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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.
In recent years, the Graph Model has become increasingly popular, especially in the application domain of social networks. The model has been semantically augmented with properties and labels attached to the graph elements. It is difficult to ensure data quality for the properties and the data structure because the model does not need a schema. In this paper, we propose a schema bound Typed Graph Model with properties and labels. These enhancements improve not only data quality but also the quality of graph analysis. The power of this model is provided by using hyper-nodes and hyper-edges, which allows to present data structures on different abstraction levels. We prove that the model is at least equivalent in expressive power to most popular data models. Therefore, it can be used as a supermodel for model management and data integration. We illustrate by example the superiority of this model over the property graph data model of Hidders and other prevalent data models, namely the relational, object-oriented, XML model, and RDF Schema.
Adoption of artificial intelligence (AI) has risen sharply in recent years but many firms are not successful in realising the expected benefits or even terminate projects before completion. While there are a number of previous studies that highlight challenges in AI projects, critical factors that lead to project failure are mostly unknown. The aim of this study is therefore to identify distinct factors that are critical for failure of AI projects. To address this, interviews with experts in the field of AI from different industries are conducted and the results are analyzed using qualitative analysis methods. The results show that both, organizational and technological issues can cause project failure. Our study contributes to knowledge by reviewing previously identified challenges in terms of their criticality for project failure based on new empirical data, as well as, by identifying previously unknown factors.
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.
Public transport maps are typically designed in a way to support route finding tasks for passengers, while they also provide an overview about stations, metro lines, and city-specific attractions. Most of those maps are designed as a static representation, maybe placed in a metro station or printed in a travel guide. In this paper, we describe a dynamic, interactive public transport map visualization enhanced by additional views for the dynamic passenger data on different levels of temporal granularity. Moreover, we also allow extra statistical information in form of density plots, calendar-based visualizations, and line graphs. All this information is linked to the contextual metro map to give a viewer insights into the relations between time points and typical routes taken by the passengers. We also integrated a graph-based view on user-selected routes, a way to interactively compare those routes, an attribute- and property-driven automatic computation of specific routes for one map as well as for all available maps in our repertoire, and finally, also the most important sights in each city are included as extra information to include in a user-selected route. We illustrate the usefulness of our interactive visualization and map navigation system by applying it to the railway system of Hamburg in Germany while also taking into account the extra passenger data. As another indication for the usefulness of the interactively enhanced metro maps we conducted a controlled user experiment with 20 participants.
The scoring of sleep stages is an essential part of sleep studies. The main objective of this research is to provide an algorithm for the automatic classification of sleep stages using signals that may be obtained in a non-obtrusive way. After reviewing the relevant research, the authors selected a multinomial logistic regression as the basis for their approach. Several parameters were derived from movement and breathing signals, and their combinations were investigated to develop an accurate and stable algorithm. The algorithm was implemented to produce successful results: the accuracy of the recognition of Wake/NREM/REM stages is equal to 73%, with Cohen's kappa of 0.44 for the analyzed 19324 sleep epochs of 30 seconds each. This approach has the advantage of using the only movement and breathing signals, which can be recorded with less effort than heart or brainwave signals, and requiring only four derived parameters for the calculations. Therefore, the new system is a significant improvement for non-obtrusive sleep stage identification compared to existing approaches.
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.
Together with many success stories, promises such as the increase in production speed and the improvement in stakeholders' collaboration have contributed to making agile a transformation in the software industry in which many companies want to take part. However, driven either by a natural and expected evolution or by contextual factors that challenge the adoption of agile methods as prescribed by their creator(s), software processes in practice mutate into hybrids over time. Are these still agile In this article, we investigate the question: what makes a software development method agile We present an empirical study grounded in a large-scale international survey that aims to identify software development methods and practices that improve or tame agility. Based on 556 data points, we analyze the perceived degree of agility in the implementation of standard project disciplines and its relation to used development methods and practices. Our findings suggest that only a small number of participants operate their projects in a purely traditional or agile manner (under 15%). That said, most project disciplines and most practices show a clear trend towards increasing degrees of agility. Compared to the methods used to develop software, the selection of practices has a stronger effect on the degree of agility of a given discipline. Finally, there are no methods or practices that explicitly guarantee or prevent agility. We conclude that agility cannot be defined solely at the process level. Additional factors need to be taken into account when trying to implement or improve agility in a software company. Finally, we discuss the field of software process-related research in the light of our findings and present a roadmap for future research.
Software is an integrated part of new features within the automotive sector, car manufacturers, the Hersteller Initiative Software (HIS) consortium defined metrics to determine software quality. Yet, problems with assigning metrics to quality attributes often occur in practice. The specified boundary values lead to discussions between contractors and clients as different standards and metric sets are used. This paper studies metrics used in the automotive sector and the quality attributes they address. The HIS, ISO/IEC 25010:2011, and ISO/IEC 26262:2018 are utilized to draw a big picture illustrating (i) which metrics and boundary values are reported in literature, (ii) how the metrics match the standards, (iii) which quality attributes are addressed, and (iv) how the metrics are supported by tools. Our findings from analyzing 38 papers include a catalog of 112 metrics of which 17 define boundary values and 48 are supported by tools. Most of the metrics are concerned with source code, are generic, and not specifically designed for automotive software development. We conclude that many metrics exist, but a clear definition of the metrics' context, notably regarding the construction of flexible and efficient measurement suites, is missing.
Context:
Test-driven development (TDD) is an agile software development approach that has been widely claimed to improve software quality. However, the extent to which TDD improves quality appears to be largely dependent upon the characteristics of the study in which it is evaluated (e.g., the research method, participant type, programming environment, etc.). The particularities of each study make the aggregation of results untenable.
Objectives:
The goal of this paper is to: increase the accuracy and generalizability of the results achieved in isolated experiments on TDD, provide joint conclusions on the performance of TDD across different industrial and academic settings, and assess the extent to which the characteristics of the experiments affect the quality-related performance of TDD.
Method:
We conduct a family of 12 experiments on TDD in academia and industry. We aggregate their results by means of meta-analysis. We perform exploratory analyses to identify variables impacting the quality-related performance of TDD.
Results:
TDD novices achieve a slightly higher code quality with iterative test-last development (i.e., ITL, the reverse approach of TDD) than with TDD. The task being developed largely determines quality. The programming environment, the order in which TDD and ITL are applied, or the learning effects from one development approach to another do not appear to affect quality. The quality-related performance of professionals using TDD drops more than for students. We hypothesize that this may be due to their being more resistant to change and potentially less motivated than students.
Conclusion:
Previous studies seem to provide conflicting results on TDD performance (i.e., positive vs. negative, respectively). We hypothesize that these conflicting results may be due to different study durations, experiment participants being unfamiliar with the TDD process, or case studies comparing the performance achieved by TDD vs. the control approach (e.g., the waterfall model), each applied to develop a different system. Further experiments with TDD experts are needed to validate these hypotheses.