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IntroductionThe purpose of this study was to determine the earliest timing of inguinal hernia repair under general anesthesia with minimized risk for respiratory complications during postoperative course.MethodsWe performed a monocentric analysis of patient records of premature and full-term infants undergoing inguinal hernia repair between 2009 and 2016. In addition to demographic and medical parameters, preexisting conditions and the perioperative course were recorded.ResultsThe study included 499 infants (preterm n = 285; full term n = 214). The number of subsequently ventilated patients was particularly high among preterm infants with bronchopulmonary dysplasia, up to 45.3% (p < 0.001). Less than 10% of subsequent ventilation occurred in preterm infants after 45 weeks of postmenstrual age at the time of surgery or in patients with a body weight of more than 4,100 g. Preterm infants with a bronchopulmonary dysplasia had an increased risk of apneas (p < 0.05). Only 10% of the preterm babies with postoperative apneas weighed more than 3,600 g at the time of surgery or were older than 44 weeks of postmenstrual age.ConclusionOur data indicate that after the 45th week of postmenstrual age and a weight above 4,100 g, the risk for respiratory failure after general anesthesia seems to be significantly decreased in preterm infants.

The MACCS (Medical Assistant for Chronic Care Service) platform enables secure sharing of key medical information between patients after kidney transplantation and physicians. Patients provide information such as vital signs, well-being, and medication intake via smartphone apps. The information is transferred directly into a database and electronic health record at the kidney transplant center, which is used for routine patient care and research. Physicians can send an updated medication plan and laboratory data directly to the patient app via this secure platform. Other features of the app are medical messages and video consultations. Consequently, the patient is better-informed, and self-management is facilitated. In addition, the transplant center and the patient's local nephrologist automatically exchange notes, medical reports, laboratory values, and medication data via the platform. A telemedicine team reviews all incoming data on a dashboard and takes action, if necessary. Tools to identify patients at risk for complications are under development. The platform exchanges data via a standardized secure interface (Health Level 7 (HL7), Fast Healthcare Interoperability Resources (FHIR)). The standardized data exchange based on HL7 FHIR guarantees interoperability with other eHealth solutions and allows rapid scalability to other chronic diseases. The underlying data protection concept is in concordance with the latest European General Data Protection Regulation. Enrollment started in February 2020, and 131 kidney transplant recipients are actively participating as of July 2020. Two large German health insurance companies are currently funding the telemedicine services of the project. The deployment for other chronic kidney diseases and solid organ transplant recipients is planned. In conclusion, the platform is designed to enable home monitoring and automatic data exchange, empower patients, reduce hospitalizations, and improve adherence, and outcomes after kidney transplantation.

A key objective of strategy management is ensuring the implementation of strategies in the day-to-day operational business processes of enterprises. For this purpose, researchers and practitioners developed an enormous body of methods for strategy management. However, the tremendous variety of strategy management methods makes it difficult to choose the most appropriate methods for a given challenge. In an effort to provide guidance for practitioners and researchers, this paper provides an integrated dataset of the 50 most widespread strategy design and implementation methods and links these methods to a large body of 100 case studies. Based on this dataset, commonly utilized methods, common challenges, typical objectives, and specifics of industries are examined.

We report on the presence of a functional hydroxyectoine biosynthesis gene cluster, ectABCD-ask , in Pseudomonas stutzeri DSM5190 T and evaluate the suitability of P. stutzeri DSM5190 T for hydroxyectoine production. Furthermore, we present information on heterologous de novo production of the compatible solute hydroxyectoine in Escherichia coli . In this host, the P. stutzeri gene cluster remained under the control of its salt-induced native promoters. We also noted the absence of trehalose when hydroxyectoine genes were expressed, as well as a remarkable inhibitory effect of externally applied betaine on hydroxyectoine synthesis. The specific heterologous production rate in E. coli under the conditions employed exceeded that of the natural producer Pseudomonas stutzeri and, for the first time, enabled effective hydroxyectoine production at low salinity (2%), with the added advantage of simple product processing due to the absence of other cosolutes.

The foliar pathogen Pseudomonas syringae pv. syringae exhibits an exceptional ability to survive on asymptomatic plants as an epiphyte. Intermittent wetting events on plants lead to osmotic and matric stresses which must be tolerated for survival as an epiphyte. In this study, we have applied bioinformatic, genetic, and biochemical approaches to address water stress tolerance in P. syringae pv. syringae strain B728a, for which a complete genome sequence is available. P. syringae pv. syringae B728a is able to produce the compatible solutes betaine, ectoine, N -acetylglutaminylglutamine amide (NAGGN), and trehalose. Analysis of osmolyte profiles of P. syringae pv. syringae B728a under a variety of in vitro and in planta conditions reveals that the osmolytes differentially contribute to water stress tolerance in this species and that they interact at the level of transcription to yield a hierarchy of expression. While the interruption of a putative gene cluster coding for NAGGN biosynthesis provided the first experimental evidence of the NAGGN biosynthetic pathway, application of this knockout strain and also a gfp reporter gene fusion strain demonstrated the small contribution of NAGGN to cell survival and desiccation tolerance of P. syringae pv. syringae B728a under in planta conditions. Additionally, detailed investigation of ectC , an orphan of the ectoine cluster (lacking the ectA and ectB homologs), revealed its functionality and that ectoine production could be detected in NaCl-amended cultures of P. syringae pv. syringae B728a to which sterilized leaves of Syringa vulgaris had been added.

Middle managers, who are responsible for business processes, are a typical source for innovative IT requirements. Since specialized requirements engineers are often not available, process managers are facing the challenge of specifying high-quality requirements. This paper extends S-BPM process models by a strategic view, so that identified IT barriers harming workflows can be explicitly recognized. A proposed template guides managers to specify correct and complete requirements. Moreover, with the help of a vector comparison, dependencies between requirements can be detected and resolved. The new modeling notation, the templates and the consistency check are finally represented using an illustrative case study of a manufacturer from Switzerland.

Adaptive case management (ACM) is an increasingly popular approach for supporting knowledge-intensive business processes. Being a new approach, it still lacks a similar degree of standardization as the more established business process management (BPM) approaches. This paper introduces the new Case Management and Model and Notation (CMMN) standard. Based on a set of ACM requirements, the applicability of CMMN for modeling ACM cases is examined thoroughly and extensions improving the ACM support of CMMN are proposed.

Successful companies use business processes for the transfer of long-term strategies in operational workflows. The modeling approach presented in this chapter shows how strategic objectives of a company can be combined with the S-BPM modeling notation. The new modeling approach is used in two case studies. First, redesign rules for the strategic optimization of workflow models are demonstrated in the case of the customer support processes of an international enterprise. A second case study introduces a company-wide monitoring system through the example of the product development process of a multinational company from Germany.

The paper deals with a physical model for the calculation of the strip temperature in a hot rolling mill. Beside the heat transfer from the strip to the environment in the different mill sections a sub-model for the material properties of steel including phase transitions is introduced. For the application in a process automation system an online adaptation of the model to the current state of the mill is indispensable. The adaptation is explained in detail.

Automatic width control is one key issue in hot strip rolling and the main actuator for width control is the vertical draft (edging) applied to slabs in the roughing sequence. In order to compensate for the occurring strip necking, a variable edger gap is applied in the edging process. This paper introduces a comprehensive mathematical optimization approach for the fully automatic generation of the associated edger roll trajectories, which is based on a nonlinear dynamic simulation model for the material flow in the roughing mill. Due to the complexity of this simulation model, gradient-based methods are applied to solve the resulting optimization problem in reasonable time. Hence, derivatives of cost functional and constraints must be provided, which entails computing sensitivity information from the underlying simulation model. Finally, numerical results for real-world examples are discussed to illustrate the capability of the presented approach. In particular, this paper examines the influence of characteristic parameters such as the slab width or the maximum edger screw in velocity onto the optimization results.

A key objective of strategy management is ensuring the implementation of strategies in the day-to-day operational business processes of enterprises. For this purpose, researchers and practitioners developed an enormous body of methods for strategy management. However, the tremendous variety of strategy management methods makes it difficult to choose the most appropriate methods for a given challenge. In order to learn from field studies and to provide guidance for practitioners and researchers, this paper provides a dataset of the 50 methods from a body of 100 case studies focusing on strategy design and implementation in the field of business process management. Based on this dataset, commonly utilised methods, common challenges, typical objectives and the role of the management levels are examined. Researchers may use this freely available dataset as a foundation for their own further research.

Adaptive Case Management is a Business Process Management approach that is quickly gaining the attention of practitioners and scientists. In an effort to examine how Subject-oriented Business Process Management relates to Adaptive Case Management, this contribution proposes extending an existing ACM approach inspired by multi-agent systems with the capability of defining temporal-logical dependencies between tasks using Subject-oriented Business Process Management.

Traditional S-BPM successfully focuses on standardized business processes which are performed according to a fixed predefined process model. Yet a substantial share of business processes is difficult to predict with exceptions to the core processes occurring frequently.

The success of knowledge work represents one of the most important assets for businesses to date, and managers across all industries are searching for new ways to increase the productivity in this domain. Since traditional approaches, such as Business Process Management do not provide the suitable context to support knowledge intensive workflows, the recent trend of Adaptive Case Management has set out to address this issue by providing a framework that supports the required flexibility and enables an agile and dynamic environment. However, fundamental knowledge about this approach is currently scattered across a series of collective volumes and web blogs that tend to focus on isolated aspects or domain-specific challenges and solution approaches. As the ongoing discussion still lacks comprehensive theoretical literature, principles are driven mostly by individual circumstances, and common ideas are not transparent. The goal of this research effort is to provide a structured, domain-independent overview about the common principles in ACM and derive a set of distinct challenges in order to contribute to the general understanding of this paradigm. This work therefore discusses and consolidates existing literature, and subsequently focuses on the role of complexity in knowledge work to provide a foundation for the resulting challenge definitions. To complement the theoretical discussion, the final section of this paper provides a series of selected solution approaches that effectively support knowledge-intensive workflows.

Businesses today have to adapt their business process models to new market changes instantaneously. New social BPM approaches leverage collaborative Enterprise 2.0 methods and tools in order to empower the process participants to improve their business processes continuously. By enabling those who are running the processes to adapt “their” processes, businesses can respond to new market demands faster. A well-tested example of such an approach is BPM 2.0. This contribution reports about a BPM implementation project conducted at Eisen-Fischer GmbH, which uses BPM 2.0 as the underlying methodology. It provides insights in the potentials and limitations of social BPM approaches like BPM 2.0. As a major objective of the BPM implementation project is to retain the existing ISO 9001 certification, this report assists businesses in a similar situation to assess the potentials social BPM may provide for their individual situation.

In literature and business practice, implementing the business strategy and analyzing business processes is often addressed separately although business processes are regarded as a competitive key resource. In many businesses, it is unclear which systematic approach is most appropriate to identify process analysis methods which support the achievement of strategic objectives best. This contribution proposes an association model for the systematic combination of corporate strategy and business process analysis methods: First, it describes how a corporate strategy can be formalized. Then, a system is designed that rates known process analysis methods according to their support of the process strategy. Users of the model only have to rate the importance of strategy classes on a numerical scale. In order to validate the model, it has been tested during expert interviews and by applying it for real processes from different companies.

Cloud computing allows enterprises to consume computational power and IT services as if they were commodities. This enables businesses to respond to new market demands faster and more cost-efficiently. However, integrating new IT services in the existing service portfolio is not simply a matter of technically integrating these services. Instead, the business users have to be enabled to control how cloud services are used in their day-to-day work. Based on real-world projects of a leading global IT service provider, this contribution suggests a process-oriented architecture that enables business users to directly participate in the integration of cloud services.

As the transition to the knowledge society is steadily proceeding in industrialized countries, increasing knowledge workers’ productivity in businesses becomes crucial. However, current business process management approaches and systems are unable to satisfy the high requirements of flexibility in knowledge intensive processes. Adaptive Case Management (ACM) is an emerging yet still immature approach in the business process management field that promises to bridge this gap. This contribution substantiates ACM by presenting a corresponding procedure model along with a software system. Applying the concepts of empowerment, the knowledge worker takes on the responsibility to adapt “his” IT environment in order to achieve efficient case handling. The validation by expert interviews critically examines the feasibility both of the concept as well as the software system.

Traditional approaches for business process management assume that process models remain unchanged. However, businesses today have to adapt their business process models to new market changes instantaneously. Current methods for business process management approaches and their supporting information systems turn out to be too time-consuming and costly. This contribution suggests a new business process management concept (BPM 2.0) along with a corresponding software system that increase the flexibility of businesses by allowing employees to improve ”their” business processes. A case study at a large European construction firm critically examines the feasibility both of the concept as well as the software system.

Implementation projects for the Microsoft Dynamics NAV, AX, and CRM family are typically conducted according to the Sure Step methodology. The Project4Sure approach extends this methodology with a software solution that assists in managing and controlling large implementation projects. This contribution proposes an extension to the Project4Sure methodology and software platform that provides a process centric approach to analyzing and realizing business requirements for projects implementing the above-mentioned ERP systems. While classical ERP implementation approaches tend to focus on the requirements laid out by managers and the IT department, the new approach integrates concepts of BPM 2.0. By utilizing the expertise of the individuals in the operational departments, it can be ensured that ERP implementations match the requirements of the actual business users.

Background Sodium/proton-antiporters (Nha) are known to play an important role in pH- and Na+-homeostasis. In microorganisms several types with different capacity, affinity and selectivity for Na+ and Li+ exist. The homeostasis system of E. coli, NhaA and NhaB, is well researched, but the function of other types of Na+/H+-antiporters like NhaD is yet to be fully understood. Since several antiporters play an important role at various points in the physiology of higher organisms, one can speculate that the main functions of some of those procaryotic antiporters differ from pH- and Na+-homeostasis. Results This study investigates the function and regulation of a gene encoding for a NhaD type antiporter which was discovered in the halophilic eubacterium Halomonas elongata. The deduced primary amino acid sequence of the abovementioned gene showed more than 60% identity to known antiporters of the NhaD type from Alkalimonas amylolytica, Shewanella oneidensis and several other marine organisms of the γ-Proteobacteria. Evidence was found for a dual regulation of H. elongata NhaD expression. The gene was cloned and expressed in E. coli. Antiporter deficient NaCl and LiCl sensitive E. coli mutants EP432 and KNabc were partially complemented by a plasmid carrying the H. elongata nhaD gene. Surprisingly the LiCl sensitivity of E. coli strain DH5α having a complete homeostasis system was increased when NhaD was co-expressed. Conclusion Since NhaD is an antiporter known so far only from halophilic or haloalcaliphilic Proteobacteria one can speculate that this type of antiporter provides a special mechanism for adaptation to marine habitats. As was already speculated – though without supporting data – and substantiated in this study this might be active Na+-import for osmoregulatory purposes.

Compatible solutes are small organic osmolytes including but not limited to sugars, polyols, amino acids, and their derivatives. They are compatible with cell metabolism even at molar concentrations. A variety of organisms synthesize or take up compatible solutes for adaptation to extreme environments. In addition to their protective action on whole cells, compatible solutes display significant effects on biomolecules in vitro. These include stabilization of native protein and nucleic acid structures. They are used as additives in polymerase chain reactions to increase product yield and specificity, but also in other nucleic acid and protein applications. Interactions of compatible solutes with nucleic acids and protein-nucleic acid complexes are much less understood than the corresponding interactions of compatible solutes with proteins. Although we may begin to understand solute/nucleic acid interactions there are only few answers to the many questions we have. I summarize here the current state of knowledge and discuss possible molecular mechanisms and thermodynamics.

Background Sodium/proton-antiporters (Nha) are known to play an important role in pH- and Na+-homeostasis. In microorganisms several types with different capacity, affinity and selectivity for Na+ and Li+ exist. The homeostasis system of E. coli, NhaA and NhaB, is well researched, but the function of other types of Na+/H+-antiporters like NhaD is yet to be fully understood. Since several antiporters play an important role at various points in the physiology of higher organisms, one can speculate that the main functions of some of those procaryotic antiporters differ from pH- and Na+-homeostasis.

The sensitivity of a nitroxide spin label to the polarity of its environment has been used to estimate the hydrophobic barrier of the proton channel of the transmembrane proton pump bacteriorhodopsin. By means of site-specific mutagenesis, single cysteine residues were introduced at 10 positions located at the protein surface, in the protein interior, and along the proton pathway. After reaction with a methanethiosulfonate spin label, the principle values of the hyperfine tensor A and the g-tensor were determined from electron paramagnetic resonance spectra measured at 170K. The shape of the hydrophobic barrier of the proton channel is characterized in terms of a polarity index, ΔA, determined from the variation of the hyperfine coupling constant Azz. The maximum of the hydrophobic barrier is found to be close to the retinal chromophore in the proton uptake pathway. The effect of the asymmetric distribution of charged and polar residues in the proton release and uptake pathways is clearly reflected in the behavior of the hydrophobic barrier. The presence of azide reduces the barrier height of both the cytoplasmic and extracellular channels. This finding supports the view of azide and other weakly acidic anions as catalysts for the formation of hydrogen-bonded networks in proton pathways of proteins.