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Wastewater generation model to predict impacts of urine separation on wastewater treatment plants
(2024)
Wastewater treatment plants (WWTPs) are under increasing pressure to enhance resource efficiency and reduce emissions into water bodies. The separation of urine within the catchment area may be an alternative to mitigate the need for costly expansions of central WWTPs. While previous investigations assumed a spatially uniform implementation of urine separation across the catchment area, the present study focuses on an adapted stochastic wastewater generation model, which allows the simulation of various wastewater streams (e.g., urine) on a household level. This enables the non-uniform separation of urine across a catchment area. The model is part of a holistic modelling framework to determine the influence of targeted urine separation in catchments on the operation and emissions of central WWTPs, which will be briefly introduced. The wastewater generation model is validated through an extensive sampling and measurement series.
Results based on observed and simulated wastewater quantity and quality for a catchment area of 366 residents for two dry weather days indicate the suitability of the model for wastewater generation and transport modelling. Based on this, four scenarios for urine separation were defined. The results indicate a potential influence of spatial distribution on the peaks of total nitrogen and total phosphorus.
Potential and risks of water reuse in Brandenburg (Germany) – an interdisciplinary case study
(2024)
For Brandenburg, a region in Germany with increasing water shortage and drought events, water reuse can counteract competition scenarios between drinking water supply, agricultural irrigation, and industrial use. Centralized and decentralized sources for reclaimed water are found to potentially substitute 245 or 28% of irrigation water, respectively, in agriculture production in Brandenburg. For such a reuse scenario, the
fate of organic micropollutants is examined for diatrizoate (DZA) and carbamazepine (CBZ). Retention in local sandy soil and transfer into roots and leaves of arugula are analyzed in lysimeter studies and greenhouse pot experiments. Vertical transport was found for DZA and accumulation in or on arugula roots with a root concentration factor of 1,925+34% but a low bioconcentration factor due to intrinsic molecule properties. CBZ was not found to be mobile in the sandy soil but accumulates in arugula roots and leaves by factors of 70+7% and 155+12%, respectively. Further research on potential plant uptake and groundwater enrichment for more substances is highly recommended as well as tertiary wastewater treatment prior to water reuse.
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)
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.
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.
This article analyses the impact of robotics on the
operation and maintenance (O&M) of offshore wind
turbines (OWTs), with a particular emphasis on the
challenges and benefits. As the world’s reliance on
renewable energy, particularly offshore wind, increases
to reduce climate change, the growing number of
OWTs requires effective O&M. Challenges consist
of logistics, accessibility and high costs. The paper
presents the application of climbing robots, unmanned
aerial vehicles and underwater robots to overcome
these challenges.
The combination of multiple robotic platforms, such
as autonomous surface vehicles and autonomous underwater
vehicles, represents a collaborative approach
to O&M. Obstacles include the need for accurate navigation,
building trust between humans and robots,
and research into artificial intelligence.
In conclusion, the integration of robotics in O&M
presents considerable advantages, increasing efficiency,
safety and cost-effectiveness. Further progress and
research into artificial intelligence are crucial in achieving
complete automation, which will transform the
O&M of OWTs.
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.
Quantum magnetometry based on optically detected magnetic resonance (ODMR) of nitrogen vacancy centers in diamond nano or microcrystals is a promising technology for sensitive, integrated magnetic-field sensors. Currently, this technology is still cost-intensive and mainly found in research. Here we propose one of the smallest fully integrated quantum sensors to date based on nitrogen vacancy (NV) centers in diamond microcrystals. It is an extremely cost-effective device that integrates a pump light source, photodiode, microwave antenna, filtering and fluorescence detection. Thus, the sensor offers an all-electric interface without the need to adjust or connect optical components. A sensitivity of 28.32nT/Hz−−−√ and a theoretical shot noise limited sensitivity of 2.87 nT/Hz−−−√ is reached. Since only generally available parts were used, the sensor can be easily produced in a small series. The form factor of (6.9 × 3.9 × 15.9) mm3 combined with the integration level is the smallest fully integrated NV-based sensor proposed so far. With a power consumption of around 0.1W, this sensor becomes interesting for a wide range of stationary and handheld systems. This development paves the way for the wide usage of quantum magnetometers in non-laboratory environments and technical applications.
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.
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.
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.
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.
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.
Background: Electronic medical records (EMRs) play a key role in improving documentation and quality of care in paediatric palliative care (PPC). Inadequate EMR design can cause incorrect prescription and administration of medications. Due to the fact of complex diseases and the resulting high level of medical complexity, patients in PPC are vulnerable to medication errors. Consequently, involving users in the development process is important. Therefore, the aim of this study was to evaluate the acceptance of a medication module from the perspective of potential users in PPC and to involve them in the development process. Methods: A qualitative observational study was conducted with 10 nurses and four physicians using a concurrent think-aloud protocol and semi-structured qualitative interviews. A qualitative content analysis was applied based on a unified theory of acceptance and use of technology. Results: Requirements from the user’s perspective could be identified as possible influences on acceptance and actual use. Requirements were grouped into the categories “performance expectancies” and “effort expectancies”. Conclusions: The results serve as a basis for further development. Attention should be given to the reduction of display fragmentation, as it decreases cognitive load. Further approaches to evaluation should be taken.
Background: Electronic medical records (EMRs) play a key role in improving documentation and quality of care in paediatric palliative care (PPC). Inadequate EMR design can cause incorrect prescription and administration of medications. Due to the fact of complex diseases and the resulting high level of medical complexity, patients in PPC are vulnerable to medication errors. Consequently, involving users in the development process is important. Therefore, the aim of this study was to evaluate the acceptance of a medication module from the perspective of potential users in PPC and to involve them in the development process. Methods: A qualitative observational study was conducted with 10 nurses and four physicians using a concurrent think-aloud protocol and semi-structured qualitative interviews. A qualitative content analysis was applied based on a unified theory of acceptance and use of technology. Results: Requirements from the user’s perspective could be identified as possible influences on acceptance and actual use. Requirements were grouped into the categories “performance expectancies” and “effort expectancies”. Conclusions: The results serve as a basis for further development. Attention should be given to the reduction of display fragmentation, as it decreases cognitive load. Further approaches to evaluation should be taken.
Background: Paediatric palliative care (PPC) is a noncurative approach to the care of children and adolescents with life-limiting and life-threatening illnesses. Electronic medical records (EMRs) play an important role in documenting such complex processes. Despite their benefits, they can introduce unintended consequences if future users are not involved in their development. Aim: The aim of this study was to evaluate the acceptance of a novel module for nursing documentation by nurses working in the context of PPC. Methods: An observational study employing concurrent think-aloud and semi-structured qualitative interviews were conducted with 11 nurses working in PPC. Based on the main determinants of the unified theory of acceptance and use of technology (UTAUT), data were analysed using qualitative content analysis. Results: The main determinants of UTAUT were found to potentially influence acceptance of the novel module. Participants perceived the module to be self-explanatory and intuitive. Some adaptations, such as the reduction of fragmentation in the display, the optimization of confusing mouseover fields, and the use of familiar nursing terminology, are reasonable ways of increasing software adoption. Conclusions: After adaptation of the modules based on the results, further evaluation with the participation of future users is required.
Approaches to Improvement of Digital Health Literacy (eHL) in the Context of Person-Centered Care
(2022)
The skills, knowledge and resources to search for, find, understand, evaluate and apply health information is defined as health literacy (HL). If individuals want to use health information from the Internet, they need Digital Health Literacy (eHL), which in addition to HL also includes, for example, media literacy. If information cannot be found or understood by patients due to low (e)HL, patients will not have the opportunity to make informed decisions. In addition, many health apps for self-management or prevention also require (e)HL. Thus, it follows that active participation in healthcare, in terms of Person-Centered Care (PCC) is only possible through (e)HL. Currently, there is a great need to strengthen these competencies in society to achieve increased empowerment of patients and their health. However, at the same time, there is a need to train and improve competencies in the field of healthcare professionals so that they can counsel and guide patients. This article provides an overview with a focus on HL and eHL in healthcare, shows the opportunities to adapt services and describes the possible handling of patients with low (e)HL. In addition, the opportunities for patients and healthcare professionals to improve (e)HL are highlighted.
Learning digital competencies can be successful if the information is also tried out immediately using interactive elements. However, interactive teaching poses a particular challenge, especially in large group formats. Various strategies are used to promote interaction, but there is little known about the results. This article shows different strategies and evaluates their influence on the interaction rate in a large group course over two terms that teaches digital medicine. Log files and participation in surveys as well as participation in chat were quantitatively evaluated. In addition, the chat messages themselves were evaluated qualitatively. For the evaluation, relation to the total number of participants was particularly relevant in order to be able to determine an interaction rate in the individual course sessions. A maximum average interaction rate of 90.97% could be determined over the entire term while the participants wrote an average of 3.96 comments during a session in the chat. In summary, this research could show that interactive elements should be well planned and used at regular intervals in order to reap the benefits.