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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.
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.
Die rasante Entwicklung der Sensortechnik im Endverbraucherbereich lässt einen klinischen Nutzen der verfügbaren dezentral erhobenen Daten aus dem Patientenalltag zur Überwachung des individuellen Gesundheitszustands vermuten. Zur Überprüfung dieser Vermutung ist die Bereitstellung einer entsprechenden Plattform in den klinischen Alltag erforderlich. Hierzu wird die bwHealthApp entwickelt, mit der sowohl die aktuelle Bandbreite als auch die Evolution der Sensortechnik auf die klinische Anwendung abbildbar ist. Mit dem flexiblen Entwurf lässt sich der klinische Nutzen für die personalisierte Medizin evaluieren. Außerdem bietet die bwHealthApp einen an Machbarkeit orientierten Diskussionsbeitrag zu offenen rechtlichen, regulatorischen und ethischen Fragestellungen der Digitalisierung in der Medizin in Deutschland.
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.
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.
An important shift in software delivery is the definition of a cloud service as an independently deployable unit by following the microservices architectural style. Container virtualization facilitates development and deployment by ensuring independence from the runtime environment. Thus, cloud services are built as container based systems - a set of containers that control the lifecycle of software and middleware components. However, using containers leads to a new paradigm for service development and operation: Self service environments enable software developers to deploy and operate container based systems on their own - you build it, you run it. Following this approach, more and more operational aspects are transferred towards the responsibility of software developers. In this work, we propose a concept for self-adaptive cloud services based on container virtualization in line with the microservices architectural style and present a model-based approach that assists software developers in building these services. Based on operational models specified by developers, the mechanisms required for self-adaptation are automatically generated. As a result, each container automatically adapts itself in a reactive, decentralized manner. We evaluate a prototype which leverages the emerging TOSCA standard to specify operational behavior in a portable manner.
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.
Cloud resources can be dynamically provisioned according to application-specific requirements and are payed on a per-use basis. This gives rise to a new concept for parallel processing: Elastic parallel computations. However, it is still an open research question to which extent parallel applications can benefit from elastic scaling, which requires resource adaptation at runtime and corresponding coordination mechanisms. In this work, we analyze how to address these system-level challenges in the context of developing and operating elastic parallel tree search applications. Based on our findings, we discuss the design and implementation of TASKWORK, a cloud-aware runtime system specifically designed for elastic parallel tree search, which enables the implementation of elastic applications by means of higher-level development frameworks. We show how to implement an elastic parallel branch-and-bound application based on an exemplary development framework and report on our experimental evaluation that also considers several benchmarks for parallel tree search.
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.
The Internet of Things (IoT) is coined by many different standards, protocols, and data formats that are often not compatible to each other. Thus, the integration of different heterogeneous (IoT) components into a uniform IoT setup can be a time-consuming manual task. This lacking interoperability between IoT components has been addressed with different approaches in the past. However, only very few of these approaches rely on Machine Learning techniques. In this work, we present a new way towards IoT interoperability based on Deep Reinforcement Learning (DRL). In detail, we demonstrate that DRL algorithms, which use network architectures inspired by Natural Language Processing (NLP), can be applied to learn to control an environment by merely taking raw JSON or XML structures, which reflect the current state of the environment, as input. Applied to IoT setups, where the current state of a component is often reflected by features embedded into JSON or XML structures and exchanged via messages, our NLP DRL approach eliminates the need for feature engineering and manually written code for pre-processing of data, feature extraction, and decision making.
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.
Decentralized energy systems are characterized by an ad hoc planing. The missing integration of energy objectives into business strategy creates difficulties resulting in inefficient energy architectures and decisions. Practice-proven methods such as balanced scorecard, enterprise architecture management and value network approach supports the transformation path towards an effective decentralized system. The methods are evaluated based on a case study. Managing multi-dimensionality, high complexity and multiple actors are the main drivers for an effective and efficient energy management system. The underlying basis to gain the positive impacts of these methods on decentralized corporate energy systems is digitization of energy data and processes.
Several studies analyzed existing Web APIs against the constraints of REST to estimate the degree of REST compliance among state-of-the-art APIs. These studies revealed that only a small number of Web APIs are truly RESTful. Moreover, identified mismatches between theoretical REST concepts and practical implementations lead us to believe that practitioners perceive many rules and best practices aligned with these REST concepts differently in terms of their importance and impact on software quality. We therefore conducted a Delphi study in which we confronted eight Web API experts from industry with a catalog of 82 REST API design rules. For each rule, we let them rate its importance and software quality impact. As consensus, our experts rated 28 rules with high, 17 with medium, and 37 with low importance. Moreover, they perceived usability, maintainability, and compatibility as the most impacted quality attributes. The detailed analysis revealed that the experts saw rules for reaching Richardson maturity level 2 as critical, while reaching level 3 was less important. As the acquired consensus data may serve as valuable input for designing a tool-supported approach for the automatic quality evaluation of RESTful APIs, we briefly discuss requirements for such an approach and comment on the applicability of the most important rules.
Hypermedia as the Engine of Application State (HATEOAS) is one of the core constraints of REST. It refers to the concept of embedding hyperlinks into the response of a queried or manipulated resource to show a client possible follow-up actions and transitions to related resources. Thus, this concept aims to provide a client with a navigational support when interacting with a Web-based application. Although HATEOAS should be implemented by any Web-based API claiming to be RESTful, API providers tend to offer service descriptions in place of embedding hyperlinks into responses. Instead of relying on a navigational support, a client developer has to read the service description and has to identify resources and their URIs that are relevant for the interaction with the API. In this paper, we introduce an approach that aims to identify transitions between resources of a Web-based API by systematically analyzing the service description only. We devise an algorithm that automatically derives a URI Model from the service description and then analyzes the payload schemas to identify feasible values for the substitution of path parameters in URI Templates. We implement this approach as a proxy application, which injects hyperlinks representing transitions into the response payload of a queried or manipulated resource. The result is a HATEOAS-like navigational support through an API. Our first prototype operates on service descriptions in the OpenAPI format. We evaluate our approach using ten real-world APIs from different domains. Furthermore, we discuss the results as well as the observations captured in these tests.
Menopause is the permanent cessation of menstruation occurring naturally in women's aging. The most frequent symptoms associated with menopausal phases are mucosal dryness, increased weight and body fat, and changes in sleep patterns. Oral symptoms in menopause derived from saliva flow reduction can lead to dry mouth, ulcers, and alterations of taste and swallowing patterns. However, the oral health phenotype of postmenopausal women has not been characterized. The aim of the study was to determine postmenopausal women's oral phenotype, including medical history, lifestyle, and oral assessment through artificial intelligence algorithms. We enrolled 100 postmenopausal women attending the Dental School of the University of Seville were included in the study. We collected an extensive questionnaire, including lifestyle, medication, and medical history. We used an unsupervised k-means algorithm to cluster the data following standard features for data analysis. Our results showed the main oral symptoms in our postmenopausal cohort were reduced salivary flow and periodontal disease. Relying on the classical assessment of the collected data, we might have a biased evaluation of postmenopausal women. Then, we used artificial intelligence analysis to evaluate our data obtaining the main features and providing a reduced feature defining the oral health phenotype. We found 6 clusters with similar features, including medication affecting salivation or smoking as essential features to obtain different phenotypes. Thus, we could obtain main features considering differential oral health phenotypes of postmenopausal women with an integrative approach providing new tools to assess the women in the dental clinic.
Companies are constantly changing their business process models. In team environments, different versions of a process model are created at the same time. These versions of a process model need to be merged from time to time to consolidate changes and create a new common version.
In this short paper, we propose a solution for modifying a merge result. The goal is to create a meaningful merge result by adding connector nodes to the model at specific locations. This increases the amount of possible result models and reduces additional implementation effort.
Software and system development is complex and diverse, and a multitude of development approaches is used and combined with each other to address the manifold challenges companies face today. To study the current state of the practice and to build a sound understanding about the utility of different development approaches and their application to modern software system development, in 2016, we launched the HELENA initiative. This paper introduces the 2nd HELENA workshop and provides an overview of the current project state. In the workshop, six teams present initial findings from their regions, impulse talk are given, and further steps of the HELENA roadmap are discussed.
In this presentation the audience will be: (a) introduced to the aims and objectives of the DBTechNet initiative, (b) briefed on the DBTech EXT virtual laboratory workshops (VLW), i.e. the educational and training (E&T) content which is freely available over the internet and includes vendor-neutral hands-on laboratory training sessions on key database technology topics, and (c) informed on some of the practical problems encountered and the way they have been addressed. Last but not least, the audience will be invited to consider incorporating some or all of the DBTech EXT VLW content into their higher education (HE), vocational education and training (VET), and/or lifelong learning/training type course curricula. This will come at no cost and no commitment on behalf of the teacher/trainer; the latter is only expected to provide his/her feedback on the pedagogical value and the quality of the E&T content received/used.
Context: Agile practices as well as UX methods are nowadays well-known and often adopted to develop complex software and products more efficiently and effectively. However, in the so called VUCA environment, which many companies are confronted with, the sole use of UX research is not sufficient to find the best solutions for customers. The implementation of Design Thinking can support this process. But many companies and their product owners don’t know how much resources they should spend for conducting Design Thinking.
Objective: This paper aims at suggesting a supportive tool, the “Discovery Effort Worthiness (DEW) Index”, for product owners and agile teams to determine a suitable amount of effort that should be spent for Design Thinking activities.
Method: A case study was conducted for the development of the DEW index. Design Thinking was introduced into the regular development cycle of an industry Scrum team. With the support of UX and Design Thinking experts, a formula was developed to determine the appropriate effort for Design Thinking.
Results: The developed “Discovery Effort Worthiness Index” provides an easy-to-use tool for companies and their product owners to determine how much effort they should spend on Design Thinking methods to discover and validate requirements. A company can map the corresponding Design Thinking methods to the results of the DEW Index calculation, and product owners can select the appropriate measures from this mapping. Therefore, they can optimize the effort spent for discovery and validation.