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For pelvic floor disorders that cannot be treated with non-surgical procedures, minimally invasive surgery has become a more frequent and safer repair procedure. More than 20 million prosthetic meshes are implanted each year worldwide. The simple selection of a single synthetic mesh construction for any level and type of pelvic floor dysfunctions without adopting the design to specific requirements increase the risks for mesh related complications. Adverse events are closely related to chronic foreign body reaction, with enhanced formation of scar tissue around the surgical meshes, manifested as pain, mesh erosion in adjacent structures (with organ tissue cut), mesh shrinkage, mesh rejection and eventually recurrence. Such events, especially scar formation depend on effective porosity of the mesh, which decreases discontinuously at a critical stretch when pore areas decrease making the surgical reconstruction ineffective that further augments the re-operation costs. The extent of fibrotic reaction is increased with higher amount of foreign body material, larger surface, small pore size or with inadequate textile elasticity. Standardized studies of different meshes are essential to evaluate influencing factors for the failure and success of the reconstruction. Measurements of elasticity and tensile strength have to consider the mesh anisotropy as result of the textile structure. An appropriate mesh then should show some integration with limited scar reaction and preserved pores that are filled with local fat tissue. This chapter reviews various tissue reactions to different monofilament mesh implants that are used for incontinence and hernia repairs and study their mechanical behavior. This helps to predict the functional and biological outcomes after tissue reinforcement with meshes and permits further optimization of the meshes for the specific indications to improve the success of the surgical treatment.
Pelvic floor dysfunction (PFD) is characterized by the failure of the levator ani (LA) muscle to maintain the pelvic hiatus, resulting in the descent of the pelvic organs below the pubococcygeal line. This chapter adopts the modified Humphrey material model to consider the effect of the muscle fiber on passive stretching of the LA muscle. The deformation of the LA muscle subjected to intra-abdominal pressure during Valsalva maneuver is compared with the magnetic resonance imaging (MRI) examination of a nulliparous female. Numerical result shows that the fiber-based Humphrey model simulates the muscle behavior better than isotropic constitutive models. Greater posterior movement of the LA muscle widens the levator hiatus due to lack of support from the anococcygeal ligament and the perineal structure as a consequence of birth-related injury and aging. Old and multiparous females with uncontrolled urogenital and rectal hiatus tend to develop PFDs such as prolapse and incontinence.
Dieser Beitrag stellt einen Bewertungsrahmen für Smart Services vor, der auf dem Konzept vollständiger Finanzpläne (VOFI) basiert. Zunächst wird eine IoT-Architektur für Smart Services eingeführt, die die Grundlage für deren Betrachtung aus Sicht der Unternehmensplanung liefert. Hierauf aufbauend wird ein Bewertungsrahmen für die finanzplanorientierte Wirtschaftlichkeitsbewertung von Smart Services geschaffen, mit dem die relevanten Zahlungsfolgen differenziert erfasst werden. Mithilfe des entwickelten VOFI-Systems wird anschließend aufgezeigt, wie mithilfe einer Risikoanalyse die Unsicherheit von Modellparametern berücksichtigt werden kann.
Information technologies, such as big data analytics, cloud computing,
cyber physical systems, robotic process automation, and the internet of things, provide a sustainable impetus for the structural development of business sectors as well as the digitalization of markets, enterprises, and processes. Within the consulting industry, the proliferation of these technologies opened up the new segment of digital transformation, which focuses on setting up, controlling, and implementing projects for enterprises from a broad range of sectors. These recent developments raise the question, which requirements evolve for IT consultants as important success factors of those digital transformation projects. Therefore, this empirical contribution provides indications regarding the qualifications and competences necessary for IT consultants in the era of digital transformation from a labor market perspective. On the one hand, this knowledge base is interesting for the academic education of consultants, since it supports a market-oriented design of adequate training measures. On the other hand, insights into the competence requirements for consultants are considered relevant for skill and talent management processes in consulting practice. Assuming that consulting companies pursue a strategic human resource management approach, labor market information may also be useful to discover strategic behavioral patterns.
The benefits of robotic process automation (RPA) are highly related to the usage of commercial off-the-shelf (COTS) software products that can be easily implemented and customized by business units. But, how to find the best fitting RPA product for a specific situation that creates the expected benefits? This question is related to the general area of software evaluation and selection. In the face of more than 75 RPA products currently on the market, guidance considering those specifics is required. Therefore, this chapter proposes a criteria-based selection method specifically for RPA. The method includes a quantitative evaluation of costs and benefits as well as a qualitative utility analysis based on functional criteria. By using the visualization of financial implications (VOFI) method, an application-oriented structure is provided that opposes the total cost of ownership to the time savings times salary (TSTS). For the utility analysis a detailed list of functional criteria for RPA is offered. The whole method is based on a multi-vocal review of scientific and non-scholarly literature including publications by business practitioners, consultants, and vendors. The application of the method is illustrated by a concrete RPA example. The illustrated
structures, templates, and criteria can be directly utilized by practitioners in their real-life RPA implementations. In addition, a normative decision process for selecting RPA alternatives is proposed before the chapter closes with a discussion and outlook.
BIG KARL and COSY
(1995)
Der Themenkomplex urbane Mobilität ist getrieben durch den Verkehrsinfarkt in Ballungszentren, durch Luftverschmutzung und Lärm, sowie den Trend zum Leben in der Stadt in den städteplanerischen Fokus gerückt. Emissionsneutrale Antriebskonzepte in der Luftfahrt führen zu Ansätzen Fluggeräte einzusetzen, die batteriegetrieben vertikal aufsteigen und landen können. Flugphysikalisch und energetisch ist diese Technik nur dann sinnvoll, wenn es zwingende Gründe gibt (z.B. Rettungseinsätze), daher wird der flugphysikalische Hintergrund prinzipiell erläutert. Es werden einige aktuelle Lufttransportkonzepte für eine urbane Personenbeförderung vorgestellt. Sollte es verstärkt zu Lufttransport über Städten kommen, müssen betroffene Lufträume geordnet und überwacht werden. Wie kompatibel Lufttransportsysteme mit den heute bereits relevanten urbanen Beförderungsmitteln sein müssen, wird kritisch diskutiert. Abschließend werden die Aspekte Akzeptanz durch die Kunden und Wirtschaftlichkeit ebenso angerissen, wie die hochproblematische Rohstoffgewinnung, die Entsorgung und das Recycling von Batterien.