. In addition to this, EMG can be used in treatment itself, e.g. biofeedback-training with an EMG is an effective and evidenced based tool to improve neuromuscular control. The purpose of this workshop is to show the advantages of implementing EMG in performing artists´ health and to demonstrate additional therapy and diagnostic options.
This workshop briefly introduces the theoretical principles of EMG and the clinical applications in the context of performing artists´ health. It explains why EMG provides an additional value in the clinical reasoning process and supports the therapist, but decision making in the clinical reasoning process should never be based on EMG solely.
In the further course of the workshop the use of EMG in diagnostics and therapy (biofeedback) with performing artists is practically demonstrated and discussed with the participants.
Approach of Presentation:
1. Short presentation: introduction and understanding of EMG (educational objective 1)
2. Short case presentation of a performing artist to introduce EMG in the field of performing artists´ health and clinical reasoning (educational objective 2)
3. Interactive practical demonstration (diagnosis and biofeedback-training) as the central part of the workshop. Questions and comments will be discussed directly throughout the group (educational objective 3)
Clinical Significance:
EMG based functional neuromuscular diagnostics and biofeedback-training provides both the therapist as well as the performing artist with additional value in their clinical work.
Educational Objectives:
At the end of the workshop, the participants will be able to…
1. understand and describe the basic principles of EMG
2. understand and describe the importance of EMG in the context of performing artists´ health, physical therapy and clinical reasoning
3. use EMG on performing artists in the performance process
Recent real-time networking developments have enabled ultra reliability, very low latency and high data rates in wired networks. Wireless networking developments have also shown that they can achieve very high data rates with consistency, but they still lack in providing ultra reliability and extremely low latency. Time Sensitive Networking (TSN) developments have brought these capabilities in Industry automation and Automotive industry too. Although TSN is standardized for wired networks for a long time, for wireless networks it will be standardized within the IEEE 802.11be standard for Wi-Fi and 3GPP Release 17 for 5G in the near future. This paper provides an overview of TSN in wired and wireless networks with the aim of comparing different simulators and presenting their offered functionality and shortcomings. These tools can be used to make oneself familiar with TSN algorithms, standards, and for the development and testing of time sensitive networks. Afterwards, the paper discusses open research questions for using TSN over wireless networks.
Analysis of methods for prioritizing critical data transmissions in agricultural vehicular networks
(2020)
Applying wireless communication technologies to agricultural vehicular networks often results in high end-to-end delays and loss of packets due to intermittent or broken connectivity. This paper analyses the methods for the successful delivery of the vehicular data within acceptable delay times. Different kinds of data that are generated and transmitted in agricultural networks are considered in this paper, followed by the data prioritization methods which allow critical data to be prioritized against other data. In this regard, Enhanced Distributed Channel Access, Differentiated Services, and application-based data rate variation are discussed in conjunction with the Simple Network Management Protocol. These techniques are simulated or tested separately and then together and the results show that even in poor network conditions, high-prioritized data is not lost or delayed.
This paper presents a framework for OMNeT++ which includes time synchronization model for WLANs. Synchronization is based on the Generalized Precision Time Protocol (gPTP) standard, which aims to achieve an accuracy of less than 100 nanoseconds. The presented model is developed and implemented in OMNeT++, a discrete event network simulator, using its INET library. A new type of WLAN node is modeled which supports time synchronization at the Link layer. A clock module for WLAN nodes is also modeled which implements variable clock drift to simulate noise interference in clock frequency oscillators. Simulations with our WLAN nodes are done and the results show that using gPTP based time synchronization in wireless networks, accuracy of ±3ns can be achieved.
Response of petunia to wood fibre amended peat substrate under ebb-and-flow irrigation (Abstract)
(2024)
A suspension of PMMA spheres in a density matched saccharose solution is investigated with a classical Searle rheometer and a NMR (Nuclear Magnetic Resonance) spectrometer. Here the NMR is used to measure the radial distribution of the PMMA spheres in the rotating cell, in addition to the local velocity profile of the suspension. The influence of particle concentration on the wall depletion is studied. Further analysis are carried out with computational fluid dynamics software. The velocity field as well as the solid distribution in the couette flow is simulated with a two-phase model including the Darcy law and compared to the experimental data.
The energy transition involves various challenges. One key aspect is the decentralization of power generation, which requires new actors. In order to integrate these into the system in the best possible way, there are various approaches e.g. in cooperation in citizens' initiatives or cooperatives (Dorniok, 2016).
Cooperation in general can enable the implementation of certain business models or can increase profitability by the exploitation of economies of scale (Skovsgaard & Jacobsen, 2017; Theurl, 2010). Synergy effects result from the utilization of know-how, different technologies or resources of the partners involved to complement the own competencies and services (Eggers & Engelbrecht, 2005; Sander, 2009). Cooperation exists in various industries and enable the participating companies to compensate their size-related resource deficits (Glaister & Buckley, 1996; Todeva & Knoke, 2005). This creates the opportunity to develop innovations, open up new markets, exploit newly created economies of scale and share costs and risks (Franco & Haase, 2015). In agriculture, cooperation in the form of cooperatives have been of essential importance for a long time, especially with the aim of exploiting synergy effects (Bareille et al., 2017). In the field of renewable energy development, cooperation in form of citizen cooperatives make a significant contribution to the participation of citizens in political, social and financial aspects of the energy transition (Huybrechts & Mertens, 2014). Energy cooperatives are frequently discussed as a potential actor in the energy transition and are increasingly being established to advance the common interests of stakeholders. For example, the joint operation of decentralized power generation plants can involve new actors in the energy transition through regional cooperation (Walk, 2014).
Existing biogas plants in Germany need new business models after the 20-year Renewable Energy Sources Act feed-in tariff expires. For continued operation, a business model innovation is needed, which can be realized based on the different technical utilization pathways. Cooperation can have a significant impact on the profitability of the different business models, especially by exploiting synergy effects (Karlsson et al., 2019). In addition, cooperation can help to ensure that existing plants continue to operate at all.
Currently, the most widespread use of biogas in Germany is in the coupled generation of electricity and heat. Additionally, there is the possibility of upgrading biogas to biomethane or biogenic hydrogen path (Mertins & Wawer, 2022).
Different options for cooperative business models that exist in the biogas utilization pathways are presented. The focus is on explaining the advantages of a joint approach compared to single-farm business models and identifying the relevant actors. Subsequently, drivers and barriers for the different cooperative business models are identified and classified based on 20 semi-structured interviews with plant operators in the administrative district of Osnabrück. The aim is to identify drivers and barriers for cooperative post-EEG operation. As a result, political instruments are to be found that make it possible to involve relevant actors and thus stimulate the best possible continued operation from the point of view of the energy system. The results are structured according to the PESTEL analysis. This assigns drivers and barriers to the categories political, economic, sociocultural, technological, ecological and legal (Kaufmann, 2021). The analysis of the interviews is supplemented and validated by a literature review.
Drivers and barriers for cooperative business models are manifold and can vary mainly depending on the plant and the operator.
Drivers
• Political
o Promotion of renewable energies: reduce dependence on fossil (Russian) fuels
• Economic
o Expectation of synergies (information sharing, shared risk, economies of scale)
o Planning security (fixed supply or purchase contracts)
o Access to new markets (not accessible by single-farm business models)
o Cost savings by sharing infrastructure, technology
o Positive return expectation
• Sociocultural
o Motivating, innovative environment
o Lowers barriers to participation in new markets
o Target-oriented partnerships
o Better use of capacities and strengths
o Strengthening regional value creation
• Technological
o Economies of scale (efficiency)
o Available, mature technology
o Storable, transportable gas
o Well-developed infrastructure
• Ecological
o Increase in plant efficiency
o Reduction of greenhouse gas emissions
o Promotion of the circular economy by utilization of organic waste and agricultural residues
o Improving soil quality (fermentation residues as fertilizer)
Barriers
• Political
o Competition to other renewable energies
• Economic
o Uncertainty about future development of energy markets
o Disagreements between the cooperation partners
o Lack of flexibility due to longer-term contractual obligations
o Allocation of profits
• Sociocultural
o Cooperation with current competitor
o Cultural differences and lack of trust
o Acceptance by the general public (e.g. overproduction of maize)
• Technological
o Different technology that is difficult to combine
o Data protection
• Ecological
o Competition for agricultural land
o Use of monocultures
o Emissions from plant
o Pollution from transport
• Legal
o Legal requirements and regulations
o Unfavorable regulatory environment, e.g. long permitting process
One finding is that uncertainty is a major barrier for plant operators. This includes uncertainty about regulatory frameworks and political requirements, as well as about the general development of the energy markets. In addition, social factors such as lack of reliability and disagreement about revenue sharing are a potential barrier. A key driver for the implementation of cooperative business models is the expectation of synergy effects. In addition, operators are driven by a positive expectation of returns and the responsibility for securing the energy supply in times of crisis.
The drivers identified can now be used to develop strategies to advance cooperative business models. In particular, synergy effects should be exploited so that operators can benefit from cooperation. The advantages can also be highlighted and communicated to increase acceptance among the general public. Another important step is to reduce the barriers discussed above. In order to reduce social barriers in particular, it may be advisable to include an external partner in the cooperation, such as a municipal utility that operates an upgrading plant and concludes purchase agreements with the individual partners. In addition, it would be politically expedient to provide the operators with a clear framework for the future in order to reduce uncertainties. As a further aspect, knowledge transfer on new technologies and markets should take place.
The expiry of national subsidies for biogas in Germany means that new business models are needed. Furthermore, hydrogen is expected to make a significant contribution to the energy transition in the future. Therefore, potentials for the production of hydrogen from biogas are identified in this study. A joint upgrading infrastructure is developed that models the collaborative upgrading of biogas to hydrogen for existing biogas plants with subsequent gas grid injection. Furthermore, regions are identified that are particularly suitable as pioneer regions in Germany due to a high potential for green hydrogen production and comparatively low costs for hydrogen production. The modeling shows that collaborative upgrading achieves significant cost savings compared to single-farm upgrading. Furthermore, the potential for hydrogen production from biogas and the costs of upgrading differ significantly within the administrative districts in Germany.
As of the reporting year 2017, extended non-financial reporting requirements will apply to certain large companies within the EU on the basis of the EU-Directive 2014/95/EU. The aim is to provide an overview of selected regulations for the new non-financial statements. This includes the analysis of the German Sustainability Code as well as the German Accounting Standard No. 20. The analysis shows a tightening of disclosure on non-financial reporting and an increased focus of disclosures on non-financial concepts, objectives and measures. Hence, the risk management of a preparer gains in importance with regard to non-financial aspects of the business activity.
The market for external ratings is dominated worldwide as well as in the European Union (EU) by three major credit rating agencies (CRAs). These “Big Three” are Standard & Poor's (S&P), Moody's and Fitch Ratings. Due to the oligopolistic market structure and possible involvement in the 2008 financial crisis, the rating agencies have constantly come under criticism. This was associated with stricter regulatory requirements to ease the situation. The EU-Regulation on credit rating agencies („CRA-Regulation“) coming into force 2009 and its amendments in 2011 and in 2013 have mainly governed such regulation. The aim of the article is to analyse potential regulatory impact on the still inherent oligopolistic situation on the EU rating market in the context of the CRA-Regulation. Selected key figures are used to observe over a defined period of time if and how the dominance has changed. The motivation for this article is the observation, that political and private efforts to establish a European rating agency as a counterweight to the three major agencies and other approaches to increase competition in the rating market, followed, which has not been resounding to date. In summary, it is shown that new agencies have a potential impact on the EU rating market and that the three major rating agencies still dominate the market but within a changed environment.
The way in which brands are economically represented in the context of financial reporting is controversial in theory and practice. This holds especially against the background of the ever- increasing importance of intangible assets. Brands and the economic success associated with them are thus regarded as a key variable for overall corporate success: cash flows can be accelerated and expanded through the use of brand-strategic options, while existing risks may be mitigated. In addition to a large number of theoretical definitions, the determination of brand value from both a marketing and an accounting perspective is also characterized by a complex interaction of numerous influencing factors. This is where the International Accounting Standards IAS 38: "Intangible Assets" (isolated acquisition of a brand) and IFRS 3: "Business Combinations" (acquisition of a brand as part of a business combination) take effect: These are intended to ensure a comparable and reliable "true and fair view" for the presentation of intangible assets in international accounting. In addition to various recognition criteria, the accounting regulation here also includes the accounting valuation of intangible assets and thus also of brands. In principle, valuation in accordance with IAS 38 is based on acquisition costs. The determination of the operating life for impact evaluation is highly controversial both in literature and in practice. Under IFRS 3, acquisition costs are to be replaced by the fair value. Regardless of the method used, possible subjectivity is one of the central issues. The current discussion approach of the International Accounting Standards Board also clearly shows the need for simplification and concretization that still exists for practice: In particular, the accounting distinction between goodwill and intangible assets is the subject of discussions with the Global Preparers Forum, among others. The interests of users, preparers and auditors of corporate financial reporting must be taken into account equally. In particular, the prohibition on recognizing self-created brands in the balance sheet makes it difficult to assess their value. Furthermore, it creates a weak point in the presentation of the true and fair view of a company's financial position and financial performance that is generally required. Regardless of the previous, the current rules provide preparers and users with a basic overview of existing intangible assets. Irrespective of how valuation is determined individually, the IASB's rules thus help to create a fundamental structure. In which approach the future discussion will result in remains open.
The accounting of small and medium enterprises is specific, compared to the accounting of large enterprises, for several reasons. First of all, lower business volume implies less demanding accounting in terms of less turnover and the number of accounts to be processed, lower financial reporting requirements, more favourable tax treatment is expected and the like. Practical experience in the years of application of EU-accounting directives, which represent the framework of financial reporting of companies at the EU level, pointed to certain difficulties or excessive administrative burden of small and medium enterprises in relation to the requirements for large companies and identified areas for improvement. The complexity of these regulations as well as problems in practical application have led to the need to develop and publish a revised single accounting directive (2013/34/EU). This Directive was primarily adopted with the aim of simplifying the accounting and financial reporting of small and medium-sized enterprises.
Today, it is common for small and medium-sized enterprises to go beyond the borders of one country. In the internationalization of business, SMEs face many challenges and potential barriers. First of all, it refers to financial, human and procedural barriers, but also to informational barriers related to regulations, rules and laws of other countries. Since the accounting and tax treatment of the same business transaction may differ between countries, it seems entirely justified to investigate whether there are differences in the regulation and regulation of the accounting system between the two countries. This paper compares the characteristics of small and medium-sized enterprises’ accounting systems between two economically strongly connected countries, Germany and Croatia, which is the main goal of this paper. It is well known that financial reporting is a particularly important, final phase of accounting data processing. Namely, financial reporting system of these two countries is compared by using the method of comparison and classification analysis. The types and scope of financial statements have been defined and the content of financial statements that SMEs are obliged to compile and publish has been analysed. The paper pays additional attention to the analysis of similarities and differences between these two accounting regulations as well as current events in the implementation of the revised accounting directive into national legislation, especially in simplifying the financial reporting of the smallest, but numerically most represented micro enterprises. The important finding of the research show that some changes have been made but there is still room to improve accounting regulations for this segment of entrepreneurship.
Since February 2019, the „Katholische Erwachsenenbildung“ has been collaborating with the Institute of Music of the University of Applied Sciences Osnabrück. An institute for adult education provides the framework for a concept in which German as a second language lessons are accompanied by musicalisation. In line with elemental musical practice, whole-body experiences with voice, movement, and body-percussion play an important role. Students with the career goal of „Educating Artist“ work alongside language teachers in this project, and are mentored by university teachers. The young musicians gain monitored teaching experience and have a great opportunity to witness and help shape the linguistic and social integration of refugees.
A consequence of increasing migration is that a large number of people need to learn the language of the country of immigration. Music and language are phenomenons that share many common characteristics, such as melody, rhythm, and timbre. Music draws attention and can cause positive emotions. Music and movement are deeply rooted in the communication of emotional states und are considered to be the evolutionary biological basis for language. Thus the close relationship between language, music, and dance is evident: They all rely on differentiating perception, are able, as systems designed for social interactions, to connect people, and allow for both collective and individual expression.
The contents and procedures of the lessons are documented in a digital diary. The entire team meets at regular intervals, in order to reflect on the experiences and conduct further planning. For these purposes, video documentation of the lessons is also used. The project will end in November 2019 with a language exam; a musical final presentation is also planned. By then at the latest, findings will be available as to if and how the musical course content was able to support language acquisition. The collaboration enables the partners to realize the combining of different objectives (learning a second language, cultural participation and music making) by bringing experts together.