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Freedom of trade, occupation and profession in times of the Covid-19 pandemic in South Africa
(2022)
This paper evaluates the freedom of trade, occupation, and profession in South Africa from a Covid-19 pandemic context. It does that by focusing on the pertinent provisions and rights contained in the Constitution of the Republic of South Africa, 1996 (the Constitution) and relevant international and regional human rights instruments. It proceeds by discussing the interlinkage between (the freedom of trade, occupation, and profession and other pertinent fundamental) rights, limitation, enforcement, and interpretation of rights. This is followed by some final observations.
Purpose: In this article, the canvas used to simplify business modeling of a platform and its visual depiction are put into the entrepreneurial context, and critically reflected accordingly. Furthermore, it is discussed to what extent the canvas is advantageous, disadvantageous, applicable, not applicable, or even contradictory.
Methodology: The analysis is based on theoretical research. Additionally, qualitative interviews with business founders were conducted.
Results: The results conclude that the canvas employed to ease the business model sharpening process supplies founders with essential aspects to cover, yet they are part of a large set of factors that play in.
Conclusion: The limitations of this study are rooted in the chosen research design based on the conceptual review.
The objective investigation of the dynamic properties of vocal fold vibrations demands the recording and further quantitative analysis of laryngeal high-speed video (HSV). Quantification of the vocal fold vibration patterns requires as a first step the segmentation of the glottal area within each video frame from which the vibrating edges of the vocal folds are usually derived. Consequently, the outcome of any further vibration analysis depends on the quality of this initial segmentation process. In this work we propose for the first time a procedure to fully automatically segment not only the time-varying glottal area but also the vocal fold tissue directly from laryngeal high-speed video (HSV) using a deep Convolutional Neural Network (CNN) approach. Eighteen different Convolutional Neural Network (CNN) network configurations were trained and evaluated on totally 13,000 high-speed video (HSV) frames obtained from 56 healthy and 74 pathologic subjects. The segmentation quality of the best performing Convolutional Neural Network (CNN) model, which uses Long Short-Term Memory (LSTM) cells to take also the temporal context into account, was intensely investigated on 15 test video sequences comprising 100 consecutive images each. As performance measures the Dice Coefficient (DC) as well as the precisions of four anatomical landmark positions were used. Over all test data a mean Dice Coefficient (DC) of 0.85 was obtained for the glottis and 0.91 and 0.90 for the right and left vocal fold (VF) respectively. The grand average precision of the identified landmarks amounts 2.2 pixels and is in the same range as comparable manual expert segmentations which can be regarded as Gold Standard. The method proposed here requires no user interaction and overcomes the limitations of current semiautomatic or computational expensive approaches. Thus, it allows also for the analysis of long high-speed video (HSV)-sequences and holds the promise to facilitate the objective analysis of vocal fold vibrations in clinical routine. The here used dataset including the ground truth will be provided freely for all scientific groups to allow a quantitative benchmarking of segmentation approaches in future.
This article presents experience curves and cost-benefit analyses for electric and plug-in hybrid cars sold in Germany. We find that between 2010 and 2016, the prices and price differentials relative to conventional cars declined at learning rates of 23 ± 2% and 32 ± 2% for electric cars and 6 ± 1% and 37 ± 2% for plug-in hybrids. If trends persist, price beak-even with conventional cars may be reached after another 7 ± 1 million electric cars and 5 ± 1 million plug-in hybrids are produced. The user costs of electric and plug-in hybrid cars relative to their conventional counterparts are declining annually by 14% and 26%. Also the costs for mitigating CO2 and air pollutant emissions through the deployment of electrified cars tend to decline. However, at current levels, NOX and particle emissions are still mitigated at lower costs by state-of-the-art after-treatment systems than through the electrification of powertrains. Overall, the observation of robust technological learning suggests policy makers should focus their support on non-cost market barriers for the electrification of road transport, addressing specifically the availability of recharging infrastructure.
Fuzzy system based on two-step cascade genetic optimization strategy for tobacco tar prediction
(2019)
There are many challenges in accurately measuring cigarette tar constituents. These include the need for standardized smoke generation methods related to unstable mixtures. In this research were developed algorithms using fusion of artificial intelligence methods to predict tar concentration. Outputs of development are three fuzzy structures optimized with genetic algorithms resulting in genetic algorithm (GA)-FUZZY, GA-adaptive neuro fuzzy inference system (ANFIS), GA-GA-FUZZY algorithms. Proposed algorithms are used for the tar prediction in the cigarette production process. The results of prediction are compared with gas chromatograph (high-performance liquid chromatography (HPLC)) readings.
Introduction: Annually, 2 million sports-related injuries are reported in Germany of which athletes contribute to a large proportion. Multiple sport injury prevention programs designed to decrease acute and overuse injuries in athletes have been proven effective. Yet, the programs’ components, general or sports-specific, that led to these positive effects are uncertain. Despite not knowing about the superiority of sports-specific injury prevention programs, coaches and athletes alike prefer more specialized rather than generalized exercise programs. Therefore, this systematic review aimed to present the available evidence on how general and sports-specific prevention programs affect injury rates in athletes.
Methods: PubMed and Web of Science were electronically searched throughout April 2018. The inclusion criteria were publication dates Jan 2006–Dec 2017, athletes (11–45 years), exercise-based injury prevention programs and injury incidence. The methodological quality was assessed with the Cochrane Collaboration assessment tools.
Results: Of the initial 6619 findings, 15 studies met the inclusion criteria. In addition, 13 studies were added from reference lists and external sources making a total of 28 studies. Of which, one used sports-specific, seven general and 20 mixed prevention strategies. Twenty-four studies revealed reduced injury rates. Of the four ineffective programs, one was general and three mixed.
Conclusion: The general and mixed programs positively affect injury rates. Sports-specific programs are uninvestigated and despite wide discussion regarding the definition, no consensus was reached. Defining such terminology and investigating the true effectiveness of such IPPs is a potential avenue for future research.
Introduction: Injury prevention programs (IPPs) are an inherent part of training in recreational and professional sports. Providing performance-enhancing benefits in addition to injury prevention may help adjust coaches and athletes’ attitudes towards implementation of injury prevention into daily routine. Conventional thinking by players and coaches alike seems to suggest that IPPs need to be specific to one’s sport to allow for performance enhancement. The systematic literature review aims to firstly determine the IPPs nature of exercises and whether they are specific to the sport or based on general conditioning. Secondly, can they demonstrate whether general, sports-specific or even mixed IPPs improve key performance indicators with the aim to better facilitate long-term implementation of these programs?
Methods: PubMed and Web of Science were electronically searched throughout March 2018. The inclusion criteria were randomized control trials, publication dates between Jan 2006 and Feb 2018, athletes (11–45 years), injury prevention programs and included predefined performance measures that could be categorized into balance, power, strength, speed/agility and endurance. The methodological quality of included articles was assessed with the Cochrane Collaboration assessment tools.
Results: Of 6619 initial findings, 22 studies met the inclusion criteria. In addition, reference lists unearthed a further 6 studies, making a total of 28. Nine studies used sports specific IPPs, eleven general and eight mixed prevention strategies. Overall, general programs ranged from 29–57% in their effectiveness across performance outcomes. Mixed IPPs improved in 80% balance outcomes but only 20–44% in others. Sports-specific programs led to larger scale improvements in balance (66%), power (83%), strength (75%), and speed/agility (62%).
Conclusion: Sports-specific IPPs have the strongest influence on most performance indices based on the significant improvement versus control groups. Other factors such as intensity, technical execution and compliance should be accounted for in future investigations in addition to exercise modality.
Geometrieerzeugung von Evolventenzahntrieben: Profilverschobene schrägverzahnte Stirnzahnräder
(2022)
In dieser Arbeit wird die Zahnradgeometrie von Stirnrädern berechnet und formatiert, um sie in ein CAD-Programm zu übertragen. Dabei werden die Konturen der Evolvente und der Trochoide nach den gleichen Regel wie bei der Herstellung durch Wälzfräsen erzeugt. Der Anwender hat die Möglichkeit die Haupteigenschaften wie Modul, Zahnkopfspiel und Eckenverrundung einzugeben. Zusätzlich können auch schrägverzahnte, profilverschobene Stirnräder mit Hochverzahnung und Kopfkürzung erzeugt werden.
Per Datenausgabe werden die Koordinaten gespeichert und durch ein Makro in das CAD-Programm übertragen. Aus den beiden Konturzügen wird der 3D-Körper durch Austragen entlang der Helix erzeugt.
Zur Weiterverarbeitung wird die Zahnradgeometrie nach manueller Tesselierung in ein universales Dateiformat exportiert.
Research in global change ecology relies heavily on global climatic grids derived from estimates of air temperature in open areas at around 2 m above the ground. These climatic grids do not reflect conditions below vegetation canopies and near the ground surface, where critical ecosystem functions occur and most terrestrial species reside. Here, we provide global maps of soil temperature and bioclimatic variables at a 1-km2 resolution for 0–5 and 5–15 cm soil depth. These maps were created by calculating the difference (i.e. offset) between in situ soil temperature measurements, based on time series from over 1200 1-km2 pixels (summarized from 8519 unique temperature sensors) across all the world's major terrestrial biomes, and coarse-grained air temperature estimates from ERA5-Land (an atmospheric reanalysis by the European Centre for Medium-Range Weather Forecasts). We show that mean annual soil temperature differs markedly from the corresponding gridded air temperature, by up to 10°C (mean = 3.0 ± 2.1°C), with substantial variation across biomes and seasons. Over the year, soils in cold and/or dry biomes are substantially warmer (+3.6 ± 2.3°C) than gridded air temperature, whereas soils in warm and humid environments are on average slightly cooler (−0.7 ± 2.3°C). The observed substantial and biome-specific offsets emphasize that the projected impacts of climate and climate change on near-surface biodiversity and ecosystem functioning are inaccurately assessed when air rather than soil temperature is used, especially in cold environments. The global soil-related bioclimatic variables provided here are an important step forward for any application in ecology and related disciplines. Nevertheless, we highlight the need to fill remaining geographic gaps by collecting more in situ measurements of microclimate conditions to further enhance the spatiotemporal resolution of global soil temperature products for ecological applications.
Electric drive systems are increasingly used in automobiles. However, the combination of comfort, dynamics and safety requirements places high demands on the torque accuracy. The complex interplay of battery, inverter and electrical machine causes a lot of system uncertainties based on parameter fluctuations and measurement errors that influence the system performance. In this paper these influences on the closed loop torque control are analyzed and quantified using a variance based sensitivity analysis. The method enables to connect the variance of the torque accuracy with the parameter uncertainties causing this variance. Moreover, it quantifies the influences of the parameters independent of the complexity of the analyzed system. In addition, two methods to ensure convergence of the estimated variance based sensitivity measures are proposed. The results of the analysis are presented for 19 static working points of an battery electric drive system.
Bauprojekte sind in der Regel komplexe Vorhaben. Sie werden mit Hilfe des Projektmanagements und dessen Verfahren, Prozessen und Techniken bewältigt. Dennoch sind deutsche Bauprojekte nicht selten von Kosten- und Terminüberschreitungen betroffen. Ziel dieser Arbeit ist es, mögliche Optimierungsfelder im Planungs- und Steuerungsprozess eines Unternehmens für Industriebauprojekte zu identifizieren und darauf aufbauende Verbesserungsansätze zu erarbeiten. Um die Ziele verfolgen zu können, wurde eine qualitative Sozialforschung mittels Experteninterviews durchgeführt. Die Expertenaussagen verdeutlichen weiterhin Optimierungspotenzial, sowohl im Planungs- als auch im Steuerungsprozess. Ausgewählte Techniken (hauptsächlich aus dem klassischen Projektmanagement) dienen indessen dazu, die Effektivität und Effizienz des Planungsprozesses zu erhöhen. Innerhalb des Steuerungsprozesses zeigt sich, dass viele Optimierungsbereiche der Steuerung auf den Defiziten der Planung beruhen.
Life-threatening cardiomyopathy is a severe, but common, complication associated with severe trauma or sepsis. Several signaling pathways involved in apoptosis and necroptosis are linked to trauma- or sepsis-associated cardiomyopathy. However, the underling causative factors are still debatable. Heparan sulfate (HS) fragments belong to the class of danger/damage-associated molecular patterns liberated from endothelial-bound proteoglycans by heparanase during tissue injury associated with trauma or sepsis. We hypothesized that HS induces apoptosis or necroptosis in murine cardiomyocytes. By using a novel Medical-In silico approach that combines conventional cell culture experiments with machine learning algorithms, we aimed to reduce a significant part of the expensive and time-consuming cell culture experiments and data generation by using computational intelligence (refinement and replacement). Cardiomyocytes exposed to HS showed an activation of the intrinsic apoptosis signal pathway via cytochrome C and the activation of caspase 3 (both p < 0.001). Notably, the exposure of HS resulted in the induction of necroptosis by tumor necrosis factor α and receptor interaction protein 3 (p < 0.05; p < 0.01) and, hence, an increased level of necrotic cardiomyocytes. In conclusion, using this novel Medical-In silico approach, our data suggest (i) that HS induces necroptosis in cardiomyocytes by phosphorylation (activation) of receptor-interacting protein 3, (ii) that HS is a therapeutic target in trauma- or sepsis-associated cardiomyopathy, and (iii) indicate that this proof-of-concept is a first step toward simulating the extent of activated components in the pro-apoptotic pathway induced by HS with only a small data set gained from the in vitro experiments by using machine learning algorithms.
This paper is structured into two parts, which are closely related: first, the analysis of the parlamentary and governmental measures against the covid-19 pandemic; and second, the future regulatory framework about freedom of movement and other rights in the European area, according to the new European pact on migration and asylum.
Hydrochar derived from Argan nut shell (ANS) was synthesized and applied to remove bisphenol A (BPA) and diuron. The results indicated that the hydrochar prepared at 200 °C (HTC@ANS-200) possessed a higher specific surface area (42 m2/g) than hydrochar (HTC@ANS-180) prepared at 180 °C (17 m2/g). The hydrochars exhibited spherical particles, which are rich in functional groups. The HTC@ANS-200 exhibited high adsorption efficiency, of about 92% of the BPA removal and 95% of diuron removal. The maximum Langmuir adsorption capacities of HTC@ANS-200 at room temperature were 1162.79 mg/for Bisphenol A and 833.33 mg/g for diuron (higher than most reported adsorbents). The adsorption process was spontaneous (− ΔG°) and exothermic (− ΔH°). Excellent reusability was reclaimed after five cycles, the removal efficiency showed a weak decrease of 4% for BPA and 1% for diuron. The analysis of Fourier transforms infrared spectrometry demonstrated that the aromatic C=C and OH played major roles in the adsorption mechanisms of BPA and diuron in this study. The high adsorption capacity was attributed to the beneficial porosity (The pore size of HTC@ANS-200 bigger than the size of BPA and diuron molecule) and surface functional groups. BPA and diuron adsorption occurred also via multiple adsorption mechanisms, including pore filling, π–π interactions, and hydrogen bonding interactions on HTC@ANS-200.
Since operational managers often monitor large numbers of wind turbines (WTs), they depend on a toolset to provide them with highly condensed information to identify and prioritize low performing WTs or schedule preventive maintenance measures. Power curves are a frequently used tool to assess the performance of WTs. The power curve health value (HV) used in this work is supposed to detect power curve anomalies since small deviations in the power curve are not easy to identify. It evaluates deviations in the linear region of power curves by performing a principal component analysis. To calculate the HV, the standard deviation in direction of the second principal component of a reference data set is compared to the standard deviation of a combined data set consisting of the reference data and data of the evaluated period. This article examines the applicability of this HV for different purposes as well as its sensitivities and provides a modified HV approach to make it more robust and suitable for heterogeneous data sets. The modified HV was tested based on ENGIE's open data wind farm and data of on- and offshore WTs from the WInD-Pool. It proved to detect anomalies in the linear region of the power curve in a reliable and sensitive manner and was also eligible to detect long term power curve degradation. Also, about 7 % of all corrective maintenance measures were preceded by high HVs with a median alarm horizon of three days. Overall, the HV proved to be a promising tool for various applications.
Big Data is now poised to mutate decision-making systems. Indeed, the decision is no longer based solely on the structured information that was hitherto collected and stored by the organization, but also on all data not structured outside the corporate straitjacket. The cloud and the information it contains impacts decisions and the industry is witnessing the emergence of business intelligence 3.0. With the growth of the internet, social networks, connected objects and communication information are now more abundant than ever before, along with rapid and substantial growth in their production. In 2012, 2.5 exabytes of data (one exabyte representing a million gigabytes of data) came every day to swell the ranks of big data (McAfee et al., 2012), which should weigh more than 40 zettabytes from 2020 (Valduriez, 2014) for 30 billion connected devices (The Internet Of Nothings, 2014) and 50 billion sensors (Davenport & Soulard, 2014). One of the most critical aspects of all of this information flow is the impact these will have on the way decisions are made. Indeed, in the part of an environment in which data was scarce and difficult to obtain, it was logical to let decision-making be conditioned by the intuition of the experienced decision-maker (Klein, Phillips, Rall, & Peluso, 2007). However, since information and knowledge are now available to everyone, the role of experts and decision-makers is gradually changing. Big data, in particular, makes it possible for analytical and decision-making systems to base their decision-making on global models. However, considering all the dimensions of the situations encountered, it was not until now that these systems were not within the reach of man, but were rationally limited (Simon & Newell, 1971). Big data and however, the processing of unstructured data requires modifying the architecture of decision support systems (DSS) of organizations. This paper is an inventory of developments undergone by aid systems decision-making, under the pressure of big data. Finally, it opens the debate on ethical questions raised by these new technologies, and it is observed that now, data analysis of personal data has become more debatable than in the past.
Covid-19 outbreak had a huge impact on the economy worldwide as businesses had to close or cease their activities due to the lockdown regulations. The “luckiest” firms were able to operate but under restricted conditions. In order to avoid what certain authors called “bankruptcy epidemic” European countries took economic and fiscal measures to help companies compensate their financial losses. In addition to Government Grants, emergency legislations have been adopted with the aim to adapt insolvency and restructuring procedures to the sanitary situation and specific rules relating to company Law have also been implemented. This paper deals with the measures taken by the state of Luxembourg and gives a brief overview of the legal amendments.
Implementation strategies of a modern showroom concept for retailers with a wide range of products
(2022)
This paper suggests a new business model based on modern technology for retail. In the age of digitalization, stationary retail is losing market shares to online retail. Therefore, there is an obvious need for change in businesses. The concept developed in this paper combines the strengths of online and stationary retail to benefit stationary retail. In the approach taken in this paper, the basis for change is modern technology. Finding innovative ways to use technologies like NFC, AI, and robotics is regarded as the key factor to sustainable success. As the implementation of modern technologies entails a particular investment, the customers’ opinion on structural changes like these has been included in the consideration. Therefore, a survey has been conducted to find out which level of innovation current customers are willing to accept thus emphasizing the need for certain changes and dissuading specific others. The result of this paper is the modern showroom concept which takes the customers’ opinion into account while implementing the right amount of technology that should pave the way to a sustainable future for stationary retail.
Aim: The aim of this scientific paper was to examine important trends and developments influencing the nursing care in order to forecast future opportunities and challenges and how to deal with them in the best possible way.
Background: The Corona-pandemic demonstrated the importance of nursing care in the entire world and had drawn attention to the issue of a well-educated and enough nursing staff. The nursing care will face opportunities and challenges due to current trends and developments, which are important to examine in order to provide the best possible nursing care.
Methods: To reach the above-mentioned aim, intensive research was done by using secondary sources and surveys.
Results/Findings: After a detailed analysis of the research it can be summarized that there are three important topics influencing the nursing care: The demographical development with an increasing life expectancy leading to an increasing amount of old people with a demand for care and decreasing birth rates leading to less working people. Cultural transformation and diversity imply many opportunities because the employment market can fill gaps with foreign workers and the immigrating people can compensate the decreasing birth rates. Nevertheless, it can imply many challenges and potential problems which need to be solved by the society and the immigrating people. Furthermore, the changing gender roles can lead to more men becoming a nurse, which might have a significant impact on the shortage of nursing staff. The third important topic influencing the nursing care is technological trends which can help to decrease physiological stress, by facilitating the nurses’ work and by taking over some work from them.
Conclusion: It can be concluded that the trends and developments influencing the nursing care are very diverse and imply many different opportunities as well as challenges.
In the last decades, there has been a widespread implementation of Green Infrastructures worldwide. Among these, green roofs appear to be particularly flexible sustainable drainage facilities. To predict their effectiveness for planning purposes, a tool is required that provides information as a function of local meteorological variables. Thus, a relatively simple daily scale, one-dimensional water balance approach has been proposed. The crucial evapotranspiration process, usually considered as a water balance dependent variable, is replaced here by empirical relationships providing an a-priori assessment of soil water losses through actual evapotranspiration. The modelling scheme, which under some simplification can be used without a calibration process, has been applied to experimental runoff data monitored at a green roof located near Bernkastel (Germany), between April 2005 and December 2006. Two different empirical relationships have been used to model actual evapotranspiration, considering a water availability limited and an energy limited scheme. Model errors quantification, ranging from 2% to 40% on the long-term scale and from 1% to 36% at the event scale, appear strongly related to the particularly considered relationship.
This paper presents a feasibility study for the production of recycled glycol modified polyethylene terephthalate (PETG) material for additive manufacturing. Past studies showed a variety of results for the recycling of 3D-printing material, therefore the precise effect on the material properties is not completely clear. For this work, PETG waste of the same grade was recycled once and further processed into 3D printing filament. The study compares three blend ratios between purchased plastic pellets and recycled pellets to determine the degradation effect of one recycling cycle and possible blend ratios to counter these effects. Furthermore, the results include a commercially available filament. The comparison uses the filament diameter, the dimensional accuracy of the printed test specimen and mechanical properties as quality criteria. The study shows that the recycled material has a minor decrease concerning the tensile strength and Young’s modulus.
Productive biofilms are gaining growing interest in research due to their potential of producing valuable compounds and bioactive substances such as antibiotics. This is supported by recent developments in biofilm photobioreactors that established the controlled phototrophic cultivation of algae and cyanobacteria. Cultivation of biofilms can be challenging due to the need of surfaces for biofilm adhesion. The total production of biomass, and thus production of e.g. bioactive substances, within the bioreactor volume highly depends on the available cultivation surface. To achieve an enlargement of surface area for biofilm photobioreactors, biocarriers can be implemented in the cultivation. Thereby, material properties and design of the biocarriers are important for initial biofilm formation and growth of cyanobacteria. In this study, special biocarriers were designed and additively manufactured to investigate different polymeric materials and surface designs regarding biofilm adhesion of the terrestrial cyanobacterium Nostoc flagelliforme (CCAP 1453/33). Properties of 3D-printed materials were characterized by determination of wettability, surface roughness, and density. To evaluate the influence of wettability on biofilm formation, material properties were specifically modified by gas-phase fluorination and biofilm formation was analyzed on biocarriers with basic and optimized geometry in shaking flask cultivation. We found that different polymeric materials revealed no significant differences in wettability and with identical surface design no significant effect on biomass adhesion was observed. However, materials treated with fluorination as well as optimized biocarrier design showed improved wettability and an increase in biomass adhesion per biocarrier surface.
Innovative biogas multi-stage biogas plant and novel analytical system: First project experiences
(2012)
The here presented applied research and development project is targeted to the development and application of new and improved techniques in plant design, performance analysis and process control. Hereto following the required steps are illustrated and the goals are outlined. The project covers the development of a previously patented anaerobic digestion process, adaption of flow cytometry as an analytical instrument and investigation of innovative ways of disposal of solid fermentation wastes. The preliminary experiences with a newly built research plant employing a novel anaerobic biogas digestion technique are discussed. In this paper the first outcomes concerning the construction and operation are discussed. A novel method of disposal of the fermentation wastes is also discussed and first results are shown.
As productive biofilms are increasingly gaining interest in research, the quantitative monitoring of biofilm formation on- or offline for the process remains a challenge. Optical coherence tomography (OCT) is a fast and often used method for scanning biofilms, but it has difficulty scanning through more dense optical materials. X-ray microtomography (μCT) can measure biofilms in most geometries but is very time-consuming. By combining both methods for the first time, the weaknesses of both methods could be compensated. The phototrophic cyanobacterium Tolypothrix distorta was cultured in a moving bed photobioreactor inside a biocarrier with a semi-enclosed geometry. An automated workflow was developed to process µCT scans of the biocarriers. This allowed quantification of biomass volume and biofilm-coverage on the biocarrier, both globally and spatially resolved. At the beginning of the cultivation, a growth limitation was detected in the outer region of the carrier, presumably due to shear stress. In the later phase, light limitations could be found inside the biocarrier. µCT data and biofilm thicknesses measured by OCT displayed good correlation. The latter could therefore be used to rapidly measure the biofilm formation in a process. The methods presented here can help gain a deeper understanding of biofilms inside a process and detect any limitations.
The concept of Circular Economy (CE) is becoming increasingly important in the pursuit of more sustainable societies. CE strategies are being applied in the sustainable management of a plethora of areas, such as energy, water, food and eco-industrial parks. The present paper focuses on the question of how CE principles can support the sustainable management of water in the agricultural sector around the world, considering different legislative environments, water resources management guidelines, environmental stressors, and CE practices. Considering these practices and circumstances, seven countries were compared: Brazil, Germany, Japan, Mexico, Morocco, Portugal, and Taiwan. Together, CE experts in the seven countries developed a set of 44 criteria to assess each of these areas. Broader establishment and respect of water resources legislation was found to be strongly correlated with lower agricultural water use. While the application of CE practices was found to not be correlated with lower consumption, this is still novel in most countries. Based on the studied countries, it can be concluded that a global CE agenda has not been reached for water resources. Further application and variety of practices is required to better represent the impact of CE on a national scale, but local success stories could support the wider application of CE in agriculture. The findings and the framework of the study can be applied to other countries in directing CE strategies for more sustainable water use in agriculture. Increasing CE implementation, motivated by legislation and better management can help ensure water security throughout nations.
Most of the land reforms of recent decades have followed an approach of “formalization and capitalization” of individual land titles (de Soto 2000). However, within the privatization agenda, benefits of unimproved land (such as land rents and value capture) are reaped privately by well-organized actors, whereas the costs of valorization (e.g., infrastructure) or opportunity costs of land use changes are shifted onto poorly organized groups. Consequences of capitalization and formalization include rent seeking and land grabbing. In developing countries, formal law often transpires to work in favor of the winners of the titling process and is opposed by the customary rights of the losers. This causes a lack of general acknowledgement of formalized law (which is made responsible for deprivation of livelihoods of vulnerable groups) and often leads to a clash of formal and customary norms. Countries may fall into a state of de facto anarchy and “de facto open access”. Encroachment and destruction of natural resources may spread. A reframing of development policy is necessary in order to fight these aberrations. Examples and evidence are provided from Cambodia, which has many features in common with other countries in Asia and Sub-Saharan Africa in this respect.
We present the concrete realization of a virtual laboratory equipped with a pedagogical agent. Its functionality and media didactics takes into account the results of an usability test on a prototype system, and the students' demand on such an automated assistance as obtained from a preliminary survey. The pedagogical agent mediates between the content and the learner by activating him or her. To provide information about the learner's skills, we propose a pragmatic and simplified competence model that is based on fundamental representations in physics (experiment, figure, text and equation). Moreover, an automated feedback relates the student's self-assessment with the submitted answer to the correctness of the respective task. In consequence, the pedagogical agent enables mental reflection for a crucial review of the own learning process. Interestingly, learning pathways can be envisioned, thus, giving valuable insight into individual strengths and weaknesses.
Passenger cars in Europe have become both heavier and more powerful over the past decades. This trend has increased vehicle utility but it might have also offset technical improvements in powertrain efficiency. Here, we analyze efficiency trade-offs and CO2 emissions for three popular compact cars in Germany. We find that mass, power, and front area of model variants has increased by 66%, 147%, and 22%, respectively between 1980 and 2018. In the same period, fuel consumption decreased 14% for gasoline models but it increased 9% for diesel models. However, if vehicle mass, power, and front area had remained at 1980 levels, technical efficiency improvements would have decreased the fuel consumption of gasoline and diesel models by 23% and 24%, respectively. The related efficiency trade-offs amount to 24 g CO2/km or 13% of the current fuel consumption for gasoline models and 40 g CO2/km or 25% of the current fuel consumption for diesel models. These findings suggest that about half of the technical efficiency improvements in gasoline models and all of the technical efficiency improvements in diesel models are offset through other vehicle attributes. By accounting for the observed efficiency trade-offs, climate policy could become more effective.
Background: The Musculoskeletal Health Questionnaire (MSK-HQ) has been developed to measure musculoskeletal health status across musculoskeletal conditions and settings. However, the MSK-HQ needs to be further evaluated across settings and different languages.
Objective: The objective of the study was to evaluate and compare measurement properties of the MSK-HQ across Danish (DK) and English (UK) cohorts of patients from primary care physiotherapy services with musculoskeletal pain.
Methods: MSK-HQ was translated into Danish according to international guidelines. Measurement invariance was assessed by differential item functioning (DIF) analyses. Test-retest reliability, measurement error, responsiveness and minimal clinically important change (MCIC) were evaluated and compared between DK (n = 153) and UK (n = 166) cohorts.
Results: The Danish version demonstrated acceptable face and construct validity. Out of the 14 MSK-HQ items, three items showed DIF for language (pain/stiffness at night, understanding condition and confidence in managing symptoms) and three items showed DIF for pain location (walking, washing/dressing and physical activity levels). Intraclass Correlation Coefficients for test-retest were 0.86 (95% CI 0.81 to 0.91) for DK cohort and 0.77 (95% CI 0.49 to 0.90) for the UK cohort. The systematic measurement error was 1.6 and 3.9 points for the DK and UK cohorts respectively, with random measurement error being 8.6 and 9.9 points. Receiver operating characteristic (ROC) curves of the change scores against patients’ own judgment at 12 weeks exceeded 0.70 in both cohorts. Absolute and relative MCIC estimates were 8–10 points and 26% for the DK cohort and 6–8 points and 29% for the UK cohort.
Conclusions: The measurement properties of MSK-HQ were acceptable across countries, but seem more suited for group than individual level evaluation. Researchers and clinicians should be aware that some discrepancy exits and should take the observed measurement error into account when evaluating change in scores over time.
Local biodiversity trends over time are likely to be decoupled from global trends, as local processes may compensate or counteract global change. We analyze 161 long-term biological time series (15–91 years) collected across Europe, using a comprehensive dataset comprising ~6,200 marine, freshwater and terrestrial taxa. We test whether (i) local long-term biodiversity trends are consistent among biogeoregions, realms and taxonomic groups, and (ii) changes in biodiversity correlate with regional climate and local conditions. Our results reveal that local trends of abundance, richness and diversity differ among biogeoregions, realms and taxonomic groups, demonstrating that biodiversity changes at local scale are often complex and cannot be easily generalized. However, we find increases in richness and abundance with increasing temperature and naturalness as well as a clear spatial pattern in changes in community composition (i.e. temporal taxonomic turnover) in most biogeoregions of Northern and Eastern Europe.
Since tangible assets of companies are becoming increasingly insignificant, emphasis should rather be placed on human capital as an essential source of competitive edge. This paper, accordingly, pursues the purpose to shed light on the major demands that the Millenials place on their prospective employers. In consequence, the work aims to identify attractiveness factors that German retailers should particularly promote in order to succeed in the war for talents and attract the most promising candidates among the German Gen Y. This work is based on a mixed-methods approach. First, interviews with German retail experts as well as generational keynote speakers were conducted in order to obtain a deep understanding and assessment of the German retail landscape from a professional perspective. The insights gained were subsequently used to design a questionnaire, which distribution led to a final sample of 216 useable responses by Millenials. Furthermore, the data obtained by interviewing experts and the survey was subsequently compared in order to evaluate to what extent the expectations of the Millenials correspond to the experts’ assessment. This study reveals Millenials to be driven by the need for growth, such as wide offers of development opportunities or scope for decision when choosing an employer. Among the relatedness needs, a harmonious working environment is particularly important, whereas a weekend off ranks first among the existential needs. Moreover, male Millenials consider Media Markt being the most popular employer in the German retail sector, while dm is preferred from a female perspective. Overall, employers of the German retail sector provide the majority of factors required by the Millenials, yet are only considered the 4th most popular industry behind the automotive, IT, art and entertainment industries. Our findings provide valuable practical implications as the research results might serve companies to build up a target group specific employer brand. Marketing strategies can be aligned with the identified attractiveness factors to efficiently and cost-effectively attract and bind Millenials to the company. Customized recruiting campaigns enhance the appeal as well as the attractiveness of an employer driving the likelihood of obtaining the strived status: Employer of Choice. To the best of the author’s knowledge, no study has yet dealt specifically with the attractiveness factors demanded by the Millenials in the context of the German retail sector as well as their most aspired employers in this industry. Furthermore, the attractiveness factors identified in the literature were embedded in Aldefer’s ERG theory. This work also offers a bilateral perspective through the widely conducted survey carried out among Millenials, which was additionally expanded through the lens of experts.
Electrical stimulation is used for example to treat neuronal disorders and depression with deep brain stimulation or transcranial electrical stimulation. Depending on the application, different electrodes are used and thus different electrical characteristics exist, which have to be handled by the stimulator. Without a measuring device the user would have to rely on the stimulator being able to deliver the needed stimulation signal. Therefore, the objective of this paper is to present a method to increase the level of confidence with characterization and modelling of the electrical behavior by using the example of one channel of our stimulation device for experimental use. In several simulation studies with an electrode model with values in a typical range for cortical applications the influence of the load onto the stimulator and the possibility to pre-estimate measuring signals in complex networks are shown.
Multimodal meaning making: The annotation of nonverbal elements in multimodal corpus transcription
(2021)
The article discusses how to integrate annotation for nonverbal elements (NVE) from multimodal raw data as part of a standardized corpus transcription. We argue that it is essential to include multimodal elements when investigating conversational data, and that in order to integrate these elements, a structured approach to complex multimodal data is needed. We discuss how to formulate a structured corpus-suitable standard syntax and taxonomy for nonverbal features such as gesture, facial expressions, and physical stance, and how to integrate it in a corpus. Using corpus examples, the article describes the development of a robust annotation system for spoken language in the corpus of Video-mediated English as a Lingua Franca Conversations (ViMELF 2018) and illustrates how the system can be used for the study of spoken discourse. The system takes into account previous research on multimodality, transcribes salient nonverbal features in a concise manner, and uses a standard syntax. While such an approach introduces a degree of subjectivity through the criteria of salience and conciseness, the system also offers considerable advantages: it is versatile and adaptable, flexible enough to work with a wide range of multimodal data, and it allows both quantitative and qualitative research on the pragmatics of interaction.
The current work investigates the capability of a tailored multivariate curve resolution–alternating least squares (MCR-ALS) algorithm to analyse glucose, phosphate, ammonium and acetate dynamics simultaneously in an E. coli BL21 fed-batch fermentation. The high-cell-density (HCDC) process is monitored by ex situ online attenuated total reflection (ATR) Fourier transform infrared (FTIR) spectroscopy and several in situ online process sensors. This approach efficiently utilises automatically generated process data to reduce the time and cost consuming reference measurement effort for multivariate calibration. To determine metabolite concentrations with accuracies between ±0.19 and ±0.96·gL−l, the presented utilisation needs primarily — besides online sensor measurements — single FTIR measurements for each of the components of interest. The ambiguities in alternating least squares solutions for concentration estimation are reduced by the insertion of analytical process knowledge primarily in the form of elementary carbon mass balances. Thus, in this way, the established idea of mass balance constraints in MCR combines with the consistency check of measured data by carbon balances, as commonly applied in bioprocess engineering. The constraints are calculated based on online process data and theoretical assumptions. This increased calculation effort is able to replace, to a large extent, the need for manually conducted quantitative chemical analysis, leads to good estimations of concentration profiles and a better process understanding.
Background: Recent shoulder injury prevention programs have utilized resistance exercises combined with different forms of instability, with the goal of eliciting functional adaptations and thereby reducing the risk of injury. However, it is still unknown how an unstable weight mass (UWM) affects the muscular activity of the shoulder stabilizers. Aim of the study was to assess neuromuscular activity of dynamic shoulder stabilizers under four conditions of stable and UWM during three shoulder exercises. It was hypothesized that a combined condition of weight with UWM would elicit greater activation due to the increased stabilization demand.
Methods: Sixteen participants (7 m/9 f) were included in this cross-sectional study and prepared with an EMG-setup for the: Mm. upper/lower trapezius (U.TA/L.TA), lateral deltoid (DE), latissimus dorsi (LD), serratus anterior (SA) and pectoralis major (PE). A maximal voluntary isometric contraction test (MVIC; 5 s.) was performed on an isokinetic dynamometer. Next, internal/external rotation (In/Ex), abduction/adduction (Ab/Ad) and diagonal flexion/extension (F/E) exercises (5 reps.) were performed with four custom-made-pipes representing different exercise conditions. First, the empty-pipe (P; 0.5 kg) and then, randomly ordered, water-filled-pipe (PW; 1 kg), weight-pipe (PG; 4.5 kg) and weight + water-filled-pipe (PWG; 4.5 kg), while EMG was recorded. Raw root-mean-square values (RMS) were normalized to MVIC (%MVIC). Differences between conditions for RMS%MVIC, scapular stabilizer (SR: U.TA/L.TA; U.TA/SA) and contraction (CR: concentric/eccentric) ratios were analyzed (paired t-test; p ≤ 0.05; Bonferroni adjusted α = 0.008).
Results: PWG showed significantly greater muscle activity for all exercises and all muscles except for PE compared to P and PW. Condition PG elicited muscular activity comparable to PWG (p > 0.008) with significantly lower activation of L.TA and SA in the In/Ex rotation. The SR ratio was significantly higher in PWG compared to P and PW. No significant differences were found for the CR ratio in all exercises and for all muscles.
Conclusion: Higher weight generated greater muscle activation whereas an UWM raised the neuromuscular activity, increasing the stabilization demands. Especially in the In/Ex rotation, an UWM increased the RMS%MVIC and SR ratio. This might improve training effects in shoulder prevention and rehabilitation programs.
Internet of Things (IoT) and Artificial Intelligence (AI) are one of the most promising and disruptive areas of current research and development. However, these areas require deep knowledge in multiple disciplines such as sensors, protocols, embedded programming, distributed systems, statistics and algorithms. This broad knowledge is not easy to acquire and the software used to design these systems is becoming increasingly complex. Small and medium-sized enterprises therefore have problems in developing new business ideas. However, node- and block-based software tools have also been released and are freely available as open source toolboxes. In this paper, we present an overview of multiple node- and block-based software tools to develop IoT- and AI-based business ideas. We arrange these tools according their capabilities and further propose extension and combinations of tools to design a useful open-source library for small and medium-sized enterprises, that is easy to use and helps with rapid prototyping, enabling new business ideas to be developed using distributed computing.
This study introduced an automated long-term fermentation process for fungals grown in pellet form. The goal was to reduce the overgrowth of bioreactor internals and sensors while better rheological properties in the fermentation broth, such as oxygen transfer and mixing time, can be achieved. Because this could not be accomplished with continuous culture and fed-batch fermentation, repeated-batch fermentation was implemented with the help of additional bioreactor internals (“sporulation supports”). This should capture some biomass during fermentation. After harvesting the suspended biomass, intermediate cleaning was performed using a cleaning device. The biomass retained on the sporulation support went through the sporulation phase. The spores were subsequently used as inocula for the next batch. The reason for this approach was that the retained pellets could otherwise cause problems (e.g., overgrowth on sensors) in subsequent batches because the fungus would then show undesirable hyphal growth. Various sporulation supports were tested for sufficient biomass fixation to start the next batch. A reproducible spore concentration within the range of the requirements could be achieved by adjusting the sporulation support (design and construction material), and an intermediate cleaning adapted to this.
The study traces the development of compulsory vaccination in Germany against the background of political discussion and legislative activities, focusing on the area of tension between state health protection and the right to medical self-determination in the context of constitutional balancing. It is based on the assumption that the right to medical self-determination traditionally dominates state decisions in a democratic constitutional state and that the scope for decision-making is constantly being further contoured in the face of current challenges.
In the single-processor scheduling problem with time restrictions there is one main processor and B resources that are used to execute the jobs. A perfect schedule has no idle times or gaps on the main processor and the makespan is therefore equal to the sum of the processing times. In general, more resources result in smaller makespans, and as it is in practical applications often more economic not to mobilize resources that will be unnecessary and expensive, we investigate in this paper the problem to find the smallest number B of resources that make a perfect schedule possible. We show that the decision version of this problem is NP-complete, derive new structural properties of perfect schedules, and we describe a Mixed Integer Linear Programming (MIP) formulation to solve the problem. A large number of computational tests show that (for our randomly chosen problem instances) only B=3 or B=4 resources are sufficient for a perfect schedule.
Online Learning algorithms and Indoor Positioning Systems are complex applications in the environment of cyber-physical systems. These distributed systems are created by networking intelligent machines and autonomous robots on the Internet of Things using embedded systems that enable the exchange of information at any time. This information is processed by Machine Learning algorithms to make decisions about current developments in production or to influence logistics processes for optimization purposes. In this article, we present and categorize the further development of the prototype of a novel Indoor Positioning System, which constantly adapts its knowledge to the conditions of its environment with the help of Online Learning. Here, we apply Online Learning algorithms in the field of sound-based indoor localization with low-cost hardware and demonstrate the improvement of the system over its predecessor and its adaptability for different applications in an experimental case study.
The integration of genetic algorithms to optimize the networks of value chains could enormously improve the performance of supply chains. For this reason, this paper describes in more detail the application of genetic algorithms in the value chains of the automotive industry. For this purpose, a theoretical model is built up to evaluate whether the application of the model can optimize the value chain. This option is described, analyzed and its restrictions are shown. Instead of looking at the entire network, individual finished goods and their bill of material are used as a basis for optimization, which greatly reduces the complexity of the original problem. The original complexity of the supply chain networks can thus be reduced and considered based on the bill of material.
Organic semiconductor distributed feedback laser fabricated by direct laser interference ablation
(2007)
We use a pulsed, frequency tripled picosecond Nd:YAG laser for holographic ablation to pattern a surface relief grating into an organic semiconductor guest-host system. The resulting second order distributed feedback lasers exhibit laser action with laser thresholds being comparable to those obtained with resonators structured by standard lithographic techniques. The details of the interference ablation of tris-(8-hydroxyquinoline) aluminum (Alq(3)) doped with the laser dye 4- dicyanomethylene-2-methyl-6-(p-dimethylaminostyryl)-4H-pyran (DCM) are presented and discussed. Lasing action is demonstrated at a wavelength of 646.6 nm, exploiting second order Bragg reflection in a relief grating with a period of 399 nm.
Aim: The aim of the study was to identify common orthopedic sports injury profiles in adolescent elite athletes with respect to age, sex, and anthropometrics.
Methods: A retrospective data analysis of 718 orthopedic presentations among 381 adolescent elite athletes from 16 different sports to a sports medical department was performed. Recorded data of history and clinical examination included area, cause and structure of acute and overuse injuries. Injury-events were analyzed in the whole cohort and stratified by age (11–14/15–17 years) and sex. Group differences were tested by chi-squared-tests. Logistic regression analysis was applied examining the influence of factors age, sex, and body mass index (BMI) on the outcome variables area and structure (α = 0.05).
Results: Higher proportions of injury-events were reported for females (60%) and athletes of the older age group (66%) than males and younger athletes. The most frequently injured area was the lower extremity (47%) followed by the spine (30.5%) and the upper extremity (12.5%). Acute injuries were mainly located at the lower extremity (74.5%), while overuse injuries were predominantly observed at the lower extremity (41%) as well as the spine (36.5%). Joints (34%), muscles (22%), and tendons (21.5%) were found to be the most often affected structures. The injured structures were different between the age groups (p = 0.022), with the older age group presenting three times more frequent with ligament pathology events (5.5%/2%) and less frequent with bony problems (11%/20.5%) than athletes of the younger age group. The injured area differed between the sexes (p = 0.005), with males having fewer spine injury-events (25.5%/34%) but more upper extremity injuries (18%/9%) than females. Regression analysis showed statistically significant influence for BMI (p = 0.002) and age (p = 0.015) on structure, whereas the area was significantly influenced by sex (p = 0.005).
Conclusion: Events of soft-tissue overuse injuries are the most common reasons resulting in orthopedic presentations of adolescent elite athletes. Mostly, the lower extremity and the spine are affected, while sex and age characteristics on affected area and structure must be considered. Therefore, prevention strategies addressing the injury-event profiles should already be implemented in early adolescence taking age, sex as well as injury entity into account.
Deep brain stimulation (DBS) is a neurosurgical intervention where electrodes are permanently implanted into the brain in order to modulate pathologic neural activity. The post-operative reconstruction of the DBS electrodes is important for an efficient stimulation parameter tuning. A major limitation of existing approaches for electrode reconstruction from post-operative imaging that prevents the clinical routine use is that they are manual or semi-automatic, and thus both time-consuming and subjective. Moreover, the existing methods rely on a simplified model of a straight line electrode trajectory, rather than the more realistic curved trajectory. The main contribution of this paper is that for the first time we present a highly accurate and fully automated method for electrode reconstruction that considers curved trajectories. The robustness of our proposed method is demonstrated using a multi-center clinical dataset consisting of N = 44 electrodes. In all cases the electrode trajectories were successfully identified and reconstructed. In addition, the accuracy is demonstrated quantitatively using a high-accuracy phantom with known ground truth. In the phantom experiment, the method could detect individual electrode contacts with high accuracy and the trajectory reconstruction reached an error level below 100 μm (0.046 ± 0.025 mm). An implementation of the method is made publicly available such that it can directly be used by researchers or clinicians. This constitutes an important step towards future integration of lead reconstruction into standard clinical care.
Background: Stratified care has the potential to be efficient in addressing the physical and psychosocial components of low back pain (LBP) and optimise treatment outcomes essential in low-income countries. This study aimed to investigate the perceptions of physiotherapists and patients in Nigeria towards stratified care for the treatment of LBP, exploring barriers and enablers to implementation.
Methods: A qualitative design with semistructured individual telephone interviews for physiotherapists and patients with LBP comprising research evidence and information on stratified care was adopted. Preceding the interviews, patients completed the Subgroups for Targeted Treatment tool. The interviews were recorded, transcribed and analysed following grounded theory methodology.
Results: Twelve physiotherapists and 13 patients with LBP participated in the study (11 female, mean age 42.8 (SD 11.47) years). Seven key categories emerged: recognising the need for change, acceptance of innovation, resistance to change, adapting practice, patient’s learning journey, trusting the therapist and needing conviction. Physiotherapists perceived stratified care to be a familiar approach based on their background training. The prevalent treatment tradition and the patient expectations were seen as major barriers to implementation of stratified care by the physiotherapists. Patients see themselves as more informed than therapists realise, yet they need conviction through communication and education to cooperate with their therapist using this approach. Viable facilitators were also identified as patients’ trust in the physiotherapist and adaptations in terms of training and modification of the approach to enhance its use.
Conclusion: Key barriers identified are the patients’ treatment expectations and physiotherapists’ adherence to the tradition of practice. Physiotherapists might facilitate implementation of the stratified care by communication, hierarchical implementation and utilisation of patients’ trust. Possibilities to develop a consensus on key strategies to overcome barriers and on utilisation of facilitators should be tested in future research.
Stratified care for low back pain (LBP) has been shown to be clinically- and cost-effective in the UK, but its transferability to the German healthcare system is unknown. This study explores LBP patients’ perspectives regarding future implementation of stratified care, through in-depth interviews (n = 12). The STarT-Back-Tool was completed by participants prior to interviews. Interview data were analysed using Grounded Theory. The overarching theme identified from the data was ‘treatment-success’, with subthemes of ‘assessment and treatment planning’, ‘acceptance of the questionnaire’ and ‘contextual factors’. Patients identified the underlying cause of pain as being of great importance (whereas STarT-Back allocates treatment based on prognosis). The integration of the STarT-Back-Tool in consultations was considered helpful as long as it does not disrupt the therapeutic relationship, and was acceptable if tool results are handled confidentially. Results indicate that for patients to find STarT-Back acceptable, the shift from a focus on identifying a cause of pain and subsequent diagnosis, to prediction-orientated treatment planning, must be made clear. Patient ‘buy in’ is important for successful uptake of clinical interventions, and findings can help to inform future strategies for implementing STarT-Back in the Germany, as well as having potential implications for transferability to other similar healthcare systems.
This paper describes the project “Visual Knowledge Communication”, a joint project that started recently. The partners are psychologists and computer scientists from four universities of the German state Rhineland-Palatinate. The starting point for the project was the fact that visualizations have attracted considerable interest in psychology as well as computer science within the last years. However, psychologists and computer scientists pursued their investigations independently from each other in the past. This project has as its main goal the support and fostering of cooperation between psychologists and computer scientists in several visualization research projects.
The paper sketches the overall project. It then discusses in more detail the authors' subproject which deals with a peer review process for animations developed by students. The basic ideas, the main goals, and the project plan are described.
This paper is a work-in-progress report. Therefore, it does not contain any results.
This scientific paper aims to collect and analyze various digital technologies connected to pharmacies and Health 4.0. Thus, the goal is to give basic recommendations for actions for pharmacies to remain successful businesses in the digital future of healthcare. While the total health sector is growing continuously, the total number of pharmacies is shrinking. To be able to face the competitive pressure on the pharmaceutical market, pharmacies have to integrate more efficient digital technologies to be able to increase customers’ experience. Hence, the acceptance and attitude of the German society towards digital health solutions are examined using a short survey and a precise questionnaire. After a detailed analysis of the survey results and the questionnaire answered by a pharmacist, specific digital methods and technologies which make sense for pharmacies can be elaborated. As the future of pharmacies is still quite unexplored, while the health market is shifting to more efficient digital solutions, pharmacies have to adapt to current developments fast. Therefore, this paper can serve as a guideline for pharmacies in the rapid changes toward more digital markets.
Background: The STarT-Back-Approach (STarT: Subgroups for Targeted Treatment) was developed in the UK and has demonstrated clinical and cost effectiveness. Based on the results of a brief questionnaire, patients with low back pain are stratified into three treatment groups. Since the organisation of physiotherapy differs between Germany and the UK, the aim of this study is to explore German physiotherapists’ views and perceptions about implementing the STarT-Back-Approach.
Methods: Three two-hour think-tank workshops with physiotherapists were conducted. Focus groups, using a semi-structured interview guideline, followed a presentation of the STarT-Back-Approach, with discussions audio recorded, transcribed and qualitatively analysed using content analysis.
Results: Nineteen physiotherapists participated (15 female, mean age 41.2 (SD 8.6) years). Three main themes emerged, each with multiple subthemes: 1) the intervention (15 subthemes), 2) the healthcare context (26 subthemes) and 3) individual characteristics (8 subthemes). Therapists’ perceptions of the extent to which the STarT-Back intervention would require changes to their normal clinical practice varied considerably. They felt that within their current healthcare context, there were significant financial disincentives that would discourage German physiotherapists from providing the STarT-Back treatment pathways, such as the early discharge of low-risk patients with supported self-management materials. They also discussed the need for appropriate standardised graduate and post-graduate skills training for German physiotherapists to treat high-risk patients with a combined physical and psychological approach (e.g., communication skills).
Conclusions: Whilst many German physiotherapists are positive about the STarT-Back-Approach, there are a number of substantial barriers to implementing the matched treatment pathways in Germany. These include financial disincentives within the healthcare system to early discharge of low-risk patients. Therapists also highlighted the need for solutions in respect of scalable physiotherapy training to gain skills in combined physical and psychological approaches.