Interoperabilit?t für Informationssysteme im Gesundheitswesen auf Basis medizinischer Standards

Eine Vernetzung der Dienstleister im Gesundheitswesen wird aus Effizienzgründen immer wichtiger. Schwierigkeiten bereitet jedoch die Interoperabilität, womit die korrekte Kommunikation von beteiligten Softwaresystemen verschiedener Herkunft gemeint ist. Dieser Beitrag konzentriert sich auf die Interoperabilitätsproblematik auf der Ebene der Anwendungsarchitekturen. Mit Hilfe von Standards und Integrationstechniken bemühen sich verschiedene Lösungsansätze die Heterogenität zu überwinden, die einer umfassenden Interoperabilität im Wege steht. Die Frage, die sich uns in diesem Zusammenhang nun stellt ist, ob diverse Standards im Gesundheitswesen sinnvoll kombiniert werden können bzw. zwischen ihnen vermittelt werden kann. In diesem Artikel stellen wir die Grundzüge einer Architektur vor, die auf der Basis von Standards eine institutionsübergreifende Interoperabilität im Gesundheitswesen ermöglichen soll. Die Strukturen der relevanten Standards werden einheitlich als Instanzen des Meta-Object Facility (MOF) spezifiziert und dann geeignet zueinander in Beziehung gesetzt. Die resultierenden Modelle und Metamodelle bilden einen Leitfaden zur Strukturanalyse der Standards und helfen so beim Entwurf der Transformationen zwischen den verschiedenen Standards. Architektur und Metamodelle dienen als Grundlage für eine prototypische Implementierung am Beispiel des Epidemiologischen Krebsregisters Niedersachsen zur Evaluation des vorgestellten Konzeptes.     

The use of heuristics during route planning by expert and novice orienteers

Expert orienteers have reported using two heuristics when planning routes to points in the environment that must be located, known as 'controls'. These heuristics constitute attending to the start first and subsequently planning forward to a given control, and attending to the control first and planning backwards to the start. The aim of this study was to establish which heuristic experts use predominantly and whether novices' use of these heuristics differs from that of experts. Two methods for tracing attention were used while 20 expert and 20 novice orienteers planned routes in the laboratory. The results were used to infer the use of heuristics. The orienteers were also interviewed about planning. We found that, when planning, experts generally attend to the control first and novices to the start first. There was also some evidence that novices work forwards from the start to the control and that experts work backwards from the control to the start. From the interviews, it would appear that experts regard the location of the control as the crux of the problem and prioritize this area during planning. These results have implications for an understanding of expertise and problem-solving in sport.     

Deviating glucose results in an international dual-center study. A root cause investigation

During a dual-center study on obese and normal weight children and adolescents, focusing on glucose metabolism, we observed a marked difference in glucose results (N = 16,840) between the two sites, Salzburg, Austria and Uppsala, Sweden (P < 0.001). After excluding differences in patient characteristics between the two populations as cause of this finding, we investigated other preanalytic influences. Finally, only the tubes used for blood collection at the two sites were left to evaluate. While the Vacuette FC-Mix tube (Greiner Bio-One, Kremsmünster, Austria) was used in Uppsala, in Salzburg blood collections were performed with a lithium heparin tube (LH-Monovette, Sarstedt, Germany). To prove our hypothesis, we collected two blood samples in either of these tubes from 51 children (Salzburg N = 27, Uppsala N = 24) and compared the measured glucose results. Indeed, we found the suspected bias and calculated a correction formula, which significantly diminished the differences of glucose results between the two sites (P = 0.023). Our finding is in line with those of other studies and although this issue should be widely known, we feel that it is widely neglected, especially when comparing glucose concentrations across Europe, using large databases without any information on preanalytic sample handling.     

"... a certain amount of engineering involved": constructing the public in participatory governance arrangements

This paper argues that it is time for public understanding of science to develop a critical inventory of the forms, formats and methods of public participation and their respective implications and ambiguities. It highlights the need for analysing not only the limitations and deficiencies of participatory arrangements but also their constructive dimension, in particular the construction of the subject of participation. Looking into participatory governance arrangements in the issue area of genetic testing in Germany and the UK the paper presents a typology of formats according to the way the respective public is constructed and identifies four major constructions of publics: the general public, the pure public, the affected public and the partisan public. Each of these enables certain speaking positions while foreclosing others. The study shows that the main purposes of participatory arrangements in this issue area are knowledge production and education rather than political deliberation and decision-making.     

Students’ confidence in their performance judgements: a comparison of different response scales

We report results of two studies on metacognitive accuracy with undergraduate education students. Participating students were asked to judge their personal performance in a multiple-choice exam as well as to state their confidence in their performance judgement (second-order judgement [SOJ]). In each study, we compared four conditions that differed in the type of the presented 5-point confidence scale for SOJs. In Study 1, four bipolar scales with different labels were applied; in Study 2, unipolar and bipolar scales were implemented. The results of Study 1 with N?=?420 students show that undergraduates on average provided accurate performance estimations. However, students were not aware of their judgement accuracy, shown by a low fit of SOJ and judgement accuracy. In addition, the type of provided scale significantly influenced the SOJs. Study 2 with N?=?348 students replicated the findings of the first study and gave further insight into the effects of uni- vs. bipolar response scales.     

A resourcification manifesto: Understanding the social process of resources becoming resources

In times of major global interconnectedness and environmental change, the pressure to identify, create, and exploit new resources is certain to intensify. Given that there are unavoidable trade-offs, conflicts, and arenas for violence involved when increasingly more material and immaterial things are turned into resources, we call for explicit research on the very process – a process that we label resourcification. The concept of resourcification shifts attention from essentialist queries about the nature of resources to a focus on the social processes through which things are turned into resources. In search of a better understanding of resources in the Anthropocene and, in particular, an understanding about the way resources emerge and are used, resourcification offers a new conceptual framework that allows for a systematic search for knowledge about the diversity of contexts, conditions, modes, and temporalities of resourcification. This Resourcification Manifesto offers a theoretical and empirical framework for a radical and disruptive approach to innovation, sustainability, and management studies and policies.     

Developing an agent-based adaptive system for scaffolding self-regulated inquiry learning in history education

This article presents a methodology for modelling the development of self-regulated learning skills in the context of computer-based learning environments using a combination of tracing techniques. The user-modelling techniques combine statistical and computational approaches to assess skill acquisition, practice, and refinement with the MetaHistoReasoning tool, a single-agent system that supports inquiry-based learning in the domain of history. Data were collected from twenty-two undergraduate students during a 4-h session where user interactions were logged by the system. A logistic regression model predicted user performance in relation to a skill categorization task with 75 % accuracy. The manner in which users apply the skills that are acquired is then assessed through a rule-based reasoning system that allows the pedagogical agent to adapt instruction. The results show that the model allows the agent to detect instances when skills are inappropriately applied as well as what type of goal that is pursued by students. We discuss the implications of these user-modelling techniques in terms of sequencing instructional content and using the tutoring agent to deliver several types of discourse moves in order to enhance learning.     

Wirksamkeit schulrelevanter Förderung in Kindertagesstätten

The present paper summarizes international and national research findings on the general and differential effectiveness of pedagogical work in early childhood education and care settings, evaluations of pilot projects on compensatory preschool education as well programs to support individual learning abilities. Based on these findings, the following conclusions are drawn: First, attending early childhood education and care settings at an early age (after the age of three) has a positive influence on the development of academic competences. Second, the effectiveness of these settings depends on the instructional quality, which could be considerably improved in Germany. Third, pilot projects on programs to support individual learning abilities could show that compensatory effects for disadvantaged groups of children exist, especially when they are interlinked with stimulating conditions in the family and at school. Fourth, effective training programs exist that can be implemented in early childhood education and care. However, a number of challenges need to be met before they can be successfully implemented.