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When simulating and optimizing urban energy systems, the focus is usually on minimizing financial costs or greenhouse gas (GHG) emissions. As energy systems transition towards a growing share of renewable energy sources and technological complexity, environmental impacts that affect more than just GHG emissions, such as resource extractions, water and land use impacts or impacts on human health, are becoming increasingly relevant.
To address this gap, this thesis introduces an automated coupling procedure for energy system modeling (ESM) and life cycle assessment (LCA). The implementation includes general recommendations and a practical coupling of the Open Energy Modelling Framework (oemof) based Spreadsheet Energy System Model Generator (SESMG) with a suitable LCA software.
The LCA procedure involves goal and scope definition, inventory analysis, impact assessment, and interpretation. To adapt these steps to different energy system models, the LCA should be attributional, process-based and territorial. Further, the openLCA software by Green-Delta serves as a suitable soft-linking tool. The main challenge of the coupling procedure is the inventory analysis. Data collection faces limitations, reasoned by the commercialization and high maintenance efforts in open-source databases. After evaluating free databases, the Prozessorientierte Basisdaten für Umweltmanagement-Instrumente (ProBas) database of the Umweltbundesamt emerged as the most suitable choice for the coupling. However, also this database lacks traceability of datasets or compatibility with a comprehensive impact assessment.
A generalized framework for the LCA application of energy systems was developed. The framework is based on an ex-post LCA assessment that considers the combination of the two approaches within every step of the procedure. Main considerations of this framework include automatic calculations of the inventory analysis and the impact assessment for different energy technologies, as well as calculations summed up for all technologies of energy system scenarios. Further, technology mapping and data harmonization are essential considerations for the automatic coupling and double counting of impacts needs to be avoided.
Subsequently, the framework is realized with the adaption of the SESMG. Its database-independent realization allows compatibility with different databases in openLCA. For the selected ProBas database, the tool can be used with different available energy technologies. The use of unit processes is encouraged for data harmonization. Result interpretation of the LCA (in general or with the SESMG) should not solely focus on the absolute values of the impact categories, but rather on the comparative strengths among scenarios and technologies.
The successful application to a reference single-family building using the ProBas database revealed varied environmental impacts, in relation with a higher reduction in GHG emissions, with an increase of 11 % in terrestrial acidification impacts in the emission-optimized scenario. These findings emphasize a more comprehensive perspective on environmental impacts and provide a valuable validation of the developed methodology.
Future research should include the improvement of data harmonization, the inclusion of more datasets for a more customized analysis of energy systems and more applications. The coupled approach offers a promising avenue for gaining deeper insights into optimizing urban energy systems.
This study investigates the role of individual differences in channel choice and switching behavior in a multichannel environment using latent class analysis on data from 1512 customers. Psychographic variables from five domains (risk attitudes, cognitive ability, motivation, personality, and decision-making style) serve as covariates for multichannel customer behavior. We identify six segments that differ significantly on six psychographic variables (readiness to take risks, need for cognition, autotelic and instrumental need for touch, and rational and intuitive decision-making styles). The results advance the theory-building of multichannel customer behavior and present insights for proactively managing customer journeys of distinct segments.
Toward a notation for modeling value driver trees: Classification development and research agenda
(2024)
In-depth analysis of customer journeys to broaden the understanding of customer behaviors and expectations in order to improve the customer experience is considered highly relevant in modern business practices. Recent studies predominantly focus on retrospective analysis of customer data, whereas more forward-directed concepts, namely predictions, are rarely addressed. Additionally, the integration of robotic process automation (RPA) to potentially increase the efficiency of customer journey analysis is not discussed in the current field of research. To fill this research gap, this paper introduces “customer journey mining”. Process mining techniques are applied to leverage digital customer data for accurate prediction of customer movements through individual journeys, creating valuable insights for improving the customer experience. Striving for improved efficiency, the potential interplay of RPA and customer journey mining is examined accordingly. The research methodology followed is based on a design science research process. An initially defined customer journey mining artifact is operationalized through an illustrative case study. This operationalization is achieved by analyzing a log file of an online travel agency functioning as an orientation for researchers and practitioners while also evaluating the initially defined framework. The data is used to train seven distinct prediction models to forecast the touchpoint a customer is most likely to visit next. Gradient-boosted trees yield the highest prediction accuracy with 43.1%. The findings further indicate technical suitability for RPA implementation, while financial viability is unlikely.
Against the setting of an increasing need for innovation and low margins, companies in the logistics
sector are facing highly competitive pressure. One field with high potential for optimization lies within
damage quotas. The use of big data analytics or data mining represents a promising approach to face
this challenge. However, within supply chain management, data mining is hardly being researched on
regarding damage quotas and thus not being utilized to its full possible extend. At the current time it
seems to predominantly be used for route and utilization optimization while the analysis of delivery
damages is hardly considered.
The aim of this research is therefore to showcase an initial approach for data mining in logistics to predict
delivery damage probabilities and to validate this by means of a multiple case study research. To create
a sound basis for evaluation, the groundwork is laid out based on CRISP-DM by the analysis of reference
data (German road-cargo market).
As a central result it is noted that data mining can systematically be used to help reducing the damages
by forecasting the probabilities of damages occurring during transport in dependence of different factors.
The approach can be utilized across different markets as long as sufficient data tracking delivery
damages is being collected within a company. Challenges arise in the field of air- and sea-freight.
The urge for personalisation and the rise of technological advancements
in the 21st century is pushing for more innovative marketing strategies. As such, this dissertation examines the impact of personality-tailored
campaigns (PTC) and how it affects purchasing decisions among
Generation Z, focusing on theoretical and practical implications.
A conceptual framework for the process of personality-tailored marketing has been developed to provide tangible value for businesses of
various industries in particular the fragrance, smartphone, and food
industry.
This working paper addresses the effectiveness of compliance management systems (CMS). The objective is to answer the question whether CMS are effective, and to consider the limits of compliance. For this purpose, the highly legalistic topic is considered in the context of business ethics and behavioural economic foundations. The review of effectiveness is based on the seven basic components set out in the Assurance Standard of the Institut der Wirtschaftsprüfer in Deutschland e. V. [Institute of Public Auditors in Germany, Incorporated Association] (IDW AssS 980).
To answer this question, reference is made to the three levels of business ethics and to selected behavioural economics concepts. For example, performance pressure, peer pressure and variable compensation schemes encourage opportunistic behaviour. It is argued that corporate compliance depends significantly on the behaviour of single individuals and their environment. Especially in the context of economic activity and competition, compliance cannot be equated to morality and ethics, or be expected as a matter of course. On the whole, the interdisciplinary consideration of corporate compliance demonstrates a natural limit whenever ethical and moral standards are contrary to economic interests.
A novel approach for ventilation systems is a periodically varying supply air flow rate, the so-called unsteady mode of operation. So far, useful effects of this unsteady operating mode have been observed, but the effect mechanisms are still unknown. In this manuscript, simulations using the recently proposed k-ω-ζ - f model implemented in a sensitized RANS computational framework for a cuboid room with swirl diffusers are compared and validated with PIV measurements.
This article explores educational media pedagogies that are predominantly non-digital, but nonetheless timely and influential. Design Thinking, Making, and Serious Play are three distinct yet interrelated approaches to problem-solving, resilience and innovation that have gained increased traction in education over the past decade. We explore the similarities and differences between these playful, experiental pedagogies and provide an overview of how these approaches can be integrated effectively into education settings. Finally, we provide transferable examples, including evaluation results, from a weeklong workshop series at Muenster University of Applied Sciences conducted in Spring 2022. The article serves as a theoretically informed practical guide for educators and practitioners seeking to select, implement and evaluate playful pedagogies. It contributes to the understanding of underlying principles, characteristics, potential impact and limitations.
Stormwater tree pits with storage elements enable the irrigation of urban trees and can potentially act as decentralized rainwater retention basins. This paper mainly focuses on analyzing this potential. Field tests were conducted to investigate the irrigation behavior and the storage effect of a storm water tree pit system using Perl hoses as irrigation elements over a period of two years.
The rainfall, storage volumes, and soil moisture within the employed planting pit were measured.
With the help of system modeling, the retention ability of the storm water tree pit system was analyzed. The available storage volume was sufficient to irrigate trees for several days. During the measurement period, about 15% of the inflowing rainwater was fed to the root zone of the tree. With practical storage volumes of 200 to 300 m3/ha, a remarkable amount of water from heavy rainfall could be completely stored, thus significantly reducing the risk of flooding. The retention effect and irrigation behavior largely depend on the soil conditions and the technical possibilities of the equipment supplying the root area (in this case, Perl hoses). Further investigations are required to determine the influence on the growth conditions of trees and optimize of the system for discharge into the root zone.
The extended quasiparticle picture is adapted to non-Fermi systems by suggesting a Pad´e approximation which interpolates between the known small scattering-rate expansion and the deviation from the Fermi energy. The first two energy-weighted sum rules are shown to be fulfilled independent of the interpolating function for any selfenergy. For various models of one-dimensional Fermions scattering with impurities the quality of the Pad´e approximation for the spectral function is demonstrated and the reduced density matrix or momentum distribution is reproduced not possessing a jump at the Fermi energy. Though the two-fold expansion is necessary to realize the spectral function and reduced density, the extended quasiparticle approximation itself is sufficient for the description of transport properties due to cancellation of divergent terms under integration.
The T-matrix approximation leads to the delay time as the time two particles spend in a correlated state. This contributes to the reduced density matrix and to an additional part in the conductivity which is presented at zero and finite temperatures. Besides a localization at certain impurity concentrations, the conductivity shows a maximum at small temperatures interpreted as onset of superconducting behaviour triggered by impurities. The Tan contact reveals the same universal behaviour as known from electron-electron scattering.
The Educational Journal of Renewable Energy Short Reviews (EduJRESR, formally published as ‘EGU Journal of Renewable Energy Short Reviews’) is a teaching project rather than a regular scientific journal.
To publish in this journal, it is a premise to take part in the master course wind power, hydro power and biomass usage at the department of Energy, Building Services and Environmental Engineering of the Münster University of Applied Sciences.
Students receive an equivalent of 2.5 credit points (European Credit Transfer and Accumulation System – ECTS) for their engagement in the course and for publishing a short review article of at most 3 000 words in this periodical. The publication process closely mimics the typical publication procedure of a regular journal.
The peer-review process, however, is conducted within the group of course-participants.
Although being just an exercise, we think that publishing the outcome of this course in a citable manner is not only promoting the motivation of our students, but may also be a helpful source of introductory information for researchers and practitioners in the field of renewable energies. We encourage students to write their articles in English, but this is not mandatory. The reader will thus find a few articles in German language.
To further encourage students practicing English writing, perfect grammar is not part of the assessment.
We especially thank our students for working with LATEX on Overleaf, although LATEX is new to some of them. In this way, the editorial workload was reduced to a minimum. We also thank our students for sharing their work under the creative commons attribution licence (CC-BY). We appreciate their contribution to scientific information, being available to every person of the world, almost without barriers. We also thank the corresponding authors and publishers of the cited work, for granting permission.
Wind energy plays a major role among renewable
energies. Its expansion is therefore important in order
to achieve the climate targets. Repowering is an
important element in the expansion of wind energy.
On the one hand, it offers a solution for many wind
turbines in Germany that are no longer subsidised due
to their age. On the other hand, modern turbines are
significantly more powerful and enable more efficient
land utilisation. This article provides an overview of
the most important aspects of onshore repowering.
There is a lot to consider when repowering wind turbines.
The legal situation for repowering aims to
be improved through simplified authorisation procedures.
Even though efforts are being made by the
government, there is still room for improvement. The
repowering potential is also dependent on the various
distance regulations to residential buildings in
the federal states. These regulations might also be
improved in the future. Another aspect is the remuneration,
which is now closer to market developments
due to the market premium model. It is also subject
to greater competition as a result of the tendering
process. At the same time, interest rates and turbine
prices have risen, which creates economic challenges
for the operators of future wind farms. Last but not
least, repowering also depends on public acceptance.
This is also to be regulated by law in the future.
As Germany aims to increase its utilization of wind
power, the potential threat to bird populations due
to this expansion is a controversial issue. This paper
aims to collect data on the magnitude of bird strikes
on wind turbines, review existing protective measures
and explore innovative solutions. After a thorough
examination of the literature, it was concluded that
although the impact on bird populations is significant,
it may be overemphasized in popular debates. This
statement is not final as further research is necessary
to assess the impact of bird strikes and explore new
solutions. Comprehensive studies on this specific topic
in Germany are limited, which makes a thorough evaluation
challenging. While there are measures in place
to protect species that may be negatively impacted, it
is possible that these measures will not be adequate
for all of them. While several innovative methods
are under examination, progress in testing and implementation
is slow. Lastly, an information problem
was identified. Since the topic is highly politicized
and polarizing, it is crucial to provide the public with
accessible and reliable information on the discussed
themes. This is currently not the case due to a lack
of data and missing information campaigns.
The upscaling of wind turbines has been increasing in
recent years and will continue to play a significant role
in the future, as it allows for the reduction of electricity
generation costs. Various challenges arise when it
comes to upscaling. This article summarizes the technical
challenges associated with upscaling wind turbines
and presenting their problem-solving approaches
and research trends based on other reviews. It was
found that the most frequently cited challenges are
related to individual components, such as rotor blades,
drive train, generator, tower, and noise impact.
For rotor blades, the challenges are increased flexibility,
more aeroelastic vibrations, increased wear,
interferences with radar and transportation difficulties.
Proposed solutions include the use of carbon-fiber
blades, prebending, novel paints, and for transportation,
segmented rotor blades and on-site manufacturing.
In the gearbox, torque increases, leading to
higher weight and susceptibility to errors. As a result,
the trend is moving towards gearless systems with
permanent magnet synchronous generators. Transportation
is the major issue with towers, which can
be resolved with on-site manufacturing. In terms of
noise emission, reducing aerodynamic noise plays the
most significant role.
This paper outlines the three main areas relevant
to dismantling: the rotor blades, hub and nacelle,
the tower and the foundation. The paper discusses
the dismantling procedures, including the removal of
the top structure, the tower and the foundation, and
evaluates various methods of dismantling the tower,
such as modular dismantling, collapse blasting, folding
blasting, wrecking ball demolition and hydraulic
ram demolition. The assessment of these methods
in practice and the potential challenges and considerations
for future dismantling, particularly as wind
turbine heights increase, are also addressed.
This review paper provides an initial overview of the
state of the art of common corrosion protection methods
for offshore wind turbines. The functions of the
individual corrosion protection methods and their
interaction are explained. In addition, the specific corrosion
protection of different zones and components
of an offshore wind turbine will be discussed. Finally,
some information is given on current and possible
future developments in this subject area.
The pursuit of Offshore Wind Energy (OWE), integral
to the German government’s ambitious renewable
energy goals raises concerns about the environmental
impact of noise emissions on marine life. This paper
delves into the theoretical background of Offshore
Wind Turbine (OWT) noise, exploring its various
phases from the survey to decommission. It examines
the types and causes of noise emissions, their effects
on marine wildlife and potential mitigation measures.
Highlighting the regulatory framework in Germany,
the paper emphasises the need for nuanced approaches
to balance renewable energy objectives with marine
ecosystem preservation.
The construction and operation of hydropower plants
for energy generation is a major issue in sustainable
energy production. Nevertheless, hydropower plants
have a negative impact on fish populations. It is crucial
to understand the causes and consequences of fish
mortality in hydropower plants in order to find sustainable
solutions that reconcile the need for energy
with the conservation of aquatic ecosystems. This
article examines the fish protection measures that can
be implemented to reduce fish mortality and maintain
ecological balance. Based on the main literature reviewed,
this article mainly refers to Germany in terms
of studies carried out and hydropower plants.
This document presents a comparative analysis of
horizontal and vertical small wind turbines for urban
areas in three power classes up to 10 kW in different
categories. The main objective was to conduct a market
analysis to assess the marketability of these wind
energy systems. The aim was to make it easier for
potential customers to make a decision. However, due
to the limited availability of data, the project encountered
considerable difficulties. As a result, the study
became a comparative assessment, which led to results
that may not be readily transferable to urban environments,
slightly missing the original objective of the
study. The results underline the difficulties associated
with conducting a comprehensive market analysis in
this sector and highlight the need for an independent
series of tests under specific conditions. The paper
concludes with a plea for future research efforts to
adapt data collection methods to urban conditions in
order to improve the relevance and applicability of
such studies in practice.
The annual wastewater flow that is treated by public
wastewater treatment plants in Germany amounts
to approx. 10 ∗ 10^9 m3/a and forms an ”artificial” hydropower
potential that can be used for energy generation
or recovery. In the context of this paper, energy
recovery in the outlet of wastewater treatment plants
is examined using the specific example of the water
wheel at the Warendorf central wastewater treatment
plant. The ”artificial” hydropower potential can be
roughly estimated at up to 20 to 105 GWh/a , whereby
this is largely dependent on the hydraulic gradient.
The strong variance results, among other things, from
the findings of the water wheel operation in Warendorf.
The decisive aspect here is the differential factor,
which describes the deviation between the theoretical
and actual energy yield of the water wheel. The
factor includes maintenance work, downtimes and insufficient
inflows, which are associated with a loss of
output. In the case study, the annual energy recovery
amounts to approx. 2 % of the annual electricity consumption
of the wastewater treatment plant and can
be estimated to 23,500 kWh (2022). In the context
of the economic analysis, it can be seen that despite
the ”low” yield, economic operation is possible if the
system is viewed as a long-term investment - payback
period of the example is approx. 14,5 years. The
27-year operation (1996 - 2023) of the water wheel
at the Warendorf central wastewater treatment plant
confirms this and important findings on successful
practical operation can be shown in the context of
this paper.
The preservation of water bodies continuity is fundamental
for aquatic communities, particularly for fish
populations. Various structures impede watercourse
continuity, impacting fish migration and habitat distribution.
Conventional fish passages often fall short
in diverse scenarios, prompting the development of
specialized solutions. This article proposes a criteria
catalog for these special fish passage solutions based
on DWA leaflet DWA-A 509. It discusses the need
for these solutions, presents a selection of specialized
options, and outlines criteria from DWA-M 509, construction
guidelines, and economic perspectives. It
scrutinizes criteria ranging from target fish species to
cost considerations. Three examples, including the
Runserau fish lift, the bristle ramp fish lock, and the
Fishcon sluice, illustrate these specialized solutions,
their functionalities, advantages, and drawbacks. Additionally,
the article compiles criteria from industry
standards and guidelines into a comprehensive evaluation
catalog. The criteria, when applied, assist in the
selection of suitable fish passage solutions based on
specific site conditions and fish species requirements.
This holistic approach aims to optimize fishway selection,
fostering the ecological sustainability of watercourses.
However, this catalog remains dynamic
and open to expansion with evolving research and
practical application, urging further exploration and
validation of these criteria through diverse case studies
and technological advancements in the field.
Wind turbine structures take a major role in the
modern conversion to renewable energy sources and
contribute to the creation of a greener world. In recent
years, the development and installation of wind
turbines have seen rapid growth. However, with the
increasing capacity and size of wind farms worldwide,
there are growing concerns about the safety and reliability
of these installations. Therefore, structural
health monitoring and the detection of damage to
wind turbines have gained considerable importance in
research. Wind turbine blades are particularly susceptible
to various types of damage due to environmental
influences. This article provides an overview of signal
responses, sensors used and non-destructive testing
techniques in the field of damage detection on wind
turbine blades. The intention of the article is to give
an insight into the possibilities of structural health
monitoring and at the same time to point out unsolved
problems in this field.
This article discusses the use of artificial intelligence
in the wind energy industry, particularly in addressing
challenges and optimizing the expansion of renewable
energies in Germany. It highlights the application
of artificial intelligence in wind forecasts and yield
predictions, bird detection, wind turbine and farm
design, condition monitoring, and predictive maintenance.
Additionally, it introduces the “WindGISKI”
research project, which aims to use artificial intelligence
to identify new areas for wind turbines. The
project utilizes a neural network to analyze and predict
flight routes, potentially reducing bird mortality.
The document also emphasizes the potential broader
applications of “WindGISKI” in other fields of activity,
such as land use planning and city development.
Overall, it underscores the significant role of artificial
intelligence in addressing challenges in wind energy
and outlines the potential for artificial intelligence
to drive the expansion of renewable energies while
addressing key obstacles.
Meanwhile, renewable energy sources such as hydropower, solar and wind energy and biomass are increasingly being used to reduce dependence on fossil fuels and thus counteract the ongoing global warming. However, these are also associated with environmental impacts. To that effect, this article takes a closer look at tidal power plants, which are classified as hydroelectric power plants, by conducting a systematic literature review. The results show that the strength and form of the environmental impact depends on the specific location and type of plant. Tidal power plants have an impact on the habitats of marine animals and thus influence their behavior and population. In addition, the operation of tidal power plants changes the sediment distribution, causes a reduction in current velocities and a change in current direction in the surrounding area and leads to a change in wave height. The construction of the power plants is associated with noise, which primarily causes changes in the behavior of some species. Furthermore, the electromagnetic fields generated can also affect marine life. In order to assess the environmental impact of tidal power plants in comparison to other renewable energies, further studies should focus on the environmental impact of the different technologies in relation to the energy yield.
This study identifies supply options for sustainable urban energy systems, which are robust to external system changes. A multi-criteria optimization model is used to minimize greenhouse gas (GHG) emissions and financial costs of a reference system. Sensitivity analyses examine the impact of changing boundary conditions related to GHG emissions, energy prices, energy demands, and population density. Options that align with both financial and emission reduction and are robust to system changes are called “no-regret” options. Options sensitive to system changes are labeled as “potential-risk” options.
There is a conflict between minimizing GHG emissions and financial costs. In the reference case, the emission-optimized scenario enables a reduction of GHG emissions (-93%), but involves higher costs (+160%) compared to the financially-optimized scenario.
No-regret options include photovoltaic systems, decentralized heat pumps, thermal storages, electricity exchange between sub-systems and with higher-level systems, and reducing energy demands through building insulation, behavioral changes, or the decrease of living space per inhabitant. Potential-risk options include solar thermal systems, natural gas technologies, high-capacity battery storages, and hydrogen for building energy supply.
When energy prices rise, financially-optimized systems approach the least-emission system design. The maximum profitability of natural gas technologies was already reached before the 2022 European energy crisis.
Wastewater Generation Model to Predict Impacts of Urine Separation on Wastewater Treatment Plants
(2023)
Wastewater treatment plants are under increasing pressure to enhance resource efficiency and reduce emissions into water bodies. Separation of urine within the catchment area may be an alternative to mitigate the need for costly expansions of central wastewater treatment plant. While previous investigations assumed a spatially uniform implementation of urine separation across the catchment area, the present study introduces a modelling framework which allows to determine the influence of targeted urine separation on the operation and emissions of central wastewater treatment plants. The framework includes an adapted stochastic wastewater generation model, the Stormwater Management Model, and Activated Sludge Model No. 3 with Bio-P module (SIMBA#). The entire application is embedded in the R programming language. The model is validated by an extensive sampling and measurement campaign. Preliminary results based on observed and simulated wastewater generation and transport for a catchment area of 436 residents indicate the suitability of the model for wastewater generation and transport modelling, but also show further need for calibration.
Purpose
The purpose of this paper is to investigate the relationships between technology orientations and export performance of small and medium-sized enterprises (SMEs).
Design/methodology/approach
A quantitative research design was adopted for this study. The paper formulates hypotheses from the literature review. These hypotheses are tested using structural equation modeling with data collected from 231 SMEs in Uganda. Data were analyzed using SPSS version 23 and AMOS.
Findings
The findings of this study showed technology orientation has a positive and significant relationship with the performance of Ugandan SMEs and that supply chain agility moderates technology orientation and export performance.
Research limitations/implications
The study discusses the findings, advances limitations and managerial implications. It also suggests future research avenues. It proposes some recommendations to help Ugandan SMEs to form flexible supply chains, use the latest technology and create strong relationship ties with their partners in the supply chain.
Practical implications
The study suggests that managers of Ugandan SMEs should use the latest technology in production, marketing, logistics and supply chain management which will enable them to respond quickly to customer tastes and preferences leading to higher levels of export performance.
Originality/value
This study contributes to the literature on strategic management showing the reliability of scales used and the confirmatory of the factor structure. This study shows that in strategic management technology, orientation is critical in increasing export performance. This study has extended the resource-based view (RBV) and dynamic capabilities theories.
From Surviving to Living (on): A Grounded Theory Study on Coping in People with Pancreatic Cancer
(2023)
Non-communicable diseases (NCD) are associated with high costs for healthcare systems. We evaluated changes in total costs, comprising direct and indirect costs, due to a 24-month non-randomized, controlled lifestyle intervention trial with six measurement time points aiming to improve the risk profile for NCDs. Overall, 187 individuals from the general population aged ≥18 years were assigned to either the intervention group (IG; n = 112), receiving a 10-week intensive lifestyle intervention focusing on a healthy, plant-based diet; physical activity; stress management; and community support, followed by a 22-month follow-up phase including monthly seminars, or a control group (CG; n = 75) without intervention. The complete data sets of 118 participants (IG: n = 79; CG: n = 39) were analyzed. At baseline, total costs per person amounted to 67.80 ± 69.17 EUR in the IG and 48.73 ± 54.41 EUR in the CG per week. The reduction in total costs was significantly greater in the IG compared to the CG after 10 weeks (p = 0.012) and 6 months (p = 0.004), whereas direct costs differed significantly after 10 weeks (p = 0.017), 6 months (p = 0.041) and 12 months (p = 0.012) between the groups. The HLCP-2 was able to reduce health-related economic costs, primarily due to the reduction in direct costs.
Objective:
We examined whether autonomic flexibility to experimentally presented stressors is reduced in somatic symptom disorder (SSD) as this would point to reduced vagal control as a proposed indicator of emotion regulation deficits.
Method:
In this experimental study, the influence of health-related and social stressors on subjective and physiological reactivity was investigated in 29 subjects with SSD without any medical condition SSD(mc−), 33 subjects with SSD with medical condition SSD(mc+) and 32 healthy controls at the age from 18 to 70 years. Self-report and physiological variables were measured before and after/during stressor exposure, using state ratings of symptom intensity, disability, tension and mood, heart rate (HR), and heart rate variability (HRV).
Results:
Overall, the tension increased and the mood worsened after exposure to stressors compared to pre-exposure. Compared to HC, the two SSD groups showed higher symptom intensity, disability, tension and worse mood. The SSD(mc−) group revealed higher HR than HC (p = .012, d = −0.77). Compared to pre-exposure, symptom impairment increased after social stressor exposure in SSD(mc−) (p < .001, d = 1.36). HRV-root mean square of successive differences (RMSSD) only decreased in HC during exposure (p = .003, d = −1.09), not in the SSD groups. The two SSD groups did not differ in their reactivity to stressors.
Conclusion:
HRV in SSD, seems to respond less flexibly to stressors, potentially reflecting overall physiological disturbance through reduced parasympathetic influence on HR. Stress reactivity in SSD(mc−) and SSD(mc+) do not seem to differ.
A communication over an Internet Protocol (IP) based network fails if an endpoint sends packets that are too big to reach their destination and if the sender is unable to detect that. The node on the path that drops these packets should respond with a Packet Too Big (PTB) message. However, multiple scenarios exist in which the sender will not receive a PTB message. Even if it does, it refrains from using the information in case it suspects that a potential attacker forged the message. In particular, we are not aware of any implementation of the secure transport protocol QUIC (e.g., used by HTTP/3) that processes PTB messages. In this paper, we present a novel parameterizable PTB detection algorithm for reliable transport protocols that does not depend on PTB messages. We further describe how to integrate our algorithm into QUIC, present results from an evaluation using the algorithm within a QUIC simulation model and, based on these results, suggest concrete parameter values.
Additive manufacturing (AM) has been growing continuously over the past 20 years, enabling unprecedented tailoring to the anatomy of each patient. In Europe, custom-made devices qualify for an exemption and pass a simplified approval process. New technologies, like AM, provoke questions about the adequacy of the current regulatory framework for custom-made devices. This article addresses the regulatory requirements for such devices in Europe and discusses the implications for AM. It concludes that the legal framework for custom-made devices entails uncertainties which need to be resolved to guide manufacturers through the regulatory requirements, highlighting the specific areas of focus for AM.
Additive manufacturing (AM) has continuously grown in recent decades. Enhanced quality, further development of technology, and fall in prices make AM applicable and capable for various industrial applications, also for the manufacture of medical devices. 3D printing offers the possibility for an unprecedented adaptation to the anatomy of each patient, generating medical devices on a case-by-case basis. In many jurisdictions, custom-made devices qualify for an exemption to pre-market approval standards. This regulation is called into question by new technologies, like AM. Therefore, this article compares the current regulatory requirements for custom-made devices in Europe, the United States, and Australia and discusses the impact on 3D printed devices. It concludes that not all jurisdictions have yet adjusted their regulatory framework for custom-made devices to technological advances. Remaining uncertainties must be eliminated in order to help manufacturers comply with the regulatory requirements, emphasizing key aspects of AM.
The use of computational modeling and simulation (CMS) as a tool for gaining insight into the technical performance and safety of medical devices has emerged continuously over the past years. However, to rely on information and decisions derived from model predictions, it is essential to establish model credibility for the specific context of use. Limited regulatory requirements and lack of consensus on the level of verification and validation activities required result in rare use of CMS as a source of evidence in the medical device approval process. The American Society of Mechanical Engineers (ASME) developed a risk-informed framework to establish appropriate credibility requirements of a computational model: the ASME V&V 40?2018 standard. This paper aims to outline the concepts of this standard and to demonstrate its application using an example from the orthotics field. The necessary steps to establish model credibility for a custom?made 3D printed wrist hand orthosis (WHO) are presented. It is shown that the credibility requirements of each verification and validation activity depend on model risk by applying two different contexts of use to the same computational model.
Objectives: In recent years, the European Union has revised its regulatory framework for medical devices, primarily to improve patient safety and public health. The Medical Device Regulation (MDR) is fully applicable since May 2021, strengthening the requirements for all stakeholders. As a result, many companies are facing enormous challenges. The aim of this study was to assess the impact of the MDR on the orthopaedic aids industry.
Methods: Two surveys were conducted: one shortly before the MDR became applicable (146 respondents) and a second survey almost two years later (233 respondents).
Results: Both surveys revealed that all businesses in the orthopaedic aids sector, regardless of size, have difficulty implementing the MDR. Key challenges include additional workload for technical documentation, increased resource expenditure and cost, and lack of clarity regarding the new requirements. Many companies are downsizing their product portfolio, resulting in potential supply shortages and a loss of competitive advantage and innovation for the medical device industry in Europe.
Conclusions: The full extent of the MDR’s impact on clinical practice is still unclear. However, many companies lack the necessary resources. The MDR can potentially be a bottleneck in the availability of medical devices.
Mobile health apps (MHAs) and medical apps (MAs) are becoming increasingly popular as digital interventions in a wide range of health-related applications in almost all sectors of healthcare. The surge in demand for digital medical solutions has been accelerated by the need for new diagnostic and therapeutic methods in the current coronavirus disease 2019 pandemic. This also applies to clinical practice in gastroenterology, which has, in many respects, undergone a recent digital transformation with numerous consequences that will impact patients and health care professionals in the near future. MHAs and MAs are considered to have great potential, especially for chronic diseases, as they can support the self-management of patients in many ways. Despite the great potential associated with the application of MHAs and MAs in gastroenterology and health care in general, there are numerous challenges to be met in the future, including both the ethical and legal aspects of applying this technology. The aim of this article is to provide an overview of the current status of MHA and MA use in the field of gastroenterology, describe the future perspectives in this field and point out some of the challenges that need to be addressed.
IntroductionAssessment of challenging behaviors in dementia is important for intervention selection. Here, we describe the technical and experimental setup and the feasibility of long-term multidimensional behavior assessment of people with dementia living in nursing homes.MethodsWe conducted 4 weeks of multimodal sensor assessment together with real-time observation of 17 residents with moderate to very severe dementia in two nursing care units. Nursing staff received extensive training on device handling and measurement procedures. Behavior of a subsample of eight participants was further recorded by videotaping during 4 weeks during day hours. Sensors were mounted on the participants' wrist and ankle and measured motion, rotation, as well as surrounding loudness level, light level, and air pressure.ResultsParticipants were in moderate to severe stages of dementia. Almost 100% of participants exhibited relevant levels of challenging behaviors. Automated quality control detected 155 potential issues. But only 11% of the recordings have been influenced by noncompliance of the participants. Qualitative debriefing of staff members suggested that implementation of the technology and observation platform in the routine procedures of the nursing home units was feasible and identified a range of user- and hardware-related implementation and handling challenges.DiscussionOur results indicate that high-quality behavior data from real-world environments can be made available for the development of intelligent assistive systems and that the problem of noncompliance seems to be manageable. Currently, we train machine-learning algorithms to detect episodes of challenging behaviors in the recorded sensor data.
Despite the enormous number of assistive technologies (ATs) in dementia care, the management of challenging behavior (CB) of persons with dementia (PwD) by informal caregivers in home care is widely disregarded. The first-line strategy to manage CB is to support the understanding of the underlying causes of CB to formulate individualized nonpharmacological interventions. App- and sensor-based approaches combining multimodal sensors (actimetry and other modalities) and caregiver information are innovative ways to support the understanding of CB for family caregivers. The main aim of this study is to describe the design of a feasibility study consisting of an outcome and a process evaluation of a newly developed app- and sensor-based intervention to manage CB of PwD for family caregivers at home. In this feasibility study, we perform an outcome and a process evaluation with a pre-post descriptive design over an 8-week intervention period. The Medical Research Council framework guides the design of this feasibility study. The data on 20 dyads (primary caregiver and PwD) are gathered through standardized questionnaires, protocols, and log files as well as semistructured qualitative interviews. The outcome measures (neuropsychiatric inventory and Cohen-Mansfield agitation inventory) are analyzed by using descriptive statistics and statistical tests relevant to the individual assessments (eg, chi-square test and Wilcoxon signed-rank test). For the analysis of the process data, the Unified Theory of Acceptance and Use of Technology is used. Log files are analyzed by using descriptive statistics, protocols are analyzed by using documentary analysis, and semistructured interviews are analyzed deductively using content analysis. The newly developed app- and sensor-based AT has been developed and was evaluated until July in 2018. The recruitment of dyads started in September 2017 and was concluded in March 2018. The data collection was completed at the end of July 2018. This study presents the protocol of the first feasibility study to encompass an outcome and process evaluation to assess a complex app- and sensor-based AT combining multimodal actimetry sensors for informal caregivers to manage CB. The feasibility study will provide in-depth information about the study procedure and on how to optimize the design of the intervention and its delivery. DERR1-10.2196/11630
Background: Currently, to the best of our knowledge, no findings exist concerning the needs of professionals in specialized pediatric palliative care (PPC) regarding electronic health records (EHRs). Several studies have highlighted benefits concerning the use of EHRs in pediatrics. However, usability is strongly affected by the degree of adaptivity to the context of application. The aim of this study is to examine the needs of professionals concerning an EHR in the specialized PPC inpatient and outpatient settings. Methods: A qualitative research design was chosen to address the complex aspects of user demands. Focus group interviews and semi-structured one-on-one interviews were conducted with PPC professionals. N = 23 participants from inpatient and N = 11 participants from outpatient settings of specialized PPC representing various professions took part in the study. Results: The findings could be grouped into four categories: (1) attitude towards the current methods of documentation, (2) attitude towards electronic documentation in general, (3) general requirements for an EHR, and (4) content requirements for an EHR. Conclusions: Professionals in specialized PPC expect and experience many benefits of using electronic documentation. Their requirements for an EHR for inpatient and outpatient settings of PPC are largely consistent with EHRs for pediatrics. However, individual specifications and adaptations are necessary for this particular setting.
Background: Pediatric palliative care (PPC) is characterized by years of multisectoral and multi-professional care. Sharing information between PPC professionals is, therefore, essential for quality care. The evidence shows that electronic cross-facility health records (ECHRs) provide useful support in this context. To our knowledge, no ECHRs have been developed through a user-centered approach for this specific setting in Germany. Methods: Guided by design thinking, first, qualitative interviews were conducted to assess the needs of PPC professionals. Second, the elicited needs were specified in focus groups (FGs). Based on the needs stated in the interviews, prototypes of the ECHR were developed and discussed in the FGs. The indicated needs were supplemented and specified in an iterative process. The prototypes were further adapted according to these results. The unified theory of acceptance and use of technology was the basic model in the evaluation of needs. Results: Across seven main categories, past and current medication, emergency view, and messaging functions were identified as the participants’ desired core components of an ECHR. Utilizing design thinking facilitated the explicit articulation of user needs. Conclusions: Developing an ECHR with the content identified would allow for real-time data during emergencies, tracking what other PPC professionals have done, and making the applied treatments visible to others. This would offer a broader picture of the complex conditions common to PPC.
Background: Electronic medical records (EMRs) offer a promising approach to mapping and documenting the complex information gathered in paediatric palliative care (PPC). However, if they are not well developed, poorly implemented EMRs have unintended consequences that may cause harm to patients. One approach to preventing such harm is the involvement of users in the participatory design to ensure user acceptance and patient safety. Therefore, the aim of this study is to evaluate the acceptance of a novel patient chart module (PCM) as part of an EMR from the perspective of potential users in PPC and to involve these professionals in the design process. Methods: A qualitative observational study with N = 16 PPC professionals (n = 10 nurses, n = 6 physicians) was conducted, including concurrent think aloud (CTA) and semi-structured interviews. A structured content analysis based on the Unified Theory of Acceptance and Use of Technology was applied. Results: The results can be summarized in terms of general observations, performance expectancy, effort expectancy and facilitating conditions, all of which are likely to have a positive influence on acceptance of the PCM from the user perspective in the context of PPC. Conclusions: The involvement of users in the development of EMRs is important for meeting the requirements in PPC. Further software adaptations are necessary to implement these requirements.
Electronic Medical Records for (Visceral) Medicine: An Overview of the Current Status and Prospects
(2021)
Background: Electronic medical records (EMRs) offer key advantages over analog documentation in healthcare. In addition to providing details about current and past treatments, EMRs enable clear and traceable documentation regardless of the location. This supports evidence-based, multi-professional treatment and leads to more efficient healthcare. However, there are still several challenges regarding the use of EMRs. Understanding these challenges is essential to improve healthcare. The aim of this article is to provide an overview of the current state of EMRs in the field of visceral medicine, to describe the future prospects in this field, and to highlight some of the challenges that need to be faced. Summary: The benefits of EMRs are manifold and particularly pronounced in the area of quality assurance and improvement of communication not only between different healthcare professionals but also between physicians and patients. Besides the danger of medical errors, the health consequences for the users (cognitive load) arise from poor usability or a system that does not fit into the real world. Involving users in the development of EMRs in the sense of participatory design can be helpful here. The use of EMRs in practice together with patients should be accompanied by training to ensure optimal outcomes in terms of shared decision-making. Key Message: EMRs offer a variety of benefits. However, it is critical to consider user involvement, setting specificity, and user training during development, implementation, and use in order to minimize unintended consequences.
Background: Pediatric palliative care (PPC) patients experience years of multisectoral and professional care. An electronic cross-facility health record (ECHR) system can support the immediate exchange of information among PPC professionals. Based on a needs assessment, a prototype ECHR system was developed. Methods: To evaluate potential users’ perspective regarding the system, a qualitative observational study was conducted consisting of a concurrent think-aloud session and a semi-structured qualitative interview. Results: Twenty PPC professionals (nurses, physicians) from specialized outpatient PPC teams, a PPC unit, and medical offices rated the ECHR system as a helpful tool to improve the exchange and collection of information, communication between PPC professionals, and treatment planning. From the user’s point of view, the basic logic of the ECHR system should be further adapted to improve the interaction of data remirrored from patient records of outpatient and inpatient care with those entered via the system. The users wished for further functions (text search) and content (information on therapies). Some content, such as the treatment process, needs to be further adapted. Conclusion: The developed ECHR system needs to be more specific in some features by offering all available information; while for other features, be less specific to offer a quick overview. The ability to share information promptly and automatically was seen as a tremendous improvement to the quality of care for PPC patients.
Adhärenz digitaler Interventionen im Gesundheitswesen: Definitionen, Methoden und offene Fragen
(2021)
AbstractMany digital interventions rely on the participation of their users to have a positive impact. In various areas it can be observed that the use of digital interventions is often reduced or fully discontinued by the users after a short period of time. This is seen as one of the main factors that can limit the effectiveness of digital interventions. In this context, the concept of adherence to digital interventions is becoming increasingly important. Adherence to digital interventions is roughly defined as “the degree to which the user followed the program as it was designed,” which can also be paraphrased as “intended use” or “use as it is designed.” However, both the theoretical–conceptual and practical discussions regarding adherence to digital interventions still receive too little attention.The aim of this narrative review article is to shed more light on the concept of adherence to digital interventions and to distinguish it from related concepts. It also discusses the methods and metrics that can be used to operationalize adherence and the predictors that positively influence adherence. Finally, needs for action to better address adherence are considered critically.
Introduction: Heroin overdose is a leading cause of mortality among drug users. This paper aims to identify individual and contextual factors associated with lethal and non-lethal heroin-related overdoses on the basis of case reports and semi-structured proxy interviews. Typical patterns within these cases are determined by means of cluster analysis. Methods: Within the CaRe (Case Reports of heroin-related overdoses) study, case reports (100 proxy reports of overdose events from 36 different facilities) were gathered and evaluated as part of a nationwide survey of experts conducted in Germany in 2019. Following initial descriptive analyses a two-step cluster analysis with the four binary variables of gender, age, time and place was conducted to identify patterns within the reported cases. Results: The case reports grouped into five clusters: 1) Younger male drug users, found in a public space during the daytime; 2) Female drug users; 3) Older male drug users, found in a public space during the daytime; 4) Drug users found at home at night; 5) Drug users found outside at night. Overdoses by female drug users and those which occurred at home and/or at night were significantly more likely to have a fatal outcome. Conclusion: Future prevention
and intervention measures should aim to consider the context, i.e.