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Software process improvement (SPI) has been around for decades: frameworks are proposed, success factors are studied, and experiences have been reported. However, the sheer mass of concepts, approaches, and standards published over the years overwhelms practitioners as well as researchers. What is out there? Are there new trends and emerging approaches? What are open issues? Still, we struggle to answer these questions about the current state of SPI and related research. In this article, we present results from an updated systematic mapping study to shed light on the field of SPI, to develop a big picture of the state of the art, and to draw conclusions for future research directions. An analysis of 769 publications draws a big picture of SPI-related research of the past quarter-century. Our study shows a high number of solution proposals, experience reports, and secondary studies, but only few theories and models on SPI in general. In particular, standard SPI models like CMMI and ISO/IEC 15,504 are analyzed, enhanced, and evaluated for applicability in practice, but these standards are also critically discussed, e.g., from the perspective of SPI in small to-medium-sized companies, which leads to new specialized frameworks. New and specialized frameworks account for the majority of the contributions found (approx. 38%). Furthermore, we find a growing interest in success factors (approx. 16%) to aid companies in conducting SPI and in adapting agile principles and practices for SPI (approx. 10%). Beyond these specific topics, the study results also show an increasing interest into secondary studies with the purpose of aggregating and structuring SPI-related knowledge. Finally, the present study helps directing future research by identifying under-researched topics awaiting further investigation.
The situation in the markets is changing rapidly and competition in the business sector is increasing rapidly. As a result, corporate marketing decisions are based on creating greater value for the consumer, which creates competitiveness and provides an advantage in competing for future customer loyalty. The purpose of this study is to determine whether there is a link between marketing communication tools and consumer perceived value in pursuit of consumer loyalty. Qualitative (observational research) and quantitative (a questionnaire survey) research methods were used to investigate the problem empirically. The observational research elucidated the value provided to the consumer by the research objects through marketing communication tools, supplementing the key questions for the quantitative study. Correlation and regression analysis were used in the study, with the results showing a statistically significant relationship between marketing communication tools and consumer perceived value in terms of user loyalty. It has also been determined that the greatest and strongest relationship in consumer value creation through marketing communication tools is the appropriate, mutually coordinated and complementary use of a package of marketing communication tools to achieve synergies that create the preconditions for increasing consumer loyalty in a competitive market.
Background: One of the most promising health care development areas is introducing telemedicine services and creating solutions based on blockchain technology. The study of systems combining both these domains indicates the ongoing expansion of digital technologies in this market segment.
Objective: This paper aims to review the feasibility of blockchain technology for telemedicine.
Methods: The authors identified relevant studies via systematic searches of databases including PubMed, Scopus, Web of Science, IEEE Xplore, and Google Scholar. The suitability of each for inclusion in this review was assessed independently. Owing to the lack of publications, available blockchain-based tokens were discovered via conventional web search engines (Google, Yahoo, and Yandex).
Results: Of the 40 discovered projects, only 18 met the selection criteria. The 5 most prevalent features of the available solutions (N=18) were medical data access (14/18, 78%), medical service processing (14/18, 78%), diagnostic support (10/18, 56%), payment transactions (10/18, 56%), and fundraising for telemedical instrument development (5/18, 28%).
Conclusions: These different features (eg, medical data access, medical service processing, epidemiology reporting, diagnostic support, and treatment support) allow us to discuss the possibilities for integration of blockchain technology into telemedicine and health care on different levels. In this area, a wide range of tasks can be identified that could be accomplished based on digital technologies using blockchains.
Background
Although teledermatology has been proven internationally to be an effective and safe addition to the care of patients in primary care, there are few pilot projects implementing teledermatology in routine outpatient care in Germany. The aim of this cluster randomized controlled trial was to evaluate whether referrals to dermatologists are reduced by implementing a store-and-forward teleconsultation system in general practitioner practices.
Methods
Eight counties were cluster randomized to the intervention and control conditions. During the 1-year intervention period between July 2018 and June 2019, 46 general practitioner practices in the 4 intervention counties implemented a store-and-forward teledermatology system with Patient Data Management System interoperability. It allowed practice teams to initiate teleconsultations for patients with dermatologic complaints. In the four control counties, treatment as usual was performed. As primary outcome, number of referrals was calculated from routine health care data. Poisson regression was used to compare referral rates between the intervention practices and 342 control practices.
Results
The primary analysis revealed no significant difference in referral rates (relative risk = 1.02; 95% confidence interval = 0.911–1.141; p = .74). Secondary analyses accounting for sociodemographic and practice characteristics but omitting county pairing resulted in significant differences of referral rates between intervention practices and control practices. Matched county pair, general practitioner age, patient age, and patient sex distribution in the practices were significantly related to referral rates.
Conclusions
While a store-and-forward teleconsultation system was successfully implemented in the German primary health care setting, the intervention's effect was superimposed by regional factors. Such regional factors should be considered in future teledermatology research.
Background: Internationally, teledermatology has proven to be a viable alternative to conventional physical referrals. Travel cost and referral times are reduced while patient safety is preserved. Especially patients from rural areas benefit from this healthcare innovation. Despite these established facts and positive experiences from EU neighboring countries like the Netherlands or the United Kingdom, Germany has not yet implemented store-and-forward teledermatology in routine care.
Methods: The TeleDerm study will implement and evaluate store-and-forward teledermatology in 50 general practitioner (GP) practices as an alternative to conventional referrals. TeleDerm aims to confirm that the possibility of store-and-forward teledermatology in GP practices is going to lead to a 15% (n = 260) reduction in referrals in the intervention arm. The study uses a cluster-randomized controlled trial design. Randomization is planned for the cluster “county”. The main observational unit is the GP practice. Poisson distribution of referrals is assumed. The evaluation of secondary outcomes like acceptance, enablers and barriers uses a mixed methods design with questionnaires and interviews.
Discussion: Due to the heterogeneity of GP practice organization, patient management software, information technology service providers, GP personal technical affinity and training, we expect several challenges in implementing teledermatology in German GP routine care. Therefore, we plan to recruit 30% more GPs than required by the power calculation. The implementation design and accompanying evaluation is expected to deliver vital insights into the specifics of implementing telemedicine in German routine care.
This paper explores the application of People Analytics in
recruiting professors for universities of applied sciences. Using data-driven personas, the research project aims to identify and communicate the different paths and connections leading candidates to a professorship. The authors introduce the concept of personas, describe the underlying data source and derive an example for the current project.
The cloud evolved into an attractive execution environment for parallel applications, which make use of compute resources to speed up the computation of large problems in science and industry. Whereas Infrastructure as a Service (IaaS) offerings have been commonly employed, more recently, serverless computing emerged as a novel cloud computing paradigm with the goal of freeing developers from resource management issues. However, as of today, serverless computing platforms are mainly used to process computations triggered by events or user requests that can be executed independently of each other and benefit from on-demand and elastic compute resources as well as per-function billing. In this work, we discuss how to employ serverless computing platforms to operate parallel applications. We specifically focus on the class of parallel task farming applications and introduce a novel approach to free developers from both parallelism and resource management issues. Our approach includes a proactive elasticity controller that adapts the physical parallelism per application run according to user-defined goals. Specifically, we show how to consider a user-defined execution time limit after which the result of the computation needs to be present while minimizing the associated monetary costs. To evaluate our concepts, we present a prototypical elastic parallel system architecture for self-tuning serverless task farming and implement two applications based on our framework. Moreover, we report on performance measurements for both applications as well as the prediction accuracy of the proposed proactive elasticity control mechanism and discuss our key findings.
Container virtualization evolved into a key technology for deployment automation in line with the DevOps paradigm. Whereas container management systems facilitate the deployment of cloud applications by employing container based artifacts, parts of the deployment logic have been applied before to build these artifacts. Current approaches do not integrate these two deployment phases in a comprehensive manner. Limited knowledge on application software and middleware encapsulated in container-based artifacts leads to maintainability and configuration issues. Besides, the deployment of cloud applications is based on custom orchestration solutions leading to lock in problems. In this paper, we propose a two-phase deployment method based on the TOSCA standard. We present integration concepts for TOSCA-based orchestration and deployment automation using container-based artifacts. Our two-phase deployment method enables capturing and aligning all the deployment logic related to a software release leading to better maintainability. Furthermore, we build a container management system, which is composed of a TOSCA-based orchestrator on Apache Mesos, to deploy container-based cloud applications automatically.
With on-demand access to compute resources, pay-per-use, and elasticity, the cloud evolved into an attractive execution environment for High Performance Computing (HPC). Whereas elasticity, which is often referred to as the most beneficial cloud-specific property, has been heavily used in the context of interactive (multi-tier) applications, elasticity-related research in the HPC domain is still in its infancy. Existing parallel computing theory as well as traditional metrics to analytically evaluate parallel systems do not comprehensively consider elasticity, i.e., the ability to control the number of processing units at runtime. To address these issues, we introduce a conceptual framework to understand elasticity in the context of parallel systems, define the term elastic parallel system, and discuss novel metrics for both elasticity control at runtime as well as the ex post performance evaluation of elastic parallel systems. Based on the conceptual framework, we provide an in depth analysis of existing research in the field to describe the state-of-the art and compile our findings into a research agenda for future research on elastic parallel systems.
Parallel applications are the computational backbone of major industry trends and grand challenges in science. Whereas these applications are typically constructed for dedicated High Performance Computing clusters and supercomputers, the cloud emerges as attractive execution environment, which provides on-demand resource provisioning and a pay-per-use model. However, cloud environments require specific application properties that may restrict parallel application design. As a result, design trade-offs are required to simultaneously maximize parallel performance and benefit from cloud-specific characteristics.
In this paper, we present a novel approach to assess the cloud readiness of parallel applications based on the design decisions made. By discovering and understanding the implications of these parallel design decisions on an application’s cloud readiness, our approach supports the migration of parallel applications to the cloud.We introduce an assessment procedure, its underlying meta model, and a corresponding instantiation to structure this multi-dimensional design space. For evaluation purposes, we present an extensive case study comprising three parallel applications and discuss their cloud readiness based on our approach.
Elasticity is considered to be the most beneficial characteristic of cloud environments, which distinguishes the cloud from clusters and grids. Whereas elasticity has become mainstream for web-based, interactive applications, it is still a major research challenge how to leverage elasticity for applications from the high-performance computing (HPC) domain, which heavily rely on efficient parallel processing techniques. In this work, we specifically address the challenges of elasticity for parallel tree search applications. Well-known meta-algorithms based on this parallel processing technique include branch-and-bound and backtracking search. We show that their characteristics render static resource provisioning inappropriate and the capability of elastic scaling desirable. Moreover, we discuss how to construct an elasticity controller that reasons about the scaling behavior of a parallel system at runtime and dynamically adapts the number of processing units according to user-defined cost and efficiency thresholds. We evaluate a prototypical elasticity controller based on our findings by employing several benchmarks for parallel tree search and discuss the applicability of the proposed approach. Our experimental results show that, by means of elastic scaling, the performance can be controlled according to user-defined thresholds, which cannot be achieved with static resource provisioning.
„Bürgerrechtler klagen gegen Weitergabe von Gesundheitsdaten“ – so titelt (spiegel.de, 2022) am 29.04.2022. Dabei geht es um die Weitergabe pseudonymisierter Daten von 73 Millionen Versicherten durch die gesetzlichen Krankenkassen. Diese Daten sollen der Forschung zur Verfügung gestellt werden. Die Kläger bezweifeln, dass die Daten nicht deanonymisiert werden können. Dieses aktuelle Beispiel zeigt einen konkreten und relevanten Anwendungsfall des Themas Anonymisierung/Pseudonymisierung im aktuariellen Kontext auf. Es ist davon auszugehen, dass die Relevanz in den kommenden Jahren weiter zunehmen wird.
Spätestens seit dem Inkrafttreten der DSGVO ist das Thema Datenschutz allgegenwärtig und stellt uns Aktuare vor große Herausforderungen. Europäische Initiativen zur Schaffung eines Binnenmarktes für Daten sollen zwar die Möglichkeit schaffen, Daten einfacher zu teilen und so beispielsweise Dritten für Forschungszwecke zur Verfügung zu stellen, werfen aber auch viele Fragestellungen auf. Eine naheliegende Lösung ist es, Daten zu anonymisieren oder zu pseudonymisieren. Aber was bedeutet das konkret und welche Konsequenzen ergeben sich daraus? Bis zu welchem Grad müssen Daten anonymisiert werden und welche ReIdentifikationsrisiken bestehen weiterhin?
Background and purpose: Transapical aortic valve replacement (TAVR) is a recent minimally invasive surgical treatment technique for elderly and high-risk patients with severe aortic stenosis. In this paper,a simple and accurate image-based method is introduced to aid the intra-operative guidance of TAVR procedure under 2-D X-ray fluoroscopy.
Methods: The proposed method fuses a 3-D aortic mesh model and anatomical valve landmarks with live 2-D fluoroscopic images. The 3-D aortic mesh model and landmarks are reconstructed from interventional X-ray C-arm CT system, and a target area for valve implantation is automatically estimated using these aortic mesh models.Based on template-based tracking approach, the overlay of visualized 3-D aortic mesh model, land-marks and target area of implantation is updated onto fluoroscopic images by approximating the aortic root motion from a pigtail catheter motion without contrast agent. Also, a rigid intensity-based registration algorithm is used to track continuously the aortic root motion in the presence of contrast agent.Furthermore, a sensorless tracking of the aortic valve prosthesis is provided to guide the physician to perform the appropriate placement of prosthesis into the estimated target area of implantation.
Results: Retrospective experiments were carried out on fifteen patient datasets from the clinical routine of the TAVR. The maximum displacement errors were less than 2.0 mm for both the dynamic overlay of aortic mesh models and image-based tracking of the prosthesis, and within the clinically accepted ranges. Moreover, high success rates of the proposed method were obtained above 91.0% for all tested patient datasets.
Conclusion: The results showed that the proposed method for computer-aided TAVR is potentially a helpful tool for physicians by automatically defining the accurate placement position of the prosthesis during the surgical procedure.
Intra-operative fluoroscopy-guided assistance system for transcatheter aortic valve implantation
(2014)
A new surgical assistance system has been developed to assist the correct positioning of the AVP during transapical TAVI. The developed assistance system automatically defines the target area for implanting the AVP under live 2-D fluoroscopy guidance. Moreover, this surgical assistance system works with low levels of contrast agent for the final deployment of AVP, reducing therefore long-term negative effects, such as renal failure in the elderly and high-risk patients.
Science-based analysis for climate action: how HSBC Bank uses the En-ROADS climate policy simulation
(2021)
In 2018, the Intergovernmental Panel on Climate Change (IPCC, 2018) found that rapid decarbonization and net negative greenhouse gas (GHG) emissions by mid-century are required to "hold the increase in global average temperature to well below 2°C above pre-industrial levels and pursue efforts to limit the temperature increase to 1.5°C," as stipulated by the Paris Agreement (UNFCCC, 2015, p. 2). Meeting these goals reduces physical climate-related risks from, for example, sea-level rise, ocean acidification, extreme weather, water shortages, declining crop yields, and other impacts. These impacts threaten our economy, security, health, and lives.
At the same time, policies to mitigate these harms by rapidly reducing GHG emissions can create transition risks for businesses - for example, stranded assets and loss of market value for fossil fuel producers and firms dependent on fossil energy (Carney, 2019). Rapid decarbonization requires an unprecedented energy transition (IEA, 2021a) driven by and affecting economic players including businesses, asset managers, and investors in all sectors and all countries (Kriegler et al., 2014).
However, GHG emissions are not falling rapidly enough to meet the goals of the Paris Agreement (Holz et al., 2018). The UNFCCC, 2021 found that the emissions reductions pledged by all nations as of early 2021 "fall far short of what is required, demonstrating the need for Parties to further strengthen their mitigation commitments under the Paris Agreement" (2021, p. 5). Businesses are faring no better. Despite high-profile calls to action from influential firms such as BlackRock (Fink, 2018, 2021), corporate action to meet climate goals has thus far fallen short (e.g. the Right, 2019 analysis of the German DAX 30 companies' emissions targets by NGO "right."). Instead of implementing climate strategies that might mitigate the risks, managers are often caught up in "firefighting" and capability traps that erode the resources needed for ambitious climate action (Sterman, 2015). Firms may also exaggerate environmental accomplishments, leading to greenwashing (Lyon and Maxwell, 2011); implement policies that are vague, rely on unproven offsets, or are not climate neutral (e.g. Sterman et al., 2018); or simply take no action at all (Delmas and Burbano, 2011; Sterman, 2015).
Adding to the confusion are difficulties evaluating the effectiveness of different climate policies. Misperceptions include wait-and-see approaches (Dutt and Gonzalez, 2012; Sterman, 2008), underestimating time delays and ignoring the unintended consequences of policies (Sterman, 2008), and beliefs in "silver bullet" solutions (Gilbert, 2009; Kriegler et al., 2013; Shackley and Dütschke, 2012). These beliefs arise in part because the climate–energy system is a high-dimensional dynamic system characterized by long time delays, multiple feedback loops, and nonlinearities (Sterman, 2011), while even simple systems are difficult for people to understand (Booth Sweeney and Sterman, 2000; Cronin et al., 2009; Kapmeier et al., 2017). Although senior executives might receive briefings on climate change, simply providing more information does not necessarily lead to more effective action (Pearce et al., 2015; Sterman, 2011).
Alternatively, interactive approaches to learning about climate change and policies to mitigate it can trigger climate action (Creutzig and Kapmeier, 2020). Decision-makers require tools and methods grounded in science that enable them to learn for themselves how a low-carbon economy can be achieved and how climate policies condition physical and transition risks. The system dynamics climate–energy simulation En-ROADS (Energy-Rapid Overview and Decision Support; Jones et al., 2019b), codeveloped by the climate think-tank Climate Interactive and the MIT Sloan Sustainability Initiative, provides such a tool.
Here we show how En-ROADS helps HSBC Bank U.S.A., the American subsidiary of U.K.-based multinational financial services company HSBC Holdings plc, focus its global sustainability strategy on activities with higher impact and relevance, communicate and implement the strategy, understand transition risks, and better align the strategy with global climate goals. We show how the versatility and interactivity of En-ROADS increases its reach throughout the organization. Finally, we discuss challenges and lessons learned that may be helpful to other organizations.
Towards Automated Surgical Documentation using automatically generated checklists from BPMN models
(2021)
The documentation of surgeries is usually created from memory only after the operation, which is an additional effort for the surgeon and afflicted with the possibility of imprecisely, shortend reports. The display of process steps in the form of checklists and the automatic creation of surgical documentation from the completed process steps could serve as a reminder, standardize the surgical procedure and save time for the surgeon. Based on two works from Reutlingen University, which implemented the creation of dynamic checklists from Business Process Modelling Notation (BPMN) models and the storage of times at which a process step was completed, a prototype was developed for an android tablet, to expand the dynamic checklists by functions such as uploading photos and files, manual user entries, the interception of foreseeable deviations from the normal course of operations and the automatic creation of OR documentation.
Purpose
For the modeling, execution, and control of complex, non-standardized intraoperative processes, a modeling language is needed that reflects the variability of interventions. As the established Business Process Model and Notation (BPMN) reaches its limits in terms of flexibility, the Case Management Model and Notation (CMMN) was considered as it addresses weakly structured processes.
Methods
To analyze the suitability of the modeling languages, BPMN and CMMN models of a Robot-Assisted Minimally Invasive Esophagectomy and Cochlea Implantation were derived and integrated into a situation recognition workflow. Test cases were used to contrast the differences and compare the advantages and disadvantages of the models concerning modeling, execution, and control. Furthermore, the impact on transferability was investigated.
Results
Compared to BPMN, CMMN allows flexibility for modeling intraoperative processes while remaining understandable. Although more effort and process knowledge are needed for execution and control within a situation recognition system, CMMN enables better transferability of the models and therefore the system. Concluding, CMMN should be chosen as a supplement to BPMN for flexible process parts that can only be covered insufficiently by BPMN, or otherwise as a replacement for the entire process.
Conclusion
CMMN offers the flexibility for variable, weakly structured process parts, and is thus suitable for surgical interventions. A combination of both notations could allow optimal use of their advantages and support the transferability of the situation recognition system.
Context-aware systems to support actors in the operating room depending on the status of the intervention require knowledge about the current situation in the intra-operative area. In literature, solutions to achieve situation awareness already exist for specific use cases, but applicability and transferability to other conditions are less addressed. It is assumed that a unified solution that can be adapted to different processes and sensors would allow for greater flexibility, applicability, and thus transferability to different applications. To enable a flexible and intervention-independent system, this work proposes a concept for an adaptable situation recognition system. The system consists of four layers with several modular components for different functionalities. The feasibility is demonstrated via prototypical implementation and functional evaluation of a first basic framework prototype. Further development goal is the stepwise extension of the prototype.
One of the key challenges for automatic assistance is the support of actors in the operating room depending on the status of the procedure. Therefore, context information collected in the operating room is used to gain knowledge about the current situation. In literature, solutions already exist for specific use cases, but it is doubtful to what extent these approaches can be transferred to other conditions. We conducted a comprehensive literature research on existing situation recognition systems for the intraoperative area, covering 274 articles and 95 cross-references published between 2010 and 2019. We contrasted and compared 58 identified approaches based on defined aspects such as used sensor data or application area. In addition, we discussed applicability and transferability. Most of the papers focus on video data for recognizing situations within laparoscopic and cataract surgeries. Not all of the approaches can be used online for real-time recognition. Using different methods, good results with recognition accuracies above 90% could be achieved. Overall, transferability is less addressed. The applicability of approaches to other circumstances seems to be possible to a limited extent. Future research should place a stronger focus on adaptability. The literature review shows differences within existing approaches for situation recognition and outlines research trends. Applicability and transferability to other conditions are less addressed in current work.
The focus of the developed maturity model was set on processes. The concept of the widespread CMM and its practices has been transferred to the perioperative domain and the concept of the new maturity model. Additional optimization goals and technological as well as networking-specific aspects enable a process- and object-focused view of the maturity model in order to ensure broad coverage of different subareas. The evaluation showed that the model is applicable to the perioperative field. Adjustments and extensions of the maturity model are future steps to improve the rating and classification of the new maturity model.