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Rotator cuff tear is a common cause of shoulder pain and disability, and arthroscopic repair is a frequently performed procedure. To improve results and reduce failure rate of this surgery, biological solutions to enhance tendon repair are being investigated. Mesenchymal stem cells contribute in creating a suitable microenvironment for tissue repair, and therefore therapeutic use of tendon tissue-specific stem cells in clinical practice is one of the most promising challenges in regenerative medicine approaches to rotator cuff repair. The aim of this article is to revise the current literature on tendon-derived stem cells for rotator cuff repair. Identification and characterization of a reservoir of progenitor cells in human shoulder periarticular tissues has been successfully confirmed by different authors. The first animal studies on the healing potential of these mesenchymal stem cells showed encouraging results. No clinical trials have been published yet. Rigorous preclinical translational studies are needed to ensure safety and efficacy of stem cells–based treatments before routine use in clinical practice.

In this paper, we present a user study based on a series of questionnaire-based surveys that we aimed at understanding the role of general social media, like popular social networking sites, in promoting the creation and evolution of network communities of place, specifically in the urban domain. We analysed hundreds of responses that we had collected in two questionnaire-based studies which involved 4,599 respondents all together. Since not all the respondents answered the same questions, we collected at least 129 and at most 2,750 responses for each item depending on the items considered. The main findings regard a novel 'attitude to exchange' score, the correlations between this score and other items and scores of interest, among which validated scores for the concept of 'sense of community', bonding 'social capital' and 'trust'; and the discriminating and facilitating factors affecting this attitude. We then relate the findings to some implications for the design of a new class of social media that could exhibit stronger collaboration-oriented functionalities, what we dub 'convivial tools', to study their impact on the welfare of local communities and the aspirations of their members in this time of economic hardship.

This paper discusses the application of gamification techniques in the Ambient Intelligence context. A three-layer framework for ambient intelligence based on the concept of interconnection among all actors involved in the intelligent environment is first delineated. Then, mechanisms for user-driven creation and modification of environment behavior are advocated in the user layer. For this purpose, event-condition-action rules are promoted in literature. With this position paper we would like to suggest that user interfaces for rule construction must be integrated with proper techniques for user engagement and motivation, such as those proposed in the gamification theory.

In this paper, we present a method by which to build a metaphorical map of a portion of the scholarly literature along conceptual dimensions that have been previously characterized in terms of positive, negative and neutral terms. The method allows to "locate" scholarly works in this space, according to multiple criteria, like the definitions that they contain; the relevant concepts that can be extracted by means of a content analysis; and relevant passages that researchers can extract in studying their content. The resulting maps are not representational, nor trying to extract any objective essence of a scientific contribution. Rather, they are resources for the qualitative research, review and interpretation of literature sources. As such, these maps are "knowledge artifacts" in themselves, as they visualize, so to say, the interpretation of a set of works by qualitative researchers, and allow to build a visual comprehension of topological and qualitative relationships between the considered literature contributions. We applied the method to the case of the "knowledge artifact" literature and report the main results in this paper.

In this paper, we discuss the concept of tacit collective knowledge and focus on how to externalize it to inform discussion and reflective thinking within a community of expert practitioners about their own distributed practices. We draw our approach by outlining the one we undertook in the domain of a scholarly community: how to assess the quality of scientific conferences in the broad area of computer science and IT study. Results show the feasibility and scalability of the approach adopted to externalize tacit collective knowledge.

In this paper, we propose an original methodology by which to assess the construct of the situated social value of open data and we apply it to the healthcare domain in regard to information by which hospitals can be ranked to compare service providers. Our methodology encompasses a questionnaire-based user study and a method by which to rank information items by their perceived social value in situated scenarios. While the social component of the construct is addressed traditionally, the main asset of our contribution is to ground the assessment of information value on a multidimensional space of potential situations where that information can be perceived as valuable, and to inquiry the respondents of the user study about their empathized perceptions in daily life scenarios, which are defined to cover the dimensional space properly. The findings of the user study are reported and the implications on the construct assessment discussed in the aim to enable IS benchmarking and more focused interventions of data quality improvement.

Surgical skills training plays an important role in medical education. In recent years, substantial progress has been made in the development of simulation programs and tools for the training and assessment of a trainee’s performance. However, these devices have generated controversy about their validity for arthroscopic surgical training, and the bridge between technological development and educational needs has not yet been clearly established. From an educational point of view, a key feature for a well-designed training program is that the learning objectives should be explicitly defined (Biggs 2003). The aim of this chapter is to address the learning objectives in simulation training, and subsequently, we focus on the number of procedures that are required to become competent.

Knowledge Artifact (KA) is an analytical construct denoting material objects that in organizations regard the creation, use, sharing and representation of knowledge. This paper aims to fill a gap in the existing literature by providing a conceptual framework for the interpretation of the heterogeneous scholar contributions proposed on this concept so far. After a comprehensive literature review we define one pole as “representational”, grounded on the idea that knowledge can be an “object per se”; and another pole as “socially situated”, where knowledge is seen as a social practice, that is a situated, context-dependent and performative interaction of human actors through and with “objects of knowing”. We propose a unifying view of the dimensions of knowledge, and, in so doing, we try to shed light on the multiple ways these can inform the “reification” of knowledge into specific IT artifacts, which we call IT Knowledge Artifact (ITKA). Our model can contribute to the design of computational artifacts supporting knowledge work in organizations.

Boundary Objects and Knowledge Artifacts are physical entities that can be found in many socio-material settings in the organizational (and interorganizational) domain, and share many characteristics. We make the point that an increasing number of authors mention either constructs partly unaware of their denotational meaning, i.e., the precise meaning it has been attached to them by their proponents to make them meaningful and useful. The risk is having these concepts lose their rhetorical, descriptive and applicative power. We contribute in stressing the importance to reconsider the denotational meaning in contrast to the metaphorical ones of these two concepts, for their role in the analysis of the functions of real objects supporting collaboration and knowledge work. This is done towards the more accurate elicitation of requirements for the digitization of these objects, as well as for the design and deployment of new IT artifacts in the organizational domain.

In this paper we present two large user studies in which we gather evidence about the adoption and satisfaction level of users in regard to electronic records that manage health related information from two distinct but complementary perspectives: that of General Practitioners (GPs) about their Electronic Medical Records (EMRs); and that of citizens/patients about their Personal Health Records (PHRs). In these user studies we also probe the user attitudes towards innovative functionalities from these two perspectives and, on the basis of the collected perceptions, we apply an original ranking method to infer what features are valued most and hence could inspire design to make PHRs more situated into the users[U+05F3] lives and drive a higher adoption of these tools. On the basis of the perceived shortcomings of current records, we envision an InterPersonal Health Record (IPHR) that is a sort of hybrid electronic record that merges together typical EMR- and PHR-related features and is endowed with specific functionalities aimed at enhancing interpersonal relationships, communication and collaboration between citizens/patients and their GPs through the record and about its contents. This study is then a contribution in understanding the current attitudes and expectations of potential users towards full-fledged prospective PHRs, as well as a first step in identifying those requirements and priority areas on which to focus further for the design and deployment of more community- and communication-oriented tools in the primary health care domain.

The paper reports on the design and development of QUESt, a platform that is aimed at enabling lay users to deploy web-based multi-page dynamic questionnaires. The platform requires little effort and no programming skills, as it uses a simple configuration file that can be expressed in an almost unstructured and text-based manner. We have validated the approach and platform in the healthcare domain, where the questionnaires were intended to solicit and collect both structured and unstructured feedback from large communities of practitioners in response to the sharing and dissemination of relevant case studies; more specifically in this paper we use a qualitative research approach, encompassing evaluation questionnaires and a particular kind of focus group, and the incremental prototype-based development that led to the current release of QUESt. The paper also reports on the experimentation of the platform in a real context, involving almost 100 orthopaedics, including the post-use evaluation of the participants. In light of this evaluation, we discuss the specific requirements of openness and flexibility that end-users ask for in order to be autonomous in developing their own tools for knowledge-sharing; in particular, we discuss the role of lightweight tools, like QUESt to support the dissemination and discussion of clinical case reports.

This paper aims to reflect on the role of Culture of Participation in fostering an Ethics of Design, as a means of true innovation in contemporary society. Participation often stands on commonalities, empathy and the desire to share our own beliefs and world views. The design of artifacts has as its first, though implicit purpose, to convey a message. Our economy relies even more on knowledge-intensive practices and tools, as a powerful lens of analysing problems and finding solutions. Being aware of the message that a powerful knowledge technology may convey offers a unprecedented instrument to improve ours and others lives, when wisely and ethically understood. Starting from a critical consideration of the "comfortable numbness" in mainstream IT design, we would like to suggest how inescapable reflections rooting in STS and in semiotic engineering may help discuss culture of participation from the alternative perspective of the "power" of design

In this paper we present an original position on how knowledge is created and shared in organizational domains. We propose a metaphor of diffusion, borrowed from genetics, and a four phase model, which aims to be as simple as the SECI model proposed within the OKCT, but also more comprehensive and sociologically-informed. Our model takes into account the individual, social and cultural dimensions of knowledge (what we denote as co-knowledge) to account for the various ways knowledge is "circulated" among people (i.e., members of any social structure); we also propose ancillary concepts like that of "Knowing Community" and "Knowledge Artifact", as analytical constructs to represent, respectively, the environment hosting such a circulation and the technological driver that either enables or supports it.

In this paper we present the findings of a country-wide survey that was aimed at getting a comprehensive picture of the current level of adoption and appropriation of Electronic Medical Records (EMRs) by General Practitioners (GPs). In this survey, which collected the responses from 800 Italian GPs coming from all over the country and exhibiting different experience and ICT skills, we investigated the level of current satisfaction of users with respect to two classes of functional and non-functional features of current EMRs, namely “core” and “advanced” ones. We also tried to detect which of these features are valued most highly by the current EMR users in order to inform prospective users, EMR vendors and policy makers in the eHealth domain. We also focused on the impact that digitization has had so far on General Practice, as it is perceived from the perspective of the front-line users (i.e., doctors). Finally we also addressed how the use of ICT could change in the near future as a tool to facilitate doctor patient communication and collaboration

Knowledge Artifact (KA) is an analytical construct by which analysts, researchers and designers from different disciplines usually denote those material objects that in organizations regard the creation, use, sharing and representation of knowledge. This paper aims to fill a gap in the existing literature by providing a conceptual framework for the interpretation of the heterogeneous contributions on this concept in the specialist literature. From our survey of the main contributions to the definition of this concept, we outline a spectrum of stances laying between two theoretical extremes: we denote one pole "representational", as it is grounded on the idea that knowledge can be an "object per se"; and the other pole "socially situated", as it builds on the viewpoint seeing knowledge as a social practice, that is an epiphenomenon of a situated, context-dependent and performative interaction of human actors through and with "objects of knowing". In proposing a unifying model to gather complementary dimensions of knowledge together, our aim is to shed light on the multiple ways these ideas can inform the "reification" of knowledge into particular IT artifacts, which we call IT Knowledge Artifact (ITKA), and on how seemingly irreconcilable positions can contribute in the design of these computational artifact supporting knowledge work in organizations.

In this paper we present a novel model of knowledge creation and diffusion (viz. the Knowledge-Stream model) in communities of knowledgeable citizens (viz. knowing communities). This model takes into account the individual, social and cultural dimensions of knowledge (what we denote as co-knowledge) to account for the various ways knowledge is “circulated” among people (i.e., members of any social structure); we also propose the concept of IT Knowledge Artifact, as the technological driver enabling such a circulation, and exemplify its main roles in a citizen science project that we are going to undertake in the domains of the urban cultural heritage and the food- and diet-related traditions. [please mind that the version shared on this platform is a reduced version (approx. 1 page less) than the one published in the conference proceedings]

Knowledge Artifact is an analytical construct by which analysts, researchers and designers from different disciplines usually denote those material objects that in organizations regard the creation, use, sharing and representation of knowledge. This makes this concept central to understanding organizational ecologies and to the design of IT artifacts that support the knowledge-related activities mentioned above. This paper aims to fill a gap in the existing IS literature by providing a conceptual mapping for the interpretation of the heterogeneous contributions on this concept in the specialist literature. Our findings suggest that currently this term denotes a multi-pole and open-ended definition, which several disciplines contribute to shape from their peculiar perspective and to their aims. That notwithstanding, it is possible to detect a spectrum of stances between two main extremes: one pole, which we denote as representational, focusing on knowledge as an "object per se", that is as something that can be either true or false, represented in formal ways, and be stored, transmitted and produced through computational inference; and another pole, which we denote as socially situated, focusing on knowledge as social practice, that is an epiphenomenon of a situated, context-dependent and performative interaction of human actors through and with "objects of knowing". Our study tries to gather complementary ideas of knowledge under a unifying model, which draws upon theories and reviews from many fields. Our main purpose is to shed light on the multiple ways these ideas can inform the "reification" of knowledge into IT artifacts, and investigate whether these seemingly irreconcilable positions can bring value to the IS design research

In this paper, we discuss the concept of InterPersonal Heath Record and its role in the most recent models of health service delivery: such a health record should integrate health-related information with communication and collaboration capabilities that could allow both patients and caregivers co-produce information and knowledge toward prevention and illness treatment and management. We then present MedIcona, a fullfledged demonstrator of the IPHR notion developed as free, open-source installation profile of Drupal 7. Its functionalities are aimed at enabling higher levels of user tailoring, content sharing and annotation among patients and their caregivers. Copyright © 2014 SCITEPRESS - Science and Technology Publications

In the last years, researchers are exploring the feasibility of visual language editors in domain-specific domains where their alleged user-friendliness can be exploited to involve end-users in configuring their artifacts. In this paper we present an experimental user study that we conducted to validate the hypothesis that adopting a visual language could help prospective end-users of an electronic medical record define their own document-related local rules. This study allows us to claim that our visual rule editor based on the OpenBlock framework, can be used with no particular training as proficiently as with a specific training and it is found user-friendly by the user panel involved. Although the conclusions of this study can not be broadly generalized, our findings are a preliminary contribution to show the importance of visual languages in domain-specific rule definition by end-users with no particular IT skills, like medical doctors are supposed to represent.

End-User Development (EUD) studies how to empower end users (among which, e.g., professionals and organizational workers) to modify, adapt and extend the software systems they daily use, thus coping with the evolving needs of their work organizations and the shop-floor environment. This research area is becoming increasingly important also for the cross fertilization of ideas and approaches that come from the fields of Information Systems and Human-Computer Interaction. However, if one considers the variety of research proposals stemming from this common ground, there is the risk of losing denotational precision of the key terms adopted in the common vocabulary of EUD. To counteract this natural semantic drift, the objective of this paper is to distinguish within three EUD complementary important notions, namely activities, roles, and artifacts, in order to help researchers deepen important phenomena regarding the ‘‘metadesign’’ of systems built to support EUD practices.

We present MedIcona, a prototypical EMR that we developed to address some challenging requirements raised from influential GPs and recently discussed in different research fields that recognize the role of images, not only medical imaging, in medical practice and the value of allowing their freehand and free-text annotation. We make the point that innovative EMRs should encompass better communication oriented features, and allows for higher levels of end-user tailoring, content sharing and image annotation

The paper reports on the outcomes of a project whose aim was to study a network of farms in the agricultural domain and promote their adoption of social computing technologies responding to their needs. This aim proved to be highly challenging since the network was found to be heterogeneous, characterized by tiers of different nature and composed of competing/cooperating actors. The paper illustrates the challenges we faced, the strategy we conceived that led to the introduction of a community-oriented ICT, and it outlines the steps of this complex process

Several recent approaches to EUD increasingly recognize an active role of the users in the construction of the tools supporting their daily practices. However, there is still a lack of a general framework that could play a role in the comparison of existing proposals and in the development of new EUD solutions. The paper proposes a conceptual framework and a related architecture, called Logic of Bricolage, that aims to be a step further in this direction. The framework is described and the architecture instantiated in three concrete EUD environments (the development of a document based application, the integration of existing applications and the construction of mashups) to show its generality and applicability. The concluding remarks point to the potential value of this formalization effort in the EUD field

In this paper we consider the case of the ICT adoption and use in an agriculture cluster in Lombardy, a northern region of Italy. At the state of the art, relationships among key factors of adoption and use of ICT in agriculture area received little attention by the academic literature. Thus, in this paper we aim to identify a research model in order to provide evidence of four different research questions concerning the determining factors for ICT adoption. The proposed case study reports and discusses the results obtained by analysing data from a survey of about 600 agricultural farms. Finally, Belief Bayesian Networks (BBNs) are used to analyse the complex influence relationships detected between research variables

The paper reports on a systematic survey of the literature around the manifold theme of workarounds in CSCW and in so doing presents a range of definitions that focus on different aspects of this phenomenon. We also report a case study in a large hospital where we discussed with some key users the opportunity of a tool that could promote awareness of existing workarounds, as a way to provide feedback on the actual use of an IT application in a bottom-up fashion. This case study led to the design of a simple process annotation tool, where users could distinguish between different kinds of workarounds: either as misalignments with respect to the organization procedures, or circumventions of the technology supporting them, or both

Since typical healthcare consumers may lack sufficient knowledge to evaluate the reliability of health-related contents published online, recent researches are addressing the usefulness of Web page evaluation tools to help these consumers assess the quality of the indications they retrieve online. This paper contributes in this line by proposing an intentionally simple composite index of information quality, the so called Medical Information Reliability (MIR) index. This index takes the attitudes of potential and actual consumers toward information quality into account, and it is intended to be applied to online sources of medical information as "trust indicator" to provide their potential consumers with a simple percentage score by which to evaluate the reliability of what they are consulting. The main idea underlying this index is to consider information quality a multidimensional aspect of an online resource and relate it to the extent such a resource is compliant with explicit requirements formulated by third-party endorsement bodies. The method to calculate the MIR index on a sample of medical sites is presented in a step-by-step manner, and a user study is discussed that validated its application to the domain of the Alternative and Complementary Medicine.

Coordination mechanisms (CMs) can be defined as any kind of computable construct whose aim is to organize activities performed by a group of actors that are called to collaborate for some purpose or reason. As such, CMs can be observed, conceived for and applied in a vast number of coordinative practices in almost every work setting. The advent of information and communication technologies has raised the issue of how these technologies could be used to help cooperating actors governing the increasing complexity of collaboration in modern organizations. This issue has been at the core of CSCW from its foundation until today: the field studies therein conducted have highlighted the flexibility by which human beings master this complexity. The requirement of flexibility has become one of the necessary conditions to guarantee the effectiveness of any computer support of coordination. The paper presents the main paradigms and approaches that have been proposed to fulfil this challenging requirement. The story shows that this effort has really been a sort of a struggle for either conceptual and technological solutions that are still to be fully realized and generally adopted in the field of work. © 2013 Springer Science+Business Media Dordrecht.

Collaborative problem solving often involves actors with heterogeneous competences or that see a common problem from different perspectives: this can make mutual understanding difficult. The paper presents case studies in different domains where collaboration leverages shared representations, and discusses the main reasons why these representations succeeded in fostering mutual understanding. We observed how the technologies proposed to manage those representations were successful only to the extent they were made able to adapt to the dynamic and open conventions that actors adopted during their activities. The point of the paper is that locality, openness and underspecification are key factors in this process, for their capability to promote tacit knowledge and to let competent actors reach a sufficient level of mutual understanding towards some common goal. The paper proposes a conceptual framework to characterize the notion of knowledge artifact interpreted as a semiotic system where actors can make sense of shared and underspecified representations, and derives from this notion implications for the design of a supportive technology

In the last years, visual languages are becoming increasingly popular in the educational domain, but scholars are also beginning to explore the possibility to adopt them in other domains where their alleged user-friendliness and simplified interaction can be considered more than a simple embellishment of existing user interfaces. In this paper we present an experimental user study that we conducted to validate the hypothesis that adopting a visual language could help end-users of a document-based information system in defining their own document-related local rules to make their graphical interfaces active and proactive with respect to content, context and mediated interactions. The user study reported in this paper allows us to claim that our visual rule editor, which extends and customizes an existing framework recently developed at the MIT (OpenBlocks), is so easy to use that even untrained end-users can execute simple tasks of rule definition as proficiently as those that conversely received an ad-hoc and effective training. Although the conclusions of this study can not be generalized, this result stands as a preliminary contribution in demonstrating the importance of visual languages and editors to make rule-based programming "as easy as a child's play"

In recent years, visual languages have become increasingly popular in the educational domain. But also researchers involved in other application domains are progressively looking at the potential of visual languages to make difficult tasks, as programming is, easier. In this paper we present the research we have conducted to provide end-users of a document management system with a visual language and the related editor by which to define content-based and context-aware rules. Rules are intended to be the proactive components of electronic documents and the visual rule editor we developed is aimed at empowering end-users and domain experts in making their documents more active with respect to both content, context and the users' interactions.

This paper focuses on tight communities and specifically on the distributed, mediated discourses that their members articulate around documents and inscribed material artifacts. The paper presents a prototype-based design experience toward the definition of a collaborative annotation tool that is endowed with discourse oriented functionalities whose main characteristics have emerged from case studies we undertook in the healthcare and agricultural domains. In latter domain an initial prototype was proposed and progressively tuned to help users propose modifications to an institutional document through the expression of comments gathered around and about a common artifact, and then build a representative summary of the opinions emerging within the community as a result of this distributed discussion. In light of the reported case study, we discuss a new perspective on this class of annotating applications and the related functionalities that could realize a new simplified model of discourse and foster its adoption in distributed settings and communities of practice

The chapter discusses the role of simple and lightweight Web-based systems in promoting a different approach to the externalization of practice-related knowledge within communities of professionals. This approach exploits common online questionnaire systems to collect the preferences of large numbers of domain experts to interesting paradigmatic work cases and proposes a statistically sound evaluation of these responses to evaluate the agreement reached within the community. We tested this approach in a case study that involved a large international medical association, that we chose as an example of a large and highly distributed community of expert professionals; in this study we challenged more than 1,000 surgeons about some border-line clinical cases where tacit notions based on lifelong practice and situated experiences coexist (and sometimes clash) with scientific evidences drawn from the specialistic literature. We make the point that a sound evaluation of the collective agreement is a necessary precondition to use such lean Web-based tools in bottom-up knowledge elicitation initiatives. To this aim, existing measures of agreement and survey-related heuristics can be exploited to get a more precise picture of the "opinion of the many" in collective settings like communities of practice. © Springer-Verlag London 2012.

In this paper we present the MIR index, a composite index of Medical Information Reliability. This percentage index is intended as a simple indicator of Information Quality of medical online resources from the perspective of their potential consumers. We exemplify its application in the domain of the Non Conventional and Complementary Medicine (NCM/CAM) for its lack of institutional professional figures; yet the structure of the index makes it suitable also for other healthcare-related domains where guidelines for IQ assurance exist.

This chapter addresses the general problem of how to design and deploy effective computational tools that support actors of an organization domain in making sense of the information these manage by means of those tools and technologies. To this aim, the chapter recognizes the complementary, but sometimes also diverging, approach of two related disciplines, Computer Supported Cooperative Work (CSCW), and Information Systems (IS). Contributions from both these academic communities are put in a common perspective to discuss a comprehensive solution to the apparently incompatible requirements of different communities of users that use the same information for different purposes. The authors take the theme of quality information standards, requirements, and users' expectations in information-intensive domains such as healthcare and hospital work as a paradigmatic case to discuss the characteristics of their proposal. This encompasses the conceptualization of a general-purpose architecture that they devised to support adequate exploitation by human actors of informative resources regarding how they perform their job and articulate their actions with others; and a specialized design-oriented construct, called Affording Mechanism (AM). An AM is a dyad composed by an artifact (i.e., the schema of a material information tool) and a dynamic relationship between the context of use and the artifact's affordances. AM relationships are expressed in terms of computable if-then statements that modulate the affordances conveyed through and by the artifact to evoke a "positive" and knowledgeable reaction in the actors' behavior. On the basis of observations performed in the hospital domain, the chapter discusses in a coherent constructivist light the role of artifacts and derives a set of general requirements for affording mechanisms that support situated behaviors. © 2012, IGI Global.

In this paper we report the findings from a CATI-based survey that involved a representative sample of General Practitioners in Italy. Respondents were asked about their use of ICT in keeping in touch with their patients; their adoption and actual use of their Electronic Patient Record (EPR); and, more importantly, their perception of usefulness of a series of novel functionalities that could enrich the next generation of EPR in general practice.

Purpose: The aim of this study was to report orthopedic surgeons' management of choice for difficult clinical scenarios of shoulder pathologies. Methods: A web questionnaire was developed including four clinical scenarios of shoulder pathologies. Subsequently, opinions were solicited from more than 1,000 members of an international association of surgeons specialized in sports traumatology and knee surgery (ESSKA). Results: The response rate was 40% (412 questionnaires). For scenario 1, first anterior dislocation of the shoulder, the most indicated treatment for 71% of respondents was an arthroscopic Bankart repair (P < 0.001). For scenario 2, shoulder arthritis with concentric erosion and cuff tear, 38% chose a shoulder replacement, while 37% preferred a supraspinatus tendon repair in combination with long head of biceps (LHB) tenodesis or tenotomy. For scenario 3, large tendon tears with 70% fatty infiltration of the infraspinatus tendon and lateral LHB instability, 70% of surgeons considered that, among conservative treatments, hyaluronic acid injection was not an appropriate management. Arthroscopic rotator cuff repair, arthroscopic acromioplasty, and LHB tenotomy gained larger consensus (81, 80, and 79% of respondents, respectively). A double-row technique for rotator cuff repair was preferred to a single-row technique (P = 0.02). Scenario 4, adhesive capsulitis, split the respondents equally, with 51% in favor of a surgical approach and 49% in favor of a conservative approach (N.S.). Conclusions: On-line questionnaires have the potential to improve knowledge about current trends in clinical practice and can help orthopedic surgeons to develop guidelines. Level of evidence: Cross-sectional; Level V (expert opinion). © 2011 Springer-Verlag.

Purpose: To describe preferences and to quantify the amount of agreement among orthopaedic surgeons regarding treatment options for four clinical scenarios of knee pathologies. Methods: A web-based survey was developed to investigate the attitudes of members of an international association of surgeons specialised in sports traumatology and knee surgery European Society of Sports Traumatology, Knee Surgery and Arthroscopy. Results: The response rate was 40 % (412 questionnaires). An inter-rater agreement score (the Normalised Chi-square based Agreement Nomogram, NX2A) was calculated for each question. For scenario 1, 56-year-old male, degenerative medial compartment on both the femoral and tibial side, the surgical approach was preferred to the conservative approach (p < 0. 001). Biological procedures were not considered appropriate, and in this respect, the respondents achieved a moderate degree of agreement (NX2A = 0. 68). For scenario 2, 35-year-old male, early knee medial arthritis, the surgical treatment was preferred to conservative treatment (p < 0. 001). The traditional closed-wedge tibial osteotomy was not regarded as an appropriate treatment with an excellent degree of agreement among surgeons (NX2A = 0. 76). For scenario 3, 46-year-old male, ACL lesion, there was an almost disagreement, as respondents showed no preference between a surgical and conservative approach (NX2A = 0. 005). Among surgical treatments, an almost perfect agreement with regard to the appropriateness of arthroscopic single-bundle ACL reconstruction with a semitendinosus/gracilis graft was reached by the surgeons (NX2A = 0. 8). For scenario 4, 69-year-old male, diffuse knee arthritis (all the compartments), an almost perfect agreement in favour of a total knee prosthesis was obtained for the management of this scenario (NX2A = 0. 85). Conclusions: Web-based survey can help orthopaedic surgeons discuss and propose indications for clinical practice in the management of some of the most co

The paper reports a case study where a relatively lightweight technology in the form of a Web-based questionnaire was used to support members of a real community of professionals in externalizing and sharing their good practices and achieving a better awareness of and agreement on topics of common interest. We focused on an important medical association that counts more 1000 doctors all around the world as its members. In particular, we report how this association used the occasion of the on-line survey enabled by our technology to increase the awareness of its members about the actual heterogeneity of preferences existing in their daily clinical practice, and to trigger discussion toward a better consensus on best practices, appropriate indications, and treatments of choice for their profession and practice. We also report the result of a post-hoc evaluation of the Web-based technology employed, and draw some implications for the better design of this kind of tool in order to collect and share collective knowledge in specific professional domains

In this paper we question the separation between technologies that support information and handle the ordered flow of work and technologies that support knowledge management. On the basis of observational studies and initiatives of participatory prototype design that we performed in the hospital domain and other cooperative work settings, the paper proposes a unified view of these high-level functionalities through the notion of Affording Mechanism. In order to clarify the implications for design, the paper discusses the relationships between knowledge and representations; the role of artifacts that are used in activities where knowledge is allegedly “produced, shared and consumed”; and finally the notion of affordance and its dynamics. In very general terms, an AM consists of an artifact and of dynamic relationships between the context of use and the artifact’s affordances, expressed in terms of simple if-then constructs. The affordances conveyed through and by the artifact are modulated in order to evoke a “positive” reaction in the actors who use these augmented artifacts and to support knowledgeable behaviors apt to the situation. Moreover, the paper illustrates a prototypical technology through examples derived from the studies mentioned above, and discusses the kind of support this application provides in the light of an unusual interpretation of what it might mean to “manage” knowledge through computer-based technology.

The highly distributed cooperation that characterizes several domain, like healthcare, collaborative design and cultural resources management, often raise coordination conflicts and collaborative problems. These problems require a suitable technological support that can make the members of the groups involved in these collaborative practices aware of the crucial information that is generated in the other groups. In this paper, we propose a framework for the design of such technological supports and illustrate its application by means of an articulated healthcare scenario. Our framework allows users to: manage the creation and execution of rules that are specific and “local” to specific groups; manage the exchange of rules, and hence of “procedural knowledge”, across and among different groups; conceive predefined procedures that are considered as “carriers” of contextual information rather than models of prescriptive behavior; become mutually aware of interdependent task articulation as a basic support of inter-group collaboration; get facilitated access to the relevant information that supports their collaborative activities.

In this paper we present the visual editing tools of the WOAD framework that we propose to make end-users autonomous in tailoring their digital documents to their ever changing needs. After a brief outline of the essential points regarding the architecture and conceptual model of WOAD, we describe the tools we have developed to allow end users to both create their own document templates and augment them with proactive and context-aware rules (called mechanisms in the WOAD framework).

In this paper we present the architecture of WOAD, a framework that we propose to make clinical end-users more autonomous in tailoring Electronic Patient Records (EPR) to their changing needs. We provide a short overview of the main concepts of WOAD and then we present the two visual tools that we developed to allow end-users to create their own templates and endow these with proactive and contextaware mechanisms. Finally, we outline the main flows of interaction that have been implemented in ProDoc, a WOAD-compliant prototypical patient record.