Platform-independent, adaptive teaching/learning systems for medical education and training

From the

Institute of Medical Biometrics and Informatics Department of Medical Informatics (Director: Prof. Dr. R. Haux)

and the

Laboratory computer-assisted training in medicine (led by Prof. Dr. Dr. h.c. H.-G. Sunday, Prof. F.J. Leven)

Platform-independent, adaptive teaching/learning systems for medical education and training

Inaugural dissertation for the degree of Doctor scientiarum humanarum (Dr. sc. hum.) from the Faculty of Medicine of the Ruprecht-Karls-Universität Heidelberg

Presented by Martin Haag of Brettheim

The most lost day of all is the one you haven't laughed at. A. DE SAINT-EXUPÉRY

Dean: Prof. Dr. Dr. h.c. H.-G. Sunday caretaker: Prof. Dr. R. Haux

Teaching/learning systems can make an important contribution to high-quality medical education, allowing students to deepen their learning experience in real practice or to prepare them better for this practice. However, the currently available CBT (computer-based training) systems have some conceptual weaknesses, which, in addition to their lack of integration into curricula, are responsible for their comparatively low use in Germany.

The present paper provides answers to the following questions:

• What conceptual characteristics must a teaching/learning system have to address the weaknesses of existing CBT systems?

• How can students make more frequent use of teaching/learning systems?

• How can the acceptance of teaching/learning systems among medical teachers be improved?

The solution concept developed provides for a teaching/learning system shell that enables specialists without computer skills to create and make high-quality teaching/learning systems available worldwide.The chosen shell approach enables easy reuse of both domain content and teaching/learning system functionality.The shell is based on extensive data structures that are described by object-oriented semantic data modeling.

Shell's teaching and learning subsystems are entirely based on Internet applications and Internet standards. They are platform-independent, ensuring that the systems created can be used on all computers with Internet access, including on students' and lecturers' private computers by selecting modems or ISDN adapters. A 7-layer architecture is proposed to solve the PerformanceProblems of Internet-based teaching/learning systems.

The systems created are adaptive and adaptable, i.e. they adapt to their users, but they can also be adapted by them themselves, depending on personal preferences.

The concepts developed were implemented in the CAMPUS project (Computer-assisted training and advanced training in medicine through platform-independent software) and the primary areas of application of the CAMPUS teaching/learning system shell are paediatrics and infectiology.

This Regulation shall enter into force on the twentieth day following that of its publication in the Official Journal of the European Union.

1.1 PROBLEMATICS and MOTIVATIONs

1.2 PROBLEMS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

1.3 OBJECTIVES and QUESTIONs

1.4 JOURNALITY of work . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

2 GROUNDLAGES The following conditions shall apply:

2.1 DEFINITIONS of the meaning of the word . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

2.2 MEDICINE education and training

2.2.1 BMG draft

2.2.2 Berlin reform course of study . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

2.2.3 Study reform and CBT

2.3 Computer-based training . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

2.3.1 Forms of interaction in teaching/learning systems

2.3.1.1 Form of interaction Presentation

2.3.1.2 Interaction form Browsing

2.3.1.3 Interaction form Drill & Practice

2.3.1.4 Form of interaction Tutorial dialogue

2.3.1.5 Form of interaction Simulation 13 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

2.3.2 Development of CBT systems

2.3.3 Problem-based learning with CASUS 15

2.4 Web . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

2.4.1 Hypertext and hypermedia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

2.4.2 Disadvantages of hypertext . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

2.5 WBT-SYSTEM ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... and ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ...

2.5.1 Types of architecture

2.5.1.1 Client based architecture . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

2.5.1.2 Remote data and knowledge architecture . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

2.5.1.3 Distributed teaching architecture

2.5.1.4 Server-based architecture

2.5.2 Client/server communication

2.5.3 Integration of existing web resources . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

2.5.3.1 Different concepts of representation

2.5.3.2 Problem of granularity 28

2.5.3.3 Quality of resources 29

2.5.3.4 The dynamics of the World Wide Web

2.5.3.5 Degree of integrability ... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

2.6 DEFINITION on the form of payment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

2.6.1 Portability of goods and services

2.6.2 Basic techniques for the creation of platform-independent WBT systems

2.7 Adaptation and adaptability . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

2.8 INTELLIGENT TUTORIAL SYSTEMS 36

2.8.1 Construction of the railway system

2.8.1.1 Expert module 37

2.8.1.2 Student module ... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

2.8.1.3 Teaching module . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

2.8.1.4 Communication module 41

2.8.1.5 Development aid 41

2.8.2 Criticism of intelligent tutoring systems

2.8.3 D3 and TRAINER 42

2.9 SEMANTIC data modelling . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

2.10 DATENBANKS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

2.10.1 Relative data model ... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

2.10.2 Object-oriented and object-relational databases

3 Design and modelling

3.1 RECOMMENDATIONS to the WBT system ... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

3.1.1 Content and didactics 53

3.1.2 Architecture and the environment

3.1.3 Basic techniques 55

3.1.4 Architectural decision 56

3.2 Phase model for the development of WBT systems

3.2.1 Pedagogical analysis 58

3.2.2 Requirement analysis 58

3.2.3 Presentation design 60

3.2.4 Modelling of domains 60

3.2.5 Modelling of educational functions

3.2.6 Distribution design . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

3.2.7 Implementation of Regulation (EC) No 62

3.2.8 Data and knowledge gathering

3.2.9 System testing of the system

3.2.10 Evaluation of the results of the work carried out

3.3 Teaching and learning system shell concept

3.4 CAMPUS CONCEPT of the European Parliament and of the Council

3.4.1 CAMPUS teaching/learning system shell

3.4.2 Shifting model . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

3.4.3 Teaching model . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

3.4.4 Case running model 73

3.5 CONCEPTUAL MODELING 75 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

3.5.1 Normal finding model 75

3.5.2 Case model ... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

3.5.3 Case-law model . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

3.5.4 Lexicon model ... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

3.5.5 Layout model . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

3.5.6 User model ... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

3.5.7 Question model 105

3.5.8 WBT system model . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

This Regulation shall enter into force on the twentieth day following that of its publication in the Official Journal of the European Union.

4.1 Works and basic techniques

4.2 Authorisation system . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

4.3 LERANCY SYSTEMs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

4.4 Educational system . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

4.5 CAMPUS/Pediatrics and CAMPUS/Infectiology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

5 CONSIDERATION AND DISCUSSION on the proposal for a Council Directive on the approximation of the laws of the Member States relating to the approximation of the laws of the Member States relating to the approximation of the laws, regulations and administrative provisions of the Member States relating to the approximation of the laws, regulations and administrative provisions of the Member States relating to the approximation of the laws, regulations and administrative provisions of the Member States relating to the approximation of the laws, regulations and administrative provisions of the Member States relating to the approximation of the laws, regulations and administrative provisions of the Member States relating to the approximation of the laws, regulations and administrative provisions of the Member States

This appropriation is intended to cover expenditure relating to:

In the case of vehicles of heading 8401 or 8402, the value of the vehicles of heading 8402 shall not exceed the value of the vehicles of heading 8402 or 8403.

I SYMBOLE AND NOTATION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

ILOGICAL MODEL The following is a summary of the results of the evaluation:

This Regulation shall enter into force on the twentieth day following that of its publication in the Official Journal of the European Union.

This Regulation shall enter into force on the twentieth day following that of its publication in the Official Journal of the European Union.

V TABLE RECOMMENDATION for the purposes of this Regulation

VI INDEX . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

1 Introduction to the directive

1.1 Problems and motivation

Already at the beginning of the sixties, after the introduction of the second generation of large computers at universities, the development of CBT systems (computer-based training) was started [OWEN, HALL et al. 65]. Although the price of computer performance has since declined by many times and is now on many desktop multimedia computers, computer-assisted training in medicine [LEVEN, SCHULZ et al. 95; KLAR, BAYER 90; KALLINOWSKI, MEHRABI et al. 97, BAUR, MICHAELIS (Hrsg.) 90] in Germany has always not reached very high levels.

CBT has been reduced through various activities [HAAG 95]. However, there is still a lack of a better integration of CBT into curricula. Teachers also still very rarely point out good teaching/learning systems to their students. The high proportion of MC tests (MultipleChoice) in physics and state examinations leaves little to be gained from the offer of medical libraries or showrooms, which are available to students as well as libraries for independent use.

The requirement of Article 2 (2) of the Medical Approval Ordinance (ÄAppO) [ÄAPPO 89] that unreasonable burdens should be avoided by teaching can thus be fulfilled.

The Scientific Council also welcomes the use of CBT systems in medical education:

Practical relevance also means the student's contact with practical clinical problems, discussions of case studies and solution strategies, of differential diagnoses and differential therapy. Personal media could be used profitably here. While audiovisual and computer-aided learning programmes or workplaces cannot replace practical experience, they are valuable tools for preparing seminars and acquiring knowledge on rare diseases or particularly difficult subjects. However, the development of the didactic potential of personal media will only be successful if the university actively contributes to the preparation of the programmes, which are prepared in accordance with the curriculum and the students have access to a full range of media.

In his most recent recommendations on the development of higher education through multimedia in study and teaching, he writes:

Multimedia study offerings deepen learning experience in real practice (e.g. laboratory work, patient examination through virtual practice; they open up new possibilities to prepare such practice efficiently and to support training opportunities in simulated environments. There are impressive examples in medicine. It is expected that in all areas where training is an important component of the professional competence and proficiency to be conveyed, multimedia will rapidly gain importance for teaching and study. This is especially true for areas where training requirements in real environments face obstacles and acceptance; for example, through the use of multimedia for animal studies can be largely abandoned.

Experience in the laboratory of computer-assisted training in medicine at the University of Heidelberg shows that medical students are very fond of working on multimedia case simulations. Purely browsing systems, especially those without multimedia components, are, however, much less appreciated by students. Unfortunately, the supply of high-quality teaching/learning systems on the commercial market is still not large. Medical publishers rely exclusively on universities and do not develop CBT systems themselves. This makes sense because the necessary expertise is concentrated there. However, it also means that the user interfaces, including those of a single user, are unfortunately often highly interconnected.

This situation will also change little in the near future, especially given the high cost of developing teaching/learning systems and the relatively low demand on the other hand. A cost-effective involvement of publishers in this area is therefore currently difficult to achieve. Medical universities must therefore continue to invest resources in the future in the creation of high-quality CBT systems if they wish to use such systems in training. This is particularly necessary in the light of the many years-long planned revision of the Medical Approval Code (e.g. BM GESUNDHEIT (Hrsg.) 93) which, among others, envisages a reduced share of the MCT expert group in tests.

Interuniversity projects such as the VIROR project (Virtual University of Oberrhein) [VIROR], in which the laboratory is involved in computer-aided medical education, also provide excellent opportunities for information exchange.

In addition, the World Wide Web [LOWE, LOMAX et al. 96] offers entirely new perspectives for the implementation of platform-independent, network-based learning/learning systems. Compared to conventional CBT systems [AUHUBER 98, HOOPER, J. O'CONNOR et al. 95, PASTERKAMP 91], which are created on a particular computer platform with a capable authoring tool and are often only capable of running on that computer platform, such systems offer substantial advantages [AUHUBER 98, MAYLEIN et al. 98].

1.2 Problems

Conventional CBT systems currently available on the market have various conceptual weaknesses and are experiencing acceptance problems among many medical practitioners. Conventional CBT systems include teaching/learning systems that run on standalone computers without a network connection and are distributed to data carriers, usually through medical specialists.

Problem 1: Conventional CBT systems are platform-dependent, so students or universities need the right hardware and software platform to work with a teaching/learning system.

Problem 2: Conventional CBT systems need to be installed. Installation takes time and space on the computer's local hard drive is required. Furthermore, installations, especially on Windows PCs, can lead to instability. Many users are therefore reluctant to install a CBTS system for testing purposes only.

Problem 3: Updating conventional CBT systems is expensive because updates must be sent to all users and played on their computers.

Problem 4: When using conventional CBT systems in self-study, students are left alone if they cannot solve questions on their own with the knowledge contained in the system.

Problem 5: Conventional CBT systems are usually not adaptive.Adaptivity, i.e. the adaptation of the teaching/learning system to the user, is practically only found in intelligent tutoring systems (see Chapter 2.8).

Problem 6: In the design of existing CBT systems, the reusability of teaching/learning content (domain knowledge, multimedia teaching/learning media, etc.) and teaching/learning system functionality has been overlooked in many cases.

Problem 7: The creation of teaching/learning systems is very time-consuming and cost-intensive, requiring not only medical expertise but also computer skills.

Problem 8: Many lecturers have a critical attitude towards CBT systems, especially those that have not been developed in collaboration with them.

1.3 Objective and question

In order to solve the above problems and thereby promote the use and development of CBT systems, it is necessary to develop systems with a fundamentally new architecture.

The following objectives and questions arise from the work:

Objective 1: Develop an innovative concept for the implementation of teaching/learning systems used in medical education and training.

The following questions are to be answered in connection with this objective:

Question 1.1: What conceptual characteristics must a teaching/learning system have in order to

to solve the problems described in Chapter 1.2 of conventional CBT systems?

Question 1.2: How can students achieve more frequent use of teaching/learning systems?

Question 1.3: How is the acceptance of teaching/learning systems among medical students

Question 1.4: How can lecturers be encouraged to use CBT systems more effectively in their courses and to encourage their students to work with CBT systems more effectively?

Question 1.5: To what extent can the concept be kept independent of the field of study?

Objective 2: Exemplary implementation of the concepts developed in the form of a prototype

I would like to thank the President-in-Office for his excellent report.

1.4 Division of work

Chapter 2 summarises all the basics relevant to the work. Chapter 3 describes in detail the solution concept for the problems described in Chapter 1. Chapter 4 summarises the implementation of the concepts under the CAMPUS project (Computer-assisted training and training in medicine through platform-independent software). Summary and discussion (Chapter 5) and a list of literature (Chapter 6) conclude the work.

2 Basics

2.1 Definitions of the term

Computer-based training (CBT): Computer-based training is a form of training in which computers are used not as a learning object but as a teaching tool.

CBT system: An application software product and any additional hardware needed that can be used on a computer for training and further training.

Conventional CBT system: CBT system which is capable of running on a standalone computer without a network connection and is usually distributed to data carriers via conventional distribution channels (often medical specialty publishers).

WBT system: CBT system based on the Internet or World Wide Web (WWW) and the standards used therein.

Web-based training (WBT): Computer-based training using WBTS systems.

Teaching/learning system functionality: Teaching/learning system functionality refers to all the components that are characteristic of teaching/learning systems and make a system suitable for training, including teaching components (implemented teaching strategies), presentation components and navigation functions (in browsing systems).

Teaching/learning systemclient: Part of a teaching/learning system which, in teaching/learning systems with client/server architecture, is located on the client computer and communicates with the teaching/learning system server via a computer network.

Teaching/learning system server: Part of a teaching/learning system which, in teaching/learning systems with client/server architecture, is located on the server computer and communicates with the teaching/learning system client via a computer network.

Basic technology: technology or programming language for the creation of WBT systems.

Teaching/learning system shell: CBT system shell in which only the teaching/learning system functionality is present and in which a CBT system is created by adding domain data and domain knowledge.The addition of domain data and domain knowledge is supported by an easy-to-use tool.

2.2 Medical education

Today, medical knowledge is so extensive that even with a strong specialization in a particular field, the amount of knowledge available is hardly overlooked [WEED 89]. Furthermore, this knowledge changes relatively quickly, so that it is practically impossible to impart a sufficient amount of medical knowledge to students during the duration of a medical course of study [ARBEITSKREIS MEDIZINERAL EDUCATION 95 P. 73]. But this is exactly what is still being attempted at most medical schools in Germany. They are based on a comprehensive subject catalogue.

There are therefore a number of different reform proposals [Working Group Medical Education 95, Science Council 92, Federal Ministry for Health (Hrsg.) 93, MFT Presidential Commission 96] in which consensus on many points appeared to emerge on the necessary measures [EITEL 93a]. In 1989, the so-called Murrhardter Kreis (a working group medical education funded by the Robert Bosch Foundation) published a study on the future of medical education. This study provided the basis for discussions on reform in Germany.

• The emphasis in medical education is on the conveyance of factual knowledge; understanding and problem-solving skills are less intensively conveyed.

• Written examinations carried out at national level require too much in-depth knowledge, which is often of little importance in professional practice and is quickly forgotten.

• Medical students are not prepared to pursue further education on their own, which would be necessary in view of the rapidly changing scientific, technological and societal context of medical vocational education and training.

• There is insufficient practice in dealing with patients and their problems.

• The use of information processing is not adequately communicated, nor are communication skills adequately trained.

• Natural sciences take precedence over psycho-social, ethical and emotional aspects in medical studies. In medical studies, doctors are trained, not doctors [PROTECT CREASE MEDICINE EDUCATION 95 p. 273].

• The clinical training provided in the study is insufficient for a career in general medicine.

• The content of the various subjects and levels of training is poorly coordinated.

• Research and health care are a priority for most university teachers over teaching, which often leads to unsatisfactory teaching quality.

• offers of education with an emphasis on natural sciences, biomedical or psycho-social aspects are not sufficiently accepted or offered by universities.

The requirements for a reform curriculum arise from the following criticisms:

• Students should be better trained for primary medical care.

• Independent, problem-oriented and active learning should be encouraged.

• The strict separation between clinical and preclinical training should be abolished.

• Contact with patients should be made possible as early as possible.

• Psychosocial and ethical aspects should be taken more into account in the study.

• Students should have more freedom of choice when designing their studies.

• Examinations should be more practical and the proportion of MC examinations should be reduced.

2.2.1 BMG draft

The draft of the Federal Ministry of Health on the reform of medical education certainly does not meet all the above requirements of a reform curriculum [GÖBEL, REMSTEDT (Hrsg.) 95] and also falls short of the recommendations of the Scientific Council [WISSENSCHAFTSRAT 92].

• Six years of study, divided into three parts (5+5 semesters, PJ), supplemented by 1.5 years of AIP.

• interconnection of preclinics and clinics.

• Summary of subjects by subject area.

• Study content should be taught as interdisciplinary and study-related as possible.

• Improvements in practical training, e.g. through seminars, teaching on the bed and subject groups in the first part of the study.

• Problem-oriented learning [ALBANESE, MITCHELL] HASMAN 89] as a new form of teaching in addition to teaching in bed.

The first part of the examination takes place after five semesters (fusion of physics and first state examination). The second part of the examination increases in scope. The oral and practical examinations are weighted more heavily. The third part takes place unchanged as an oral collegiate examination in four subjects.

• An experimental clause should allow for the establishment of model courses.

• Reduction of the number of entries by 20%.

In the meantime, even this draft has not been able to obtain the necessary approval in the relevant committees.The 8th Novel of the Medical Approval Rules has therefore now been postponed indefinitely.However, an experimental clause is likely to be introduced to enable model studies such as the planned reform study programme in Berlin.

2.2.2 Berlin reform course of study

In Berlin, following a student strike in the WS 1988/89, a working group for reform studies in medicine was set up. The task of this working group was to design and organize a reform study programme. In addition to university professors from the basic subjects, representatives of the clinical disciplines worked on the design as well as student representatives [Haller, Burger et al. 95]. The model in the design of the study programme was McMaster University in Canada. The result of the work group was presented in 1993. The reform study programme was originally scheduled to start its operations in 1995. However, not all the legal (change of the Approval Rules) and financial requirements for a study are still given.

Problem-oriented interdisciplinary lectures

Figure 1: Distribution of hours at the Berlin Reform School

2.2.3 Study reform and CBT

In contrast to the teaching/learning forms, the teaching/learning content in the reform curricula remains largely unchanged. Due to advances in medical research, these are in any case undergoing constant change. Computers play a more important role as teaching tools in reform courses than in conventional courses of study. Because students must be reinforced by problem-oriented learning (ALBANESE, MITCHELL, HASMAN 89) and a higher proportion of self-study must be enabled to self-study and self-responsible further education. In this way, teaching/learning systems provided in medical or on-line courses can make an important contribution to current medical careers [WISSFATFATFATFATFATFATFATFATFATFATFATFATFATFATFATFATFATFATFATFATFATFATFATFATFATFATFATFATFATFATFATFATFATFATFATFATFATFATFATFATFATFATFATFATFATFATFATFATFATFATFATFATFATFATFATFATFATFATFATFATFATFATFATFATFATFATFATFATFATFATFATFATFATFATFATFATFATFATFATFATFATFATFATFATFATFATFATFATFATFATFATFATFATFATFATFATFATFATFATFATFATFATFATFATFATFATFATFATFATFATFATFATFATFATFATFATFATFATFATFATFATFATFATFATFATFATFATFATFATFATFATFATFATFATFATFATFATFATFATFATFATFATFATFATFATFATFATFATFATFATFATFATFATFATFATFATFATFATFATFATFATFATFATFATFATFATFATFATFATFATFATFATFATFATFATFATFATF

2.3 Computer-based training

2.3.1 Interactions in teaching/learning systems

For CBT systems in the medical field, five different forms of interaction can be distinguished (see Figure 2) [HAAG, MAYLEIN et al. 98]. A real teaching/learning system can also have several of the interaction forms listed at the same time. For example, if in a teaching/learning system, in addition to a case simulation (interaction form simulation, etc.) there is also an electronic lexicon (interaction browsing, etc.) in which users can derive the knowledge they need for successful case processing.

Figure 2: Interaction forms and architectural types of CBTS systems

In the interactive form presentation, the system presents subjects in a linear form, in the electronic form of a slide presentation or a sound recording. The user's interventions are limited to moving forward or backward in the presentation and stopping it in the case of an automatic presentation.

When browsing, users are provided with the content of the teaching/learning system in the form of a hypertext in which they can navigate freely. It is up to the user to decide which content to view at all and in what order. Usually there is a directory of content and/or a list of keywords that can be jumped over to specific content. The content is linked by links, creating a network of information elements.

Electronic textbooks [KNAUP 94] are a typical example of this form of interaction.

2.3.1.3 Form of interaction Drill & Practice

The interaction form Drill & Practice is used to deepen the knowledge of facts learned with other teaching media (e.g. books). This is done by answering questions or editing exercises asked by the teaching/learning system. It provides feedback on whether or not the question has been answered correctly or whether or not the exercise has been performed correctly. However, the system does not attempt to determine why a question has been answered incorrectly in this form of interaction.

2.3.1.4 Form of interaction Tutorial dialogue

In contrast to the forms of interaction presentation and browsing in which the teaching/learning system plays a passive role, the CBT system plays an active role in the interaction form of Tutorial Dialogue. Typically, after the presentation of individual teaching/learning units, knowledge control questions are asked, with the help of which the CBTS system tries to determine whether and to what extent the previous teaching/learning unit has been understood. If questions are answered incorrectly, the system gives specific clarifications and presents further information and knowledge to eliminate the identified deficit.

A special form of Tutorial Dialogue is the Intelligent Tutorial Dialogue, in which artificial intelligence methods [WENGER 87] are used to control the dialogue between the CBT system and users in such a way as to promote learning progress in an ideal way, by continuously analysing the user's learning behaviour, prior knowledge, preferences and, on the basis of this information, controlling the further development of the program (e.g. [FONTAINE, LE BEUX et al. 94]).

In the interaction form simulation, the teaching/learning system behaves passively, presenting the user with the most realistic model of a reality segment and showing the model's reactions to user actions, but the system does not provide direct feedback on user actions.

2.3.2 Development of CBT systems

For the development of conventional CBT systems with the interaction forms presentation (see Chapter 2.3.1.1) and browsing (see Chapter 2.3.1.2) there are a greater number of different author systems available commercially.

Script or card-based systems: In script or card-based systems, the author creates so-called scripts, which are processed when certain events occur (e.g. selecting a button with the mouse, entering text, etc.). The script languages are usually very powerful and support the creation of hypertext. Under Windows on the PC, Toolbook is very widespread and is commonly used. On the Apple Macintosh, HyperCard [APPLE 93] and SuperCard are very commonly used for the creation of CBTS systems. Script or card-based systems usually also allow the creation of more complex learning/learning systems.

Icon-based systems: Icon-based systems allow the creation of teaching/learning systems without having to be programmed in the traditional sense. Authors can create the programming process using graphical programming by positioning and linking icons to each other. The different icons each represent basic constructs (loop, if instruction, etc.) as is known from programming languages such as Pascal. With these types of systems, specialists without major computer skills can quickly create presentations and simple teaching/learning systems. However, the flexibility in programming is limited.

Time-based systems: Time-based systems are very suitable for creating presentations. Various actions can be arranged along a time beam, such as displaying an image, input field, or playing a sound file. Animations can be created very easily by arranging individual images along the time beam.

For example, in the case of script and card-based authoring systems, both the domain content is recorded on a map and the learning/learning system functionality in the form of scripts is anchored to the text objects (buttons, text fields, etc.) on the map. Furthermore, the systems created on the target computer usually have to be installed and updated only by the fact that the instructional/learning system formats are only installed on an older version of the CBT system, or in many cases only on an older version of the CBT system.

2.3.3 Problem-based learning with CASUS

One of the most active working groups in the field of medical CBT in Germany currently works at the Ludwig-Maximilians-Universität München under the direction of Martin Fischer. With the teaching/learning system CASUS [FISCHER, GRÄSEL et al. 95] developed in this working group, medical students can learn from teaching/learning experiences. The system consists of two components: an author system and a play module or player.

• First impression of the patient

• History of the work

• Physical examination

• Laboratory testing

• Technical examination

• Diagnosis

• Therapy and course of action Figure 3: Schematic programme structure of a CASUS

It can be varied by adding further steps, loops and jumps. Because the authors enter the (multimedia) contents of the cards themselves freely for the case presentation, authors have different card layouts (a total of 6) with which they can present a teaching/learning case. Between the individual presentation cards, cards can be integrated into the case history, on which learners must answer questions about the teaching/learning case. Because authors enter the (multimedia) contents of the cards themselves freely, it is hardly possible to reuse individual case components without reusing the large case components in other teaching/learning cases. Such reuse is not supported by CASUS systems.

Teaching/learning events can currently be stored in two databases: an object-oriented NeoAccess database and a relational Oracle database. The NeoAccess database is accessed via a specially developed CASUS data server. ORACLE is accessed using the SQL (Structured Query Language) Net protocol. The necessary database access functionality is implemented in the author system.

2.4 The World Wide Web

Until the early 1990s, the Internet was used almost exclusively by scientists and technology enthusiasts around the world. With the availability of the World Wide Web [BERNES-LEE, CAILLEAU et al. 92], which began development in 1989 at CERN (European Laboratory for Particle Physics), this situation fundamentally changed. The World Wide Web also made documents distributed worldwide on Internet hosts available and also integrated pre-existing Internet services under an easy-to-use user interface.

There are hardly any companies, institutions, television stations, etc. that are not present on the Web. The World Web offers a number of tools for creating applications in the medical field [CIMINO, SOCRUS et al. p. 282] and the fact that many people have already used a Web browser, there is hardly any fear of touch. According to their own observations, even computer-experienced users are very quickly able to use Web browsers. The World Web offers a number of tools for creating applications in the medical field [CIMINO, SOCRUS et al. p. 282].

The indisputable strengths of the World Wide Web, such as ease of use and wide availability of software, also face some weaknesses:

• The Hypertext Transmission Protocol (HTTP) is a stateless protocol. It does not establish a continuous connection between the browser and the server, but a new one for each user action [IBRAHIM, FRANKLIN 95]. This causes problems in multi-level human-machine dialogues because the server does not have information about the previous interaction steps.

• If users have entered data in input fields and at a later time press the back button or go back to the input area via the history list, they will find that the data entered is still in the input fields and may then be prompted to resend the data.

• The World Wide Web cannot determine whether certain information is in the system [RAMM 95], so it cannot be considered as an information system. The lack of quality of many offers on the World Wide Web is also lamented (e.g. [STOLL 96]). Another author warns in this context of the danger that the Web can easily develop into the world's largest vanity press1 [LLAURADO 97] because anyone can be an author, editor and publisher with a computer at the same time. These roles can all be filled anonymously.

• Another problem is the Uniform Resource Locator (URLs). When renaming documents or servers or restructuring, all external references to the documents involved are necessarily empty. Worldwide, it is estimated that up to 25% of all references are empty.

So the World Wide Web is showing clear weaknesses: broader approaches such as Hyper-G [KAPPE, MAURER] DALITZ, HEYER 95, where at least the technical weaknesses are deadened, however, currently have little chance, because there is now a huge and often free supply of software for the Web.

2.4.1 Hypertext and hypermedia

The concept of hypertext was first described in 1945 by Vannevar Bush, an adviser to then-U.S. President Roosevelt [NIELSEN 95]. Although Bush's Memex system for spreading large volumes of text remained unrealized, it became increasingly clear that Bush's vision was to be realized. Thus, the volume of manuals for highly complicated devices such as jet aircraft (handbook volume of about 300,000 pages [VENTURA 88, quoted in SCHULMEISTER 96 p. 207]) compels the documents to be deposited in electronic form and made available to users.

According to Spiro and Jehng [SPIRO, JEHNG 90, cited in SCHULMEISTER 96 S. 248] hypertext systems are particularly well suited for ill-structured domains. By contrast, AI methods are so far largely limited to well-structured application areas, e.g. mathematics, physics or programming languages.

Hypertext systems can be divided into three levels [CAMPBELL AND GOODMAN 1988, quoted in NIELSEN 95]:

Presentation level: The presentation level defines which commands are accessible to the user, what nodes and references look like, etc. Thus, for example, certain types of links can be withheld from the newcomer.

Hypertext Abstract Machine (HAM) level: At the HAM level, the structure of the nodes and links in the system is defined, e.g. different link types, node attributes (owner, last modification...). For the import and export of hypertext, the HAM level is best suited as it is platform-independent (as opposed to the database level) and also the presentation level varies greatly from system to system. However, the exchange of hypertext is not quite simple, as not only the texts but also various graphic, sound and video formats must be exchanged.

Database level: The database level has little specific to do with hypertext. It is about storing the data in such a way that the smallest parts of it can be accessed in a very short time.

There are currently very few systems that are based on this model in their internal structure, but the model is useful for standardization efforts and shows interesting prospects for the future [NIELSEN 95].

2.4.2 Disadvantages of hypertext

Hypermedia is a non-pedagogical technology, one which is open to learning through browsing, but which must rely on the student's own intelligence for learning guidance. [DUCHASTEL 92, quoted in SCHULMEISTER 96 P. 185]

Accordingly, hypertext systems can only be used by people who are able to identify their own learning needs and systematically meet them by navigating in hypertext.

• Guided tours: authors set learning paths for specific groups of users. Individuals from the user group can follow the specified learning paths sequentially without having to navigate. The learning path can usually be left anywhere.

• Backtrack: Different backtrack methods can be used. The easiest solution to simply call the nodes in reverse order is certainly not particularly smart. Especially if a user has visited several nodes several times. The single-revisited backtrack is a useful alternative. The nodes are called back in reverse order, but nodes that have been visited several times are only called once.

• History lists: In a list, the last x-jumped nodes are entered. The user can choose from this list where he or she wants to jump.

• Bookmarks: Bookmarks allow a user to highlight hypertext pages, allowing them to quickly jump to a highlighted page if needed.

• Overview diagrams: overview diagrams show, for example, at different levels of abstraction, an overview of the content available. An alternative is the so-called fisheye view, in which individual areas and nodes are presented in more detail the closer they are to the user's current location in the hypertext. Link inheritance creates clusters. Only the individual clusters are then connected by references (links).

• Metaphors: Metaphors should be applied consistently throughout the system and should not change as it confuses the user.

Cognitive overhead refers to the effort required to read a hypertext in addition to the effort to acquire knowledge in order to find a place in the reference web at all [CONKLIN 87].

Lost in hyperspace is a phenomenon in which users of a hypertext system are not guided, but are able to move freely in hyperspace. It can easily happen that a user loses an overview of where he or she is at the moment. This phenomenon is called lost in hyperspace [HALASZ 88]. It can also happen that he or she encounters new information that interests him or her and forgets what he or she was originally looking for.

2.5 WBT systems

2.5.1 Types of architecture

The World Wide Web has a client/server architecture [NIEMANN 96], which allows for the creation of distributed teaching/learning systems based on it. Teaching/learning systems can generally be divided into the three layers of presentation layer, teaching system logic layer, and domain data & knowledge layer. The presentation layer represents the user interface between the user and the teaching system logic. User activities (main actions, input, etc.) are processed by the teaching system logic and the response to the presentation layer is further distributed to it. The processing of these layers is based on the teaching knowledge that is contained in the domain data & knowledge layer.

Servers

A total of four different architecture types can be distinguished for WBT systems [HAAG, MAYLEIN et al. 98]. Three architecture types (remote data & knowledge, distributed teaching and server-based) can only be found for WBT systems, while client-based is the architecture type of conventional CBT systems.

Client

presentation presentation presentation presentation presentation

Figure 4: Architectural types of WBT systems

However, CBT systems usually do not require very high computing power, so most basic technologies provide adequate performance. A major impact on performance is the amount of code that the server transmits to the client, especially if only a small network bandwidth is available. If all the system code is transmitted to the client, then the system will be transmitted continuously and continuously, and only the results will be transmitted during the running of the program/system.

Client-based WBT systems have the architecture of conventional CBTS systems. The complete WBT system is transmitted to and runs on the client via a computer network. The server serves merely as a file server, it has no other functions. All three layers of the teaching/learning system are thus located on the client (see Figure 4 [HAAG, MAYLEIN et al. 98]). For the development of client-based WBT systems, a number of basic techniques are available (see Chapter 2.6.) The advantage of the network is that the development of such systems is very little different from the development of conventional CBT systems.

2.5.1.2 Remote data and knowledge architecture

The advantage of such an architecture over the client-based architecture is that not all the multimedia information elements available in the system and the complete domain knowledge available in the system, but only the actually needed parts of the server must be transferred from the server to the client (see Figure 4). In addition, in the background, regardless of the user's activities, domain data and domain knowledge can be loaded on the client's network.

There are a number of different providers that offer tools for transparent access to the domain data & knowledge layer. The development of systems with such an architecture is therefore hardly more difficult than that of a client-based architecture. For example, with the Visual Database Development Edition [SYMANTEC] Symantec offers a development environment that allows easy access to remote relational databases. As a developer, you do not have to worry about the communication between the database server and the client. On the client side, there is also no need for a database driver.

2.5.1.3 Distributed teaching architecture

In this type of architecture, the learning system logic layer is divided. Part of the learning system logic is located on the client, the other part on the server (see Figure 4). Requests to the domain data & knowledge layer can be generated here depending on previous user interactions on the server. The results of the queries can also be analyzed there. This results in performance failures. Multiple queries to the domain data & knowledge layer can be generated and executed completely on the server. Only the results of such queries must be transferred to the client.

The selection of an appropriate knowledge control question from a set of available questions is a good example of illustrating the advantages of this architecture. Appropriate questions to a user should have an appropriate degree of difficulty, they should match the current learning situation, and they should be new to the user. If such a question cannot be found on the first query to the domain data & knowledge layer, further queries can be used to find a question with the best approximation to the requirements. If several questions meet the requirements, then one of the questions can be selected based on the teaching knowledge on the server and sent to the client. Those parts of the teaching layer that are used to monitor user logging activities and to provide adequate communications, can be found on the server's network and, in particular, can be sent over to the server.

As with remote data & knowledge WBT systems, it is possible to load prospective domain data and knowledge independently of user activity from the server. If these data and knowledge are needed, they are already available to the client and do not need to be requested by the server alone. The response speed of a system can thus be optimized. WBT systems with this architecture on the one hand offer the best performance and the lowest network load of all other architectures, but are also necessary for implementation. Two applications, a client application and a server application must be created, which must communicate with each other over a computer network.

In this type of architecture, only the presentation layer is located on the client. Teaching knowledge as well as domain data and domain knowledge are located on the server. The presentation layer redirects all user inputs to the server. There, they are processed and the result of the processing is returned to the client. This is usually done in the form of an HTML file. The advantage of server-based architectures is that any data tools can be used on the server side without depending on the platform on the client side.

However, WBT systems with a server-based architecture are not very performing because all user activity has to be evaluated by the server (construction of a network connection is always required) and too many simultaneous users can easily overload the server computer, resulting in poor overall system performance. An example of a WBT system with a server-based architecture is the Interactive Patient of Marshall University [HAYES, LEHMANN 96].

The user interface of an existing conventional CBT system must be replaced by, for example, an HTML user interface and connected to the existing logic layer of the teaching system.

Application of this Directive

2.5.2 Client/server communication

For the creation of WBT systems with distributed teaching architecture, communication mechanisms between teaching/learning system servers and clients need to be developed, particularly RMI (Remote Method Invocation) and CORBA (Common Object Request Broker Architecture).

Sockets are very flexible and satisfactory for general communication. However, the messages to be transmitted must be encoded and decoded on both the client-side and the server-side, so a protocol for data exchange must be designed and implemented. An alternative is remote procedure calls (RPC), which abstract the communication interface at the level of procedural calls. Instead of working directly with sockets, a programmer calls on remote procedures as if they were local. Arguments of a call are packaged and transmitted to the remote computer.

RMI Stubs skeletons

System Transport Layer Remote reference layer

Java-RMI was developed specifically for the Java environment. While other RMIS systems can be adapted to handle Java objects, these systems have disadvantages in the optimal integration of Java, as they must maintain interoperability with other languages. Java-RMI, on the other hand, is based on a homogeneous Java environment and can therefore often benefit from the advantages of the Java object model. The Java RMI model is fully integrated into Java. This supports the simple creation of dependable, distributed applications.

The RMI system consists of three layers:

1. stub/skeleton layer: The stub/skeleton layer consists of a client side made up of so-called stubs (proxies) and a server side made up of skeletons.

2. remote reference layer: The remote reference layer forms the connecting layer between the transport layer and the stub/skeleton layer. It is independent of these layers and is responsible for performing the semantics of a call.

Transport layer 3: The transport layer is responsible for connection building and connection management. It is based on the Transmission Control Protocol (TCP) and uses Java sockets.

All three layers are completely independent of each other and can be exchanged individually.

Dynamic Dynamic IDL Object IDL ORB Invocation Skeleton Skeleton Adapter Stubs Interface Interface

Figure 6: CORBA (Common Object Request Broker Architecture) CORBA (Common Object Request Broker Architecture) [REDLICH 96, SAYEGH 97] is based on a heterogeneous, multilingual environment, as opposed to RMI, and must therefore have a language-independent object model. The CORBA standard of the OMG (Object Management Group) defines interfaces for communication between objects. The central distributed component of the CORBA architecture is the so-called Request Broker (ORB), which is used to exchange messages between different objects.

Creating a CORBA application takes several steps [REDLICH 96 S. 3] and is more complex than handling RMI:

1. create interface description for the remote object 2. translate interface description 3. implement servers 4. register servers 5. implement clients 6. activate all components (run the application)

Because CORBA has a language-independent object model, the interfaces between objects must be defined using a special language called Interface Definition Language (IDL). From an interface description, the interface for the programming language used is then generated. The rules for translating the IDL definitions into semantically equivalent Java constructs are called Language Mapping.

2.5.3 Integration of existing WWW resources

In addition to the WBT systems specifically designed for training, there are also Atlantis (The Whole Brain Atlas), the Pittsburgh Case Index (PITTSBURGH CASE INDEX), the University of Iowa Family Practice Handbook (UNIVERSTITY OF IOWA FAMILY PRACTICE HANDBOOK), a collection of case descriptions (PITTSBURGH CASE INDEX), and the University of Iowa Family Practice Handbook (UNIVERSTITY OF IOWA FAMILY PRACTICE HANDBOOK), a series of conventional and therapeutic guidelines (HSHSTEL WHOLE BRAIN ATLAS), a collection of case descriptions (PITTSBURGH CASE INDEX), and an extensive collection of data (PITTSBURGH CASE INDEX), which can be used to integrate knowledge and knowledge in a wide range of subjects, such as libraries, libraries, libraries, libraries, libraries, libraries, libraries, libraries, libraries, libraries, libraries, libraries, libraries, libraries, libraries, libraries, libraries, libraries, libraries, libraries, libraries, libraries, libraries, libraries, libraries, libraries, libraries, libraries, libraries, libraries, libraries, libraries, libraries, libraries, libraries, libraries, libraries, libraries, etc.

2.5.3.1 Different representation concepts From traditional hypertext systems, the WWW differs not only in its size, worldwide distribution and often redundant supply of knowledge and information, but also in the wide variety of different concepts used to represent information and knowledge units on nodes and edges of the hypertext base. The authors of WWW resources can implement their own concepts without restrictions. They can also define any references that can also transcend the boundaries of different representation and print integration concepts.

2.5.3.2 Granularity problem In integrating existing resources, learners must be spared the problems of independent information and knowledge search resulting from the inadequate description of objects on the web by search aids, coupled with the high heterogeneity of the concepts used. Although there is a great deal of medical knowledge available on the web (e.g. [HERSH, BROWN et al. 96], the search for high-quality and relevant knowledge is often frustrating [DETMER, SHORTLIFE 97].

To guide learners as well as possible, a detailed examination at the level of individual documents is usually required, where appropriate taking into account resource-dependent access to resources. However, an examination of the resource as a whole is also necessary, as it serves as a basis of confidence in the quality of existing knowledge between the knowledge seeker and the resource. Since a change in resource is usually accompanied by a change in representation and presentation concepts, learners can consciously adopt and adapt to the new concepts.

2.5.3.3 Resource quality Because every person on the web with a computer can be an author, editor and publisher at the same time [LLAURADO 97] and there are no quality standards as applied to paper-based media, the quality of medical resources varies greatly.

Many documents are incomplete, misleading or erroneous, and it is often difficult to distinguish between wheat and wheat, useful and harmful [SILBERG, LUNDBERG et al. 97]. However, in the future, quality certificates such as the HON Code of Conduct [HON] or the Medical Matrix Code of Conduct may be introduced as a general standard or standard. At least these can provide clues for assessing the quality of an integrated resource. The expected quality of a conventional resource is the most important criterion for consultation in the medical field [COVELL, UMAN et al. 85].

2.5.3.4 Web dynamics The Web has a very high dynamic characteristic. Even if only resources are used for integration, which change only relatively rarely, it must nevertheless be ensured that relevant content and structural changes can be identified and taken into account.

2.5.3.5 Degree of integrability How well an external resource can be integrated into WBT systems depends primarily on the document access method of the resource to be integrated.

Hierarchical access structures (menu structures): This group of resources consists of static knowledge documents and, as a rule, other hierarchically arranged documents that allow access by browsing. Depending on the representation concept used, such resources can be easily integrated. Direct addressing and description of individual documents is possible. The effort for integration is quite high, as appropriate documents must be assigned to specific learning situations each. However, if necessary, the classification can be done at a higher hierarchical level, where a document is representative of all the specific documents assigned to it.

Server-side query mechanisms: In these access procedures, a process on a WWW server generates documents using query parameters. Individual documents cannot be addressed directly. However, appropriate queries can be linked to or generated on the basis of specific learning situations. An example of this form of integration is provided by the Dermatological Online Atlas of the University of Erlangen-Nürnberg (BITTORF, BAUER et al. 95).

Application-driven: Application-driven document accesses are web applications that are based on programming languages such as Java [RODGERS 96; MIDDENDORF, SINGER et al. 96] or JavaScript [FLANAGAN, KUHNERT 98]; however, the use of HTML frames, plug-ins or ActiveX [SCHMITT 96] usually also means that individual documents can no longer be directly described and addressed.

2.6 Platform independence

2.6.1 Portability

For Balzert [BALZERT 96 S. 776] portability means that the concepts used in the creation of the application software are available on different computer platforms (from different manufacturers).

Object code portability (binary portability): The running application can be executed on different platforms without further action. Java applications are characterized by binary portability. By compiling Java program code, platform-independent byte code is generated, which can be interpreted by a Java Virtual Machine available for almost all platforms without any changes to the program code being necessary when switching the computer platform.

Source code portability: An application's source code can be transferred from one platform to another, where the source code is recompiled and can then be executed.

Design portability: An application is designed so that the concepts can be easily transformed into different implementations.

Platform independence is always understood in the sense of binary portability, i.e. platform-independent WBT systems should be capable of running on different computer platforms without changes to the source code and recompilation.

2.6.2 Basic techniques for the creation of platform-independent systems

WBT systems

The following briefly describes the main basic techniques currently available for the creation of platform-independent teaching/learning systems.

HTML: HTML [RAGGETT 97] is the page description language of the World Wide Web. It serves as the basis for the creation of Web pages. The basic techniques listed below are embedded in HTML code in WBT systems. The created systems thus run in the Web browser window. HTML is available on virtually all platforms and there are very powerful and often free tools to create HTML documents [SCHULZ, SCHRADER et al. 97].

Java: Java [FLAGANAN 98] is a new object-oriented programming language with a Clike syntax. Platform independence is provided by the byte code virtual machine (VM) interpreter. Java source code is compiled from Java compiler to byte code and executed by the virtual machine. One of the main advantages of Java is excellent networking support.

JavaScript: JavaScript [FLANAGAN, KUHNERT 97] is a compact, object-based2 scripting language that has been part of the Netscape Web browser since version 2.0 and is also available in a subset of Microsoft's Internet Explorer. The JavaScript language has great similarities to Java and thus C, but is easier to learn and program because only existing objects and functions need to be called on. JavaScript is only suitable for relatively limited problems, as it is not arbitrarily extensible and far from as flexible as Java.

Plug-ins: Plug-ins allow you to play external programs in a Web browser window. One example is the Macromedia Shockwave Plug-in. This enables programs created with the Macromedia Director to run in the Web browser window as well. A major disadvantage of plug-ins is that they must be downloaded and installed from the network before the first use.

ActiveX: Microsoft refers to the Internet extensions of its Component Object Model (COM) with ActiveX [SCHMITT 96]. ActiveX components can be created quite comfortably with visual programming languages such as Microsoft's Visual Basic. Existing components can be used in the Web without much effort. ActiveX also has several major disadvantages. ActiveX components are currently only available in Microsoft's Internet Explorer on the Windows platform.

CGI: The Common Gateway Interface (CGI) is a standardized interface of web servers. This interface allows the call of external programs on the web server. This allows the functionality of a web server to be extended at any time. The main disadvantage of CGI applications is that they are not very performing, as a connection to the server must be built for each user response. Its great advantage is that any programming language (dependent on the platform) can be used on the server side without losing the platform independence on the client side.

2 JavaScript is not object-oriented. Only the predefined objects can be used.

2.7 Adaptability and adaptability

Adaptivity in relation to CBT systems means the adaptation of a teaching/learning system to its users. Adaptive teaching/learning systems are, therefore, systems which automatically adapt themselves to the changing learning needs of learners during a teaching/learning process. It is assumed that ...the higher the learning success or the less the learning time required, the better this adaptation succeeds. [LEUTNER 92 S. 1]. Adaptive systems are intended to facilitate the success of the individual user, as well as to increase the productivity, in the case of medical CBT students, and the efficiency of the learning system [SNER 94].

Adaptive systems can be divided into three groups [KROGSÄTER, THOMAS 94]:

• Adaptive assistance systems: The assistance is either adapted to the context of the task or to specific user preferences.

• Adaptive user interfaces: Human-computer interaction is tailored to a user's specific needs and preferences.

• Adaptive applications: These systems adapt their functionality or internal functioning depending on previous user activities or current state space.

Before discussing the possibilities of adaptation of teaching/learning systems, a characterization of good teachers should be given:

Good instructors are skilled at tailoring their behaviour to the particular skill level of students and to both the quality and quantity of students' knowledge. This adaptation takes several forms, including: - varying the information content of descriptions and explanations; - varying the degree of detail of descriptions and explanations; - varying the aspects of the problem they focus on during a given exercise; - gradually broadening and deepening the student's knowledge in a way that builds on and refines the student's existing knowledge; - overlooking student mistakes that involve principles that the instructor judges the student to be unprepared to comprehend. [CHEIKES, RAGNEMALM 95 S. 95]

However, it is quite questionable whether teaching/learning systems are actually capable of adapting to their pupils as well as a competent teacher [cf. YETIM 94 p. 34f.]. Wenger [WENGER 97 p. 426] also admits that adaptability, even in the best currently available teaching/learning systems, is rather modest compared to human teachers.

The following is a description of how adaptivity can be characterized in CBT systems and what adaptation measures are generally feasible in teaching/learning systems.

Adaptation rate: The adaptation rate indicates the frequency of adaptation attempts of the teaching system to its users.

Type of adaptation measure: In teaching, the target (learning material and competence to be acquired), teaching method and time can be adapted.

Adaptation means Adaptation measure Objective Method Time (example) Fixed Fixed Progressive selection

Variable Mastery Learning Related Teaching Objective

Adjusted fixed internal (underground) differentiation

Variable support training/subsidy training adjusted fixed fixed rating according to conventional.

Adjusted to fixed external (school) differentiation

Adapted (by method) integrated school system

Table 1: Classification of adaptation measures

If the objective, method and time available are fixed, then adaptation can only consist in the continuous exclusion of learners who will not achieve the desired learning objectives in the specified time. If the teaching time is not limited, then teaching can be done until all students have reached the learning goal (goal-driven learning or mastery learning). If different teaching methods are available, then the teaching method that best meets the individual's needs can be used for limited teaching time. Furthermore, if a longer teaching time is possible to eliminate gaps, then teaching time is different.

Adaptation purpose: Adaptation purpose describes the purpose for which an adaptation measure should be used at all. Salomon [SALOMON 72, quoted in LEUTNER 92 S. 13] outlines three heuristic models to gain interaction hypotheses. However, when using an adaptation measure to eliminate individual deficiencies in learning requirements through additional instruction Salomon speaks of a support model.

A method for adapting the difficulty level of exercise examples to the current level of knowledge of the learner is proposed by Lichtfeld, Driscoll and Dempsey [LICHTFELD, DRISCOLL, DEMPSEY 90, cited in LEUTNER 92 S. 53]: If the user correctly processes an exercise example, then the system selects an example of the next higher difficulty level at the next exercise. If it does not correctly process the task, then it selects an example of the next lower difficulty level.

Many adaptive systems are not only adaptive but also adaptable. That is, not only does the system adapt to its users, but they can also adapt the system to their desires if they are not satisfied with the automatic adaptation. Oppermann and Simm distinguish between the adaptability of the functionality and the adaptability of the user interface [SCHNEIDER-HUFSCHMIDT, KÜHME et al. 93] in a system [OPPERMANN, SIMM 94]:

• Scope of functions (not all functions are available at all times)

• User-defined commands (e.g. macros)

• Add-ins (for example, by menu)

• Default values when performing functions and object attributes

• Trigger: At user-determined system states, the system starts functions

• access to functionality (individual functions may be omitted)

• Dialog behaviour (e.g. suppressing dialog boxes, turning on help such as balloon help on the Macintosh)

• Layout (e.g. colour of windows etc.)

• Cross-platform interface adaptations (e.g. maximum time for double-clicking, the path taken by the mouse depending on the path taken by the mouse) Adaptability is a solution approach to address the problems arising from inadequate system adaptation to user behaviour [PAETAU 1990 p. 271]. Users should therefore be able to turn on and off the adaptation of the whole system or individual parts.

2.8 Intelligent teaching systems

Adaptivity is most commonly used in the context of Intelligent Tutorial Systems (ITSen) [LUSTI 92; WINKELS, BREUKER 92].

In the 1970s, teaching/learning systems were developed with the aim of programming decision rules, i.e. decision-relevant knowledge itself, rather than just decision outcomes.

However, both non-intelligent CBT systems and intelligent tutoring systems must also be subject to common requirements [LARKIN, CHABAY (ed.) 92 p. 6f.]:

• Promoting active learning through the teaching/learning system: learners should not passively absorb information by reading text on screen or watching animations, but rather actively develop teaching/learning content, which can be done by requiring learners to answer questions or solve tasks (Ask, dont tell).

• Implementation of appropriate user interfaces: The user interface of a teaching/learning system should be adequate to the content to be conveyed.

• Learners should learn to deal with relevant tasks and solve them appropriately.

• In case of incorrect user input, feedback from the system is required.

• The individual knowledge of learners must be taken into account by the system.

2.8.1 Construction

In the literature, intelligent tutoring systems are usually divided into the four components Expert module, Student module, Teaching module and Communication module (see e.g. LUSTI 92). These are briefly characterized below.

2.8.1.1 Expert module The expert module represents the knowledge of a human expert in a particular field of expertise. Its function is to always find the optimal next step of interaction.

Rules: Knowledge is represented in rules in the form of conditional actions. If all the conditions of a rule are met, then all the actions indicated are carried out. Rules are relatively easy to implement on the one hand, e.g. in the prologue, on the other hand, there are problems in the representation of knowledge in rules but also problems on [STRASSER 92 p. 21]:

• Lack of flexibility: rules are created for a given class of problems. Changed classes of problems can no longer be solved even if the necessary knowledge is present in the knowledge base.

• Inadequate explanation: explanations based on rule traces are often inadequate.

• Problems of knowledge acquisition: It is very difficult to create a robust and versatile system of rules, partly because experts in the field are often unaware of the knowledge they have used to solve a specific problem.

• Implicit control structures: domain knowledge and control structure are often inextricably linked. Under these conditions, the clarity and reusability of the knowledge base in other systems and similar problems are hardly possible. In rules, shallow knowledge is often encoded. The transition from shallow knowledge to deep knowledge is achieved by explicitly describing the knowledge base inherent in the domain.

Semantic networks: In semantic networks, knowledge is represented in the form of a graph consisting of nodes and edges. The nodes are connected to each other by edges. The edges can be labelled and thus typed. KL-ONE is a knowledge representation language based on semantic networks. Objects are here called concepts whose properties are roles. The core idea of KL-ONE is the strict separation of defining and optional roles and the distinction between generic concepts and instances.

Constraints: Constraints can be used to specify relationships between quantities using mathematical (un) equations. Constraints are conditions that must be met by the solution sought. Constraints can only be used in domains that have a numerical character.

Frames: The frame concept comes from Minsky [MINSKY 75]. Frames represent analogies to human experience knowledge. Frames are objects that are described by slots (the properties of the frames) and facets (the properties of the slots). There are facets for the default value, the actual value, the range of values, etc.

2.8.1.2 Student module Intelligent tutoring systems can be individualized if they are designed to take into account differences between students. The process of doing this is called student modelling. Unfortunately, student modelling is hard, and increasingly researchers are trying to avoid the need. [MCCALLA 92 S. 107]

The student module monitors a student's problem-solving behaviour and detects changes. The main component of many student modules is the error diagnosis. By comparing the solutions of the expert module and the learner, it is attempted to find out whether it is a random or a systematic error. When the latter occurs, it is attempted to give the learner specific assurances and explanations.

The main student models are stereotypes, overlapping models, error theories, error recovery, error generation, and a combination of previous models [REINHARDT, SCHEWE 95 S. 84] Stereotypes [RICH 89] are sets of characteristic expressions that often occur in common with individuals. They are important because they allow many plausible assumptions to be made with relatively few observations. However, it must be possible to override these assumptions (inferences) by actual observations. Therefore, it is necessary to exclude techniques for non-monotonous stereotypes. Typical stereotypes are typical.

The overlay model considers student knowledge as a subset of the expert knowledge contained in the system. Since overlay models do not require knowledge beyond the expert model, they are relatively easy to implement. With flat knowledge in the expert model, the concepts known to the student simply have to be cut off. Here, probabilities can also be given, indicating how secure the system is that a concept has actually been understood by the user. However, it becomes more difficult if the expert model contains deep knowledge, such as the NEOMYCIN expert model for the GUIDON2 storage model [Cells 89 S. 391]. Some overlay models may also present problems, even if the system is used in a way that is not actually understood by the user.

Perturbation models (to perturbate, disturb) serve to reflect the student's view of the expert model, while maintaining a close relationship between the student and the expert model. The student model differs from the expert model by errors and lack of knowledge, which is also considered to be errors in the model. Many ITEs use this type of model.

According to Woolf [WOOLF 90], student models are not yet effectively integrated into existing systems. The main problem with student modeling is to exploit a user's characteristics only from their interaction with the system.

Self, one of the most renowned researchers in this field, recommends that, when creating a student model, you reject visions, choose realistic goals and consider the following points [SELF 90]:

• Avoid guessing - get the student to tell you what you need to know

• Don't diagnose what you can't treat

• Empathize with students' beliefs, dont label them as bugs

• Dont feign omniscience - adopt a fallible collaborator role When using student models, two perspectives have emerged. One side recommends the reticent use of information about the users of a system [BIERMAN, KAMSTEEG et al. 92] as it is difficult to construct complete and correct student models and also to use them correctly. Reticent use of user information can reduce the likelihood of errors in the teaching/learning system, e.g. the presentation of inappropriate information. The other side recommends intensive use of student models.

2.8.1.3 Teaching module The teaching module is responsible, inter alia, for selecting the most appropriate teaching/learning form and for interrupting tutors when necessary.

• Cognitive Apprenticeship: The learner looks to an expert in solving tasks and can ask questions. Gradually the expert allows the learner to solve smaller subtasks themselves. These subtasks become increasingly complex until the learner is finally able to solve a complete task successfully.

• Successive refinement: This teaching strategy is particularly suitable for complex knowledge domains. First, a general overview is provided, which is then progressively refined.

• Discovery Learning: A teacher here chooses a learning environment that is adapted to the learner's preconceptions. This is a very demanding task. DOMINIE can only select a field of knowledge in which the learner is new to it but which has structural similarities to an area that the student has already learned.

• Discovery Assessment: This strategy is coupled with discovery learning. After selecting a suitable learning environment, it is necessary to observe the students and, where appropriate, provide assistance.

• Abstraction: The aim is to provide the learner with an overview of the possibilities in the system.

• Socratic Diagnosis: The learner has already constructed a model of the domain of knowledge, but it contains errors. The teacher identifies these errors and makes it clear to the learner that his model generates false conclusions and therefore must be erroneous.

• Practice: The learner is observed solving a task; if he/she deviates from the correct path, he/she receives suggestions from the tutor.

• Direct Assessment: The learner is interviewed directly.Multiple choice questions and gap texts are particularly suitable.

DOMINIE chooses each of the eight strategies described on the basis of different criteria. The system always tries to achieve a meaningful allocation of the time available between teaching and examination. On the one hand, as much material as possible is to be developed in the shortest possible time, but on the other hand, it must also be ensured that the learner has correctly understood and memorized the material presented so far. The teaching strategy applied is appropriate to the subject to be taught and the student's previous learning success in different teaching strategies is taken into account by the system.

In total, there are three ways to arrive at a teaching model [LEUTNER 92 P. 66]:

• Programmer's intuition: developers of a CBT system rely on their intuition and rely on their own experience with teaching/learning situations, for example during their school years.

• Interviewing experienced teachers: conducting a survey comparable to the questioning and observation of experts in the creation of knowledge-based systems and expert systems [SPITZER, BÜRSNER 95; CHIZZALI-BONFADIN, ADLASSNIG et al. 97; PUPPE 93].

• Instructional theory formation: Optionally, an existing learning theory is extended to an instructional theory or an instructional theory is redeveloped.

2.8.1.4 Communication module The communication module defines the form in which the system communicates with the operators.

Ideally, a user interface with free input is ideal. However, free input is very expensive to implement. Thus, the implementation of a natural language user interface in Sophie I alone took two years [LUSTI 92 S. 227]. Alternative responses or selection menus can also be offered to the user as easier alternatives to implement. However, unlike free input, users here have the possibility to limit obviously incorrect responses through intelligent exclusions. On the other hand, implementing a dialogue about alternative responses or selection menus is much easier.

2.8.1.5 Development support The very labor-intensive development of intelligent tutorial systems can be simplified and accelerated in two ways [LUSTI 92 S. 197]. Developers can reuse object-independent modules of an existing teaching/learning system, such as a teaching or communication module, and only need to adapt the expert module to the changing task. The other option is to use an ITS shell [PUPPE, GAPPA et al. 96]. The advantage of this approach is that the shell automatically provides the necessary inference mechanisms and does not have to be implemented by itself.

2.8.2 Criticism of intelligent tutoring systems

In his book Basics of Hypermedial Learning Systems [SCHULMEISTER 96] schoolteacher practises harsh criticism of intelligent tutorial systems and their researchers and developers:

The field of Intelligent Tutorial Systems is apparently stuck in the programmatic stage: even if you only look at the essays of a single journal on the subject of ITS, the same statements, systematizations and references to AI literature are repeated over and over again. I have rarely seen so much redundancy on a bunch, and rarely such a small community of researchers publishing the same material on the same development stage (Anderson, Brown, Duchastel, Jonassen, Lesgold, OShea, Self, Sleeman).

• Each system is completely redesigned without the use of old components.

• Modularity (for reuse) is not very common in ITSs, unlike in commercial software.

• Development is widely understood as an iterative improvement process.

• The integration of already available software packages is prevented by the fact that they only offer a limited or no external software interface at all.

• Evaluation is hampered by the lack of complete systems.

Lusti calls implementation distances, practice distances and modesty important problems in the development of ITS [LUSTI 92]. A central problem is also the high development effort and high costs associated with the creation of intelligent tutoring systems. Nevertheless, although a very high effort has been made and will be made in many ITS projects, only relatively simple subjects can be imaged. ITSe often teach small subfields of mathematics or programming languages.

Similarly, it is still unclear what are called ATI (aptitude treatment interactions) effects associated with ITS, which include the influence of individual learning requirements on learning success [LEUTNER 92], such as how the response to different learning media depends on traits of students such as intelligence or anxiety.

To date, there has been little evidence of the usefulness of tutorials for ITSe or tutorially usable expert systems [ENGLER, FÜHRER et al. 95].

2.8.3 D3 and TRAINER

As an example of Intelligent Tutorial Systems, D3 [PUPPE, GAPPA et al. 96] and the ITS-Shell TRAINER [PUPPE, REINHARDT 95] based on it are to be used. D3 is an expert system shell developed by a working group at the University of Würzburg led by Prof. Puppe. It supports various forms of knowledge representation and knowledge processing [REINHARDT, SCHEWE 95]:

• Statistical diagnostics: use of the Bayes set.The necessary symptom-diagnostic probabilities can be determined from a case database.

• Case-based diagnostics: searching the database for similar cases and transferring the solution to your own case.

• Heuristic diagnosis: symptom-diagnosis chains, usually with safety factors.

• set covering diagnosis: based on the overlap or causal relationship between diagnoses and symptoms.

• Functional diagnostics: model-based diagnostics. The model describes the behaviour of the individual components.

At present, some medical knowledge bases for D3, including rheumatology and neurology, are already available, which are a prerequisite for creating case simulations with TRAINER.

Students can learn how to solve medical teaching/learning problems using the TRAINER system.The system offers two learning modes for this purpose.In one, the system presents the examinations divided by an expert into different groups (anamnesia, clinical examination, laboratory, etc.) in sequential order and the student must make a suspect diagnosis after each group.In the other mode, some symptoms are named and the student must decide which further examinations he wants to carry out.In this way, the system can criticize the decisions made by the student.TRAINER does not yet have a student model.

The most common criticism of D3 concerns its user interface, which is often criticized as too cumbersome and not intuitive in operation.

2.9 Semantic data modelling

As early as 1971, the X3 Committee of the ANSI (American National Standards Institute) set up a working group called SPARC (Standards Planning and Requirements Committee). The aim of the working group was to determine whether and where standards can be defined in database systems. After a long period of time, the working group presented an interim report describing a three-schema architecture of a DBMS. The ANSI/X3/SPARC proposal consists of the external schema (the view of the user or programmer on the data), the conceptual schema (the enterprise view of the data, the description of the rich world through entities, relationships, etc.) and the internal schema (physical data on a concrete basis).

Conceptual object types and relationships between objects or database schemes

Logical relations, attributes and semantic integrityDatabase schema

Physical commands and contents of data

Figure 7: The three levels of data modeling are related to the relational data model (see Chapter 2.10.1) and can be used well as a basis for communication, e.g. between domain experts and developers. The implemented conceptual scheme is often referred to in the literature as the logical scheme (SCHLAGETER, STUCKY 83). The logical scheme takes into account the data model to be used, but it is just like the conceptual scheme is completely independent of the hardware used. Man [MANN 93 S. 9] describes, in accordance with [SCHLAGETER, STUCKY 83], three conceptual schemes in the context of object-oriented semantic modeling (Figure 7).

In the further course of this work, object-oriented, semantic data modeling is oriented to this 3-level model. Conceptual data modeling is very well suited to object-oriented software development. It enables real world modeling, i.e. objects can be represented as we perceive them in our environment. The conceptual model can be represented using an ER model (entity relationship) [CHEN 76] .

An ER scheme consists of 5 components [ROUH, STICLE 97 p. 37]:

1. an exact designation of a scheme 2. at least one declaration of object types 3. zero or more declarations of relationship types 4. zero or more integrity rules 5. zero or more derivation rules

Not all components can be represented by graphical means, so the whole scheme is defined by text and illustrated by diagrams. The scheme definition in the extended Backus-Naur form (EBNF) [VENTER] is included in the following table.

In the case of an entity, the name of the entity is defined in the following paragraphs:

{;<relationship set>} {;<integrity rule>}. <schemaname> ::= <name> <entity set> ::= entityset <entity set name>

(attributes: <attribute> {, <attribute>}; identifier: <identifier> {, <identifier>})

I'm not going to be able to do that. I'm not going to be able to do that. I'm not going to be able to do that.

{, <identifier>}]]) <subset declaration> ::= subsetof <entity set name> ::= <entity set name> ::= <name> <relationship set> ::= relationship <relationship set name>

(participants: <participant>, <participant> )

<partparticipant> ) <attribute> ::= <attribute name> <domain> [not null] <identifier> ::= <attribute name> <attribute name> ::= <name> <relationship set name> ::= <name> <wholeparticipant> ::= <participant> ::= <partparticipant> ::= <participant>

... <nonneg_integer> ::= 0 ̊ 1 ̊ ... <name> ::= (<letter> ̊ 2 ̊ ... ̊ 9) <letter> ::= a ̊ b ̊ ... ̊ z ̊ A ̊ B ̊ ... ̊ Z ̊ ̊ ̊ ̊ ̊ 0 ̊ 1 ̊ 2 ̊ ... ̊ 9 Figure 8: Syntax of the ER schema declaration

Since a grammar in EBNF cannot prevent all incorrect wording, some additional conditions need to be added [RAUH, STICKEL 97 p. 45]:

1.All object and relationship names (<entity set name>,<relationship name>) may only be used once in the scheme. 2.Attribute names (<attribute name>) may only be used once within an object or relationship type.

3. All object names within a participant declaration of a relationship type must also contain an entity set name. 4. The role names must not be omitted when declaring recursive relationship types. 5. If an object type occurs multiple times in a participant declaration, a different role name must be chosen for each occurrence. 6. For the cardinality statements: the sub-limit (mincard) must always be less than or equal to the upper limit (max) n. If the Ocard is the outer limit, the sub-limit can take any integer greater than or equal to zero.

For the added aggregation relationship, the following additional condition is defined: <wholeparticipant> contains <partparticipant>, but not vice versa.

For the formulation of integrity rules in an ER scheme, the slightly modified Entity Relationship Calculus (ERC) [RAUH, STICKEL 97] shall be used.

We're going to have to find a way to make sure that we're able to do that. We're going to have to make sure that we're able to do that.

In the case of an entity, the value of the underlying assets shall be the sum of the underlying assets of the underlying assets of the underlying assets of the underlying assets of the underlying assets of the underlying assets.

The value of a variable is defined as the sum of the values of the attributes of the variable.

<value variable> <entity variable> <entity variable> ::= <name > <attribute variable> ::= <construct variable> [ <attribute name> ] <construct variable> ::= <entity variable> <entity variable> ::= <name> <relationship variable> <entity set name> <relationship variable>: <role > <condition variable> ::= <value variable> ::= <value variable> ::= <value variable> <a1> <a1> <a1> ::= <a1> <a1> <a2> <a2> <a2> <a2> <a2> <a2> <a2> <a2> <a2> <a2> <a2> <a2> <a2> <a2> <a2> <a2> <a2> <a2> <a2> <a2> <a2> <a2> <a2> <a2> <a2> <a2> <a2> <a2> <a2> <a2> <a2> <a2> <a2> <a2> <a2> <a2> <a2> <a2> <a2> <a2> <a2> <a2> <a2> <a2> <a2> <a2> <a2> <a2> <a2> <a2> <a2> <a2> <a2> <a2> <a2> <a2> <a2> <a <a <a <a <a <a <a <a <a <a <a <a <a <a <a <a> <a <a <a <a <a <a <a <a <a <a <a <a <a <a <a <a <a <a <a <a <a <a <a <a <a

As regards the rules of integrity, it is agreed that the following requirements must not be explicitly stated and must always be fulfilled.

• The values of attributes clearly follow the value of the identifier.

• Identifiers are never indefinite (zero).

• The cardinality of the types of relationships indicated in the scheme structure should be considered as rules of integrity which must be respected.

As mentioned above, there is no standard for the ER model. The type of graphical representation can be freely chosen. In the work, the Unified Modeling Language class diagrams known from object-oriented programming [BURKHARDT 97] are used. This graphical representation was chosen for several reasons.

An important advantage is that many constructs in the ER model are closely related to the classes required for object-oriented realization. The designed ER model can therefore partly automatically generate the required classes. An essential difference between entity-relationhip modeling (ERM) and object-oriented analysis is that ERM objects can only represent static aspects such as attributes and relationships, while classes can also contain methods. The latter can also be considered in terms of their behaviour.

2.10 Databases

Data and knowledge present in a teaching/learning system must be stored permanently, mainly in relation to or alternatively in relation to object-oriented or object-relational database systems, which are described in this chapter.

2.10.1 Relational data model

For a more detailed description, refer to the widely available literature [ULLMAN 88; SCHLAGETER, STUCKY 83; GARDARIN, VALDURIEZ 89].

A variable A of the attribute type is defined by

In this case, DTYP refers to any data type (real, string, ...) whose range of values is denoted by WB(DTYP. WB(DTYP) basically also includes the missing value ω.

The range of values of A is limited by the set of semantic integrity conditions sib0:

WB(A) := {x ∈ WB(DTYP) ∀ sib ∈ sib0: sib(x) = true} with sib0:

Relational scheme A relational scheme is the summation of a finite set of attributes to the set of attributes A: = {A1,A2,...,An}.

U WB(Ai) with a(Ai) ∈ WB(Ai), n ≥ 1 is multiplied by n over A

Duplicates are images that assign a current value of =1 to each attribute of the relation scheme A.

The value range of relation scheme A is defined by:

Relation A variable R of the type of relation is defined as

The range of values of R is limited by the number of semantic integrity conditions sib1 over relation scheme A.

WB(R) := {x WB(A) ∀ sib ∈ sib1 : sib(x) = true} {} with sib1 : {sib sib: PM(WB(A)) → {true, false}}

PM(X) is the power quantity of a quantity X.

DB schema As a DB schema, the summation of a finite set of relationships to a set R:={R1,R2,...,Rm} Ri: 5(/Ai ↓ sibi1) , i = 1, ..., m; m ≥ 1 Database A variable DB of the database type is defined by The range of values of DB is limited by the amount of semantic integrity conditions sib2 over the database schema R WB (DB) := {x WB) R (R) ∀ sib ∈ sib2 : sib (x) = truth} with sib2 : {sib ↓: sibR) {true, false}} The projection is an attribute: m

UWB(Ci), with a c c c c c) : = a c), i = 1,...,I

It corresponds to a limitation of Figure a to C. =1

Several arrangements have been made to simplify the presentation of Level 1 (sib1) semantic integrity conditions [GERNETH 92]:

Let's say the relationship variables R: 5 (/ A ̊ sib1R) and R: 5 (/ A ̊ ̊ ̊ sib1R) with R, R ̊ ∈ R and the database variable DB: '% ̊ R ̊ sib2)

(1) The primary keys of R can be controlled with the boolean function PS(P,x), with P ∈ A, x WB(A):

PS(P, x) : (∀ a,b ∈ x: (a{P} = b{P} ⇒ (a=b)) (∀ a ∈ x: a(P) ≠ ω)).

In semantic integrity conditions, the boolean function PS(P,x) ensures the uniqueness of the primary key (key integrity). Only single-digit key attributes (surrogate keys) are to be used as primary keys.

(2) The boolean function nf(B, x) (nf stands for not missing) ensures that all attributes of an attribute B have a value in each duplex.

If the value of the underlying equation is equal to or greater than the sum of the values of the underlying equation, the value of the underlying equation is less than or equal to the sum of the underlying equations.

(3) The boolean function nf1(B, x) ensures that at least one attribute of a set of attributes B has a value in each duplex.

For the purposes of this Regulation, the following definitions shall apply:

For the simplified specification of semantic integrity conditions at level 2 (sib2) the boolean function FS(((R,P),(R,P), v) is defined (FS stands for foreign keys) where P ∈ A, P ∈ A and v ∈ WB. Foreign keys are attributes that appear in the database as a primary key attribute in any relation. The given boolean function controls whether a foreign key P of the relation R is also present as a primary key P in the specified relation R of DB.

FS(((R,P), (R,P), v) : ∀ b ∈ v(R), b(P) ≠ ω: ( b∈ v(R): (b(P) = b(P))).

In order to ensure the integrity of the database, no duplicates referenced by foreign keys may be deleted.

Discussion of the relation model The relation model [CODD 70] runs to its limits fairly quickly if more complex subjects (e.g. CAD graphics) are to be properly modelled (see LAUSEN, VOSSEN 96).

However, there are a number of sophisticated, commercially available and widely used database management systems and standards for the relationship model, and the use of such a system offers the great advantage of being able to switch to a software product from another manufacturer at any time without great difficulty.

2.10.2 Object-oriented and object-relational databases

Object-oriented databases [HEUER 92] are a serious alternative in areas where relational databases have proven to be inadequate; for example, multimedia systems require complex objects to be stored and easily accessible; and object- or type-specific operations are often desirable.

Commercially a number of object-oriented database systems are available, e.g. GemStone, ObjectStore, Illustra and O2. GemStone expands Smalltalk to create a database system. ObjectStore expands C++ in a similar way. Illustra has its roots in Postgres and Ingres and is thus the expansion of one of the first relational database systems (Ingres) to object-oriented. O2 is a database system in the classical sense with its own DDL (data definition language) and DML (data manipulation language).

One of the reasons for the previously less widespread use of object-oriented database systems is the fact that old databases must first be ported, which is the absence of generally accepted standards. Standardisation attempts are SQL3 (Structured Query Language) and ODMG-93 (Object Database Management Group), but none of the two standards have yet been adopted. In SQL3 it is a language of object-oriented database systems, which is a language of relation.

3 Design and modelling

3.1 Requirements for WBT systems

The weaknesses of traditional CBT systems mentioned in the first chapter require the design of novel teaching/learning systems. The requirements to be met from the point of view of authors and developers are described below [HAAG, MAYLEIN et al. 98]. Numerous other criteria for the quality of electronic publications from a user's perspective include the catalogue of criteria for electronic publications in medicine [SCHULZ, AUHUBER et al.]. However, the term electronic publication in medicine is generally defined as a WBT system, so that not all defined requirements can be applied to WBT systems. In addition to developing high-quality WBT systems, high-quality architectural and basic requirements can be evaluated on the basis of existing WBT systems and, on the other hand, maintaining new WBT systems.

3.1.1 Content and teaching

Content requirements are not limited to WBT systems, but must also be met by conventional CBT systems and other teaching/learning media such as books:

• The target group (s) for which a system has been developed must be clearly defined and informed to the user before the process begins, thus avoiding the dissatisfaction of users of a system resulting from the lack of adequate learning content to the current level of knowledge of learners.

• The learning objectives to be achieved with a WBT system must be clearly defined and communicated to the user, allowing the user to decide for himself before editing a system whether the editing of the system will bring him closer to his personal learning objectives.

• The width and depth of the material presented must be sufficient for the target group.

• The knowledge available in the system must be technically correct and up-to-date, which is best achieved through a review process of the finished system by medical experts.

• The didactic structure of the system should be appropriate to the target group and the learning objectives.

• The system should provide adequate feedback to promote learning progress.

• The system should be intuitive to use; the use of metaphors can help.

3.1.2 Architecture

The architecture of a WBT system should meet as many of the following requirements as possible:

• High performance: WBT systems should have good performance in order to be accepted by users. Performance depends on both the available network bandwidth and the system architecture. Ideally, WBT systems should still offer acceptable waiting and response times even at low network bandwidth, such as those available when using fast modems (e.g. 33.6 kbit/s transmission rate).

• Low network load: a WBT system should use the available network resources as gently as possible, usually resulting in better overall system performance. The size of a WBTS system plays an important role in network load.

• Good reusability: Individual components of a WBT system must be reusable for other projects with the least possible effort; content must be represented in the system in such a way that it is easy to export and reuse it in other systems.

• Ease of expansion: The architecture of the WBT system should allow system functionality to be extended with minimal effort without affecting teaching/learning content.

It should be easy to update or supplement the teaching/learning content.

Ideally, an author component should be available so that medical specialists can make updates and additions quickly, comfortably and without outside assistance.

• Adequate adaptability and adaptability: the system should adapt independently to a user's personal preferences and needs to promote learning progress, but it should also be adaptable by the users themselves.

• Automatic update: changes to the system must be made automatically available to users.

• Low hardware requirements: The architecture of the system should be chosen in such a way that no high-end computers are required on the client side.

• Multimedia components: Medical students are no longer satisfied with teaching/learning systems that have only one text surface. The use of different media (text, image, animation, sound...) makes the systems more attractive to users and the learning effects should be enhanced in media didactics after the summation thesis when multiple channels are used to capture information [WEIDENMANN 91 P. 13].

• Ergonomic user interface: The user interface should be oriented to common GUI standards [MICROSOFT 95, APPLE 92], be kept as simple as possible and allow for intuitive operation of the system.

• Ease of implementation: The architecture should be feasible with reasonable effort.

• Good integration: WBT systems need to be able to be integrated into clinical workplace systems with little effort.

• Integrated communication component: Communication between learners to each other and between learners and teachers should be possible directly from the system, so that users do not have to start additional programs for the purpose of communication.

3.1.3 Basic techniques

The selection of suitable tools and programming languages is an important prerequisite for the creation of high-quality WBT systems.Table 2 presents the main basic techniques (see Chapter 2.6.2) and assigns them to the architectural types (see Chapter 2.5.1) for which they are particularly suitable.

Java client-based, remote data & knowledge, distributed teaching

Table 2: Basic techniques for the creation of WBT systems

The basic techniques shall be subject to the following requirements:

• Extensive platform independence: The basic technologies used should allow the creation of WBT systems that function seamlessly on as many platforms as possible and across as many operating systems as possible, thus keeping the number of potential users of the system as large as possible.

• High security: This aspect needs to be given a great deal of attention, as many of the computers used in medical education and training are located in clinical networks where highly sensitive patient data is processed; therefore, it must be excluded that malicious WBT systems can spy on data or cause damage to the computers on which teaching/learning systems are processed; for developers, this means that they cannot use basic technologies that do not have adequate protection mechanisms against misuse.

• High performance: The basic techniques used should be of high performance.

• Support for network functions: For the implementation of WBT systems with distributed teaching architecture, it is important that the basic technologies support network functions such as remote procedure call and the like.

• Multimedia support: The use of multimedia components must be well supported.

• Freedom of installation: The basic techniques used should allow the creation of WBTS systems that do not require installation. Installations can cause instability on a computer and can cause already installed programs to cease to function. Moreover, the barrier to using a system is higher when installation is required.

• High productivity: In order to limit development costs, the basic techniques used should allow for high productivity.

3.1.4 Architectural decision

Distributed teaching has been chosen as the architecture type. This architecture type offers low-bandwidth performance advantages over the other architecture types presented in Chapter 2.5.1. The more complex implementation compared to the other architectures is taken into account, among other things because the teaching/learning system shell concept presented in Chapter 3.3 provides excellent reusability.

Table 3 evaluates a distributed teaching architecture with regard to the requirements specified in Chapter 2 (see HAAG, LEVEN 97). Since different basic techniques can be used for implementation, the table includes the assessment of the architecture using the basic techniques in question. HTML always serves as the basis for the integration of the other basic techniques. The assessments also relate to ideal implementations, i.e. the assessment of real systems may fall under more restrictive circumstances than indicated in the table. While the specific layer of distributed teaching architecture (high performance, low networking, so-called distribution) should be defined independently of the use of the other basic techniques, the use of the object-oriented architecture should be made of the object-oriented architecture, and the interaction between the object-oriented and object-oriented programming systems, such as Java and CORB and Java can be made more difficult because of the complexity of the interaction between the object-oriented and object-oriented concepts.

Requirements HTML and Java HTML and Java HTML and Java

RMI CORBA Extended platform downtime + + + frequency Adequate security + + + High performance ++ ++ ++ Low network load ++ ++ ++ No installation ++ ++ Good reusability + + + Easy expandability + + ++ Automatic update ++ ++ Low cost / High pro- o ductiveness Multimedia components + + Ergonomic user experience + + area Easy to implement -- o -

Table 3: Assessment of an ideal distributed teaching architecture

Legend: & and o satisfactory ++ very good - bad + good - very bad

3.2 Phase model for the development of WBT systems

The development of CBT systems [KERRES 98] requires, as well as the creation of other software types, a systematic, structured approach and is of great advantage. A methodology designed to support the creation of teaching/learning systems is therefore described below. The presented phase model does not define methods of software engineering. Rather, it can be used to refer to the common and established methods in this field [BURKHARDT 97; BOOCH 94; RUMBAUGH, BLAHAUGH et al. [JACOBSON, CHRISTERSON et al. 92].

The requirements of the previous chapter good reusability and easy extensibility require as complete a separation as possible of teaching knowledge (learning strategies, etc.) and domain data or domain knowledge. For implementation, an object-oriented programming language is proposed to meet the requirement of good reusability (e.g. [BODENDORF 90 p. 76]) but such use is not a prerequisite for the efficient use of a CBT system.

3.2.1 Educational analysis

In the development of teaching/learning systems, the didactic concept must be developed at an initial stage. The author (specialty expert) must define the teaching/learning objectives as well as the teaching/learning content to be conveyed and the target group to be targeted. The teaching/learning content should be structured in such a way as to be presented later to the users of the CBT system. A learning taxonomy should be used to define the teaching/learning objectives (e.g. [BLOOM 72]).

3.2.2 Requirement analysis

In the requirements analysis, the author and the developer shall jointly draw up a specification listing in as much detail as possible the requirements for the functionality of the teaching/learning system to be created, specifying exactly how the CBTS system responds to user input and activity, specifying whether and how the system is to adapt to users, and defining which system functions are to be made available via a menu or buttons on screen pages (e.g. help function).

Method Phase Results Persons tool

Teaching concept: (1) Teaching analysis Teaching/learning objectives and author Teaching content analysis Text editor Interaction forms

Authors, developers, requirements, other text editors

(3) Prototyping developer, author, metaphorist presentationUser screen layouts design GUI builder

ERM, OOA, OOD, (4) Semant.

OOA, OOD, Dec.- (5) Teaching model tables ... developers teaching function modelling (user model) CASE tools

OOD (6) Distribution model developers Distribution design CASE tools

(7) Teaching developers implementation/learning systemsshell development environment, DDL

(8) Data and teaching/learning system Author knowledge gathering DML, database tool

Proposal for a Council Regulation (EEC) on the approximation of the laws of the Member States relating to the approximation of the laws of the Member States on the approximation of the laws of the Member States relating to the approximation of the laws of the Member States relating to the approximation of the laws of the Member States relating to the approximation of the laws of the Member States relating to the approximation of the laws of the Member States relating to the approximation of the laws of the Member States relating to the approximation of the laws of the Member States relating to the approximation of the laws of the Member States relating to the approximation of the laws of the Member States

Evaluation concept (10) developer, author, improvement forevaluation, text editor, electron.

Figure 10: Phase model for the creation of WBT systems The specification is facilitated by the fact that the interaction forms have already been defined in the previous step. For example, if the system has the interaction form of browsing, the author usually wants a search function or an index. The developer is thus better able to point out to the authors what he thinks are missing system functions. After listing all the requirements, the developer chooses an appropriate programming language and programming environment for implementation.

3.2.3 Presentation design

First, it must be decided at this stage whether or not metaphors can and should be used. The presentation of a doctor's room with various examination tools, a book wall, etc. where the software operation is possible by selecting objects with the mouse is an example of a metaphor. Metaphors also allow computer-experienced users to use a CBT system intuitively. They should therefore be used when this is possible. Subsequently, screen layouts can be created. While the author introduces his preferences to the look of the user interface, the developer must pay attention directly to the consistency and availability of the user guidelines.

3.2.4 Domain modelling

The strict separation between domain data and domain knowledge on the one hand and teaching knowledge on the other makes it necessary to model them strictly separately from each other. It is recommended to design multiple models to reduce complexity and make the domain model overall clearer and more understandable. Tools that have a model view controller (MVC) are particularly suitable for this purpose. For partially overlapping models, changes to multiple objects at the same time are also automatically left in the other models. Domain knowledge can be represented in semantic networks.

3.2.5 Modelling of teaching functionality

Learning functionality modeling is concerned with modeling the learning functionality developed and defined jointly by author and developer in the requirements analysis. It is necessary to determine how the system reacts to user actions or to the absence of user actions, whether it plays an active or passive role towards the user and when it presents to the user what parts of the domain data and knowledge contained in the system. It is therefore necessary to model active, procedural knowledge. The description can be made, for example, by means of decision tables, rules or pseudocodes. In the case of the use of an object-oriented programming language, it is necessary to determine which objects represent each other, which methods are responsible for which tasks, and which object-oriented models are to be used, and which models are to be used in a system of automated modeling, which must also be representative of the user, and which information is to be made available, for example, in the case of an object-oriented programming language, such as object-oriented programming language, which must be used to demonstrate which methods are appropriate to each other, and which models are to be used to perform tasks, and which are also to be used in an automated model, such as a model for the user, and which must also be used in a model, such as in the form of the form of an object-oriented model, such as in the model, and in the model of the model of the model of the user's design, and in the model of the model of the model of the model of the model of the user.

3.2.6 Distribution design

CBT systems can be divided into the three layers of presentation layer, teaching system logic layer and domain data & knowledge layer [HAAG, MAYLEIN et al. 98]. In the distribution design, it is necessary to decide on which computer (client or server) these layers are located. In the distributed teaching architecture (see Chapter 2.5.1.3) it is necessary to determine in addition for all the language teaching projects (see Learning Function Modeling phase) where they are located. If it is found that a restructuring of the classes or class competences provides advantages for the distributed CBT system, it is also possible to use such a single learning resource to re-modulate the client interface.

3.2.7 Implementation

With the help of the already selected development environment, the empty teaching/learning system (only interface and teaching system logic, structure of the domain data & knowledge layer) is implemented, using the screen layouts already created as well as the classes that may have been generated in the two previous steps.

3.2.8 Data and knowledge gathering

Once the teaching/learning system shell has been completed, it must be filled with content (domain data and domain knowledge). This is the author's task. He must now bring the teaching/learning content defined in the didactic analysis into the system. To facilitate this task, a suitable tool should be provided to the author.

3.2.9 Testing of the system

The test of the completed CBT system should involve both developers, authors and members of the intended target group. Before starting the test, the developer must draw up a test plan to ensure that the entire teaching/learning system is also being tested, not just parts of it. The tests performed and errors made must be recorded in writing. The developer can then revise the system on the basis of the error logs. Testing and error correction are carried out until no errors are found. The system can now be used in practice.

3.2.10 Evaluation

In order to determine whether the teaching/learning system is able to achieve the teaching/learning objectives defined in the didactic analysis, an evaluation must be carried out, but first an evaluation concept must be developed, which lists the questions and specifies appropriate methods for answering them. The user acceptance of a system or the degree of user satisfaction can be determined relatively easily by questionnaires completed by the users.

3.3 Teaching/learning system shell concept

For example, in medical browsing systems, there is almost always a directory of content and/or an index through which users can search for information on a targeted basis. Case simulations are almost always constructed at the same time, starting with assay and clinical examination and ending with the selection of working principles and therapeutic principles. While in the field of artificial PPE, the so-called expert systems are also designed to provide expertise in the field of information systems such as the DPRS, DPRS, DPRS, DPRS, DPRS, DPRS, DPRS, DPRS, DPRS, DPRS, DPRS, DPRS, DPRS, DPRS, DPRS, DPRS, DPRS, DPRS, DPRS, DPRS, DPRS, DPRS, DPRS, DPRS, DPRS, DPRS, DPRS, DPRS, DPRS, DPRS, DPRS, DPRS, DPRS, DPRS, DPRS, DPRS, DPRS, DPRS, DPRS, DPRS, DPRS, DPRS, DPRS, DPRS, DPRS, DPRS, DPRS, DPRS, DPRS, DPRS, DPRS, DPRS, DPRS, DPRS, DPRS, DPRS, DPRS, DPRS, DPRS, DPRS, DPRS, DPRS, DPRS, DPRS, DPRS, DPRS, DPRS, DPRS, DPRS, DPRS, DPRS, DPRS, DPRS, DPRS, DPRS, DPRS, DPRS, DPRS, DPRS, DPRS, DPRS, DPRS, DPRS, DPRS, DPRS, DPRS, DPRS, DPRS, DPRS, DPRS, DPRS, DPRS, DPRS, DPRS, DPRS, DPRS, DPRS, DPRS, and DPRS, DPRS, and other members

It is therefore not very easy and time-consuming to create knowledge bases that are also suitable for training purposes. For each field for which an intelligent tutoring system is to be developed, there must be a knowledge base in which the underlying domain knowledge is available in sufficient depth. However, it is very difficult for the creation of knowledge bases to acquire experts in the field, which makes this approach difficult to implement in practice. The concept presented in this paper for platform-independent and adaptive teaching/learning systems has therefore been deliberately designed so that it is developed without a comprehensive knowledge base.

In order to substantially simplify the development of teaching/learning systems, it is therefore proposed that, by analogy with the expert system shells of the design and the implementation of a teaching/learning system shell, authoring systems be commercially available (see Chapter 2.3.2), which provide the required functionality at least partly at a relatively high level of abstraction, but also have disadvantages. In order to substantially simplify the development of teaching/learning systems, it is proposed that authoring systems be able to provide the required functionality without, or only with the assistance of computer scientists in comparison with authors, authors adapted to high-quality teaching/learning systems.

However, when using a teaching/learning system shell, only phases 1 to 2 and phases 8 to 10 should be taken into account. In this case, phases 3 to 7 have already been carried out by the developers of Shell. Shell's wide availability can be achieved by the fact that, in addition to the teaching/learning system to be created, the author component is also available independently of the platform and on the Internet.

3.4 CAMPUS concept

For the implementation of the ideas, concepts and models developed in the framework of this work, the CAMPUS project (Computer-assisted education and training in medicine through platform-independent software) was launched.

The CAMPUS concept is intended to meet as many of the requirements for WBT systems as possible as defined in Chapter 3.1. In addition, the idea of a teaching/learning system shell (see Chapter 3.3) is to be taken into account, as it provides some important advantages, in particular in terms of the reusability of content and the rapid creation of teaching/learning systems.

Since the conception and implementation of a comprehensive shell would have far-reaching implications for the scope of this work, the following explanations focus on the interaction forms simulation (case simulation), browsing (systematic teaching knowledge) and drill & practice (questions). However, the concept presented can easily be extended to the still lacking forms of interaction and additional functionality. In particular, it is pointed out that the conception was based on the assumption that the system would be used in training courses.

3.4.1 CAMPUS teaching/learning system shell

The CAMPUS teaching/learning system shell consists of four subsystems (see Figure 11):

1. Author subsystem 2. Learning subsystem 3. Teaching subsystem 4. Administration subsystem Author registration Administrator interface Application system Author interface Teaching subsystem Case simulation simulation User management lung / -edit Lexicon creation/ Browsing Access control -edit Presentation presentation lung / -edit Administration subsystem Tutor dialog creation Tutorial dialogue lung / -edit user protocols Lab simulation lung drill & practice / -edit Difficulty of questions Drill & practice creation Searching on the Internet ung / -edit Presentation questions and communication ordering synchronously and asynchronously.

Adaptation Feedback Layout creation/ system adaptation revision

Assistance with user registration system operation

Case findingImport of resources Difficulty of cases

Teaching/learning subsystem Author subsystem Learning subsystem

Database interface Knowledge bank interface Communication interface

ICD-10 server user database knowledge bank

Figure 11: CAMPUS teaching/learning system shell

The author subsystem [SINGER, HAAG et al. 98] enables CAMPUS teaching/learning systems (with various forms of interaction) to be used in the workplace of a lecturer. The author subsystem also supports the use of existing resources on the Web. The authors can or should concentrate entirely on the technical content. The author subsystem is platform-independent and can run on standard computers with an Internet connection. The author subsystem also supports the use of existing resources on the Web. Thus, it is possible for authors to enter different HTML documents into the US knowledge bank [PELZER 98]. The authors can also combine such documents with relevant keyboards in the central lexicon of the CAMP system and, in any case, the CAMP system with the help of the author's own computer system.

The learning subsystem allows learners to log in and work with CAMPUS teaching/learning systems. It supports all five forms of interaction described in Chapter 2.3.1. Login is required so that the CAMPUS system can determine, for example, which teaching/learning cases have already been successfully processed, which semester a student is in, etc. The learning subsystem presents teaching/learning cases, displays questions, and allows students to conveniently access external resources on the Internet and communicate with teachers and students via email and IRC (Internet Relay Chat).

The instructional subsystem is responsible for recording the essential learning actions and storing them in the user database. The instructional subsystem is able to adapt itself to the needs of the learner by constantly evaluating this data, such as the type of case presentation or form of interaction. The instructional subsystem is therefore responsible for adapting the system to the learners (see Chapter 3.4.3) and generating appropriate feedback on the learner's actions. The administrative subsystem is used for user management and access control.

3.4.2 Layers model

Client/server applications in which a database management system is used for data storage are usually based on a two- or three-layer model (two-tier model or three-tier model or multi-tier model) [KLUTE 97]. In the two-tier model, the client layer contains the entire program logic, including the drivers for accessing the DBMS in the server layer. In this context, one speaks of so-called fat clients. In the three-tier model, an additional layer (usually called middleware) is used. In the two-tier model, the client layer completes the network layer independently of the DBMS used. In the three-tier client layer, no client layer is used to provide access to the DBMS, which in turn leads to the loss of benefits to the second-tier model in the server layer.

Improved system response times are achieved by the introduction of a caching layer (layer 3) which allows the database access to be disconnected from the user's activities. Prospective data can be requested from the DBMS and stored in the caching layer. If the data are now used, they are already on the client and do not need to be requested first. Also, the division of the learning system logic layer into two parts (layer 2, layer 5) brings performance improvements. One part is located on the server, the other part is located on the client.

The database access layer (layer 6) is responsible for the transparent access of the teaching system logic layer II (layer 5) to the database. The database management system used can be subsequently replaced without any problems.

3.4.3 Teaching model

The teaching model describes how the system adapts to its users and thus attempts to optimally promote learning progress.The individual parameters of the teaching model can be changed by the authors at any time.

The system provides for the following types of adaptability:

1. Automatic Display of supporting texts for system operation:

Yes No 2. General questions on case handling:

Yes (difficulty levels: light, medium, heavy) No 3. Concrete questions on a specific teaching/learning course:

Yes (difficulty levels: light, medium, heavy) No 4. Form of presentation/interaction

Total Complete Decision Compact 5th degree of difficulty in teaching/learning

light medium heavy 6. reporting time

When a window is opened, the associated system help is automatically displayed to a user if it is new to him or he has only seen it once. The help contains instructions for both program operation and case editing. By default, the associated help page is displayed twice in each window. However, this value can be changed by the author. Of course, users can display contextual help pages at any time by clicking on help buttons.

The CAMPUS system contains two disjoint sets of questions: firstly, there are general questions on case studies, such as laboratory tests or technical investigation procedures; secondly, there are specific questions on the specific teaching/learning cases; these questions are used, inter alia, to assist users in case studies.

General questions Questions on specific cases teaching/learning

Figure 13: Adaptation of the difficulty level of questions and teaching/learning situations

All questions in the system are assigned to one of three difficulty levels (light, medium, heavy). The difficulty level appropriate to a particular situation is determined as follows: on the basis of the number of semesters of a new user, a specific starting point x:= (current number of semesters) is determined for general questions and w:= (current number of semesters) for questions on specific teaching/learning situations. In the conditions 1 ≤ x ≤ n and 1 ≤ w ≤ m (in the case of specific teaching/learning situations), easy questions are determined in the conditions (n + 1) ≤ x ≤ 2 n or (must + 1) ≤ 2 m (w ≤ 2 m) for general questions and their difficulty levels are multiplied by 2 m (n + 1 m) for general questions and difficulty levels (n + 1 m) for the next particle (n + 1 m) for the next particle (n + 1 m) for the next particle (n + 1 m) for the next particle (n + 1 m) for the next particle (n + 1 m) for the next particle (n + 1 m) and the next particle (n + 1 m) for the next particle (n + 1 m) for the next particle (n + 1 m) for the next particle (n) for the next particle (n + 1 and the next particle (n) for each particle (n) for each particle (n) for each particle (n) for each particle (n)

If a question is answered correctly in the time available, the user is placed in the next higher state (x: = x + 1 or w: = w + 1). If he answers it incorrectly, then he is reduced to z states (default value: z = 2) (x: = x - z or w: = w - z). General questions and questions on each teaching/learning case are treated separately in principle.

For the presentation of teaching/learning cases, four different presentation/interaction forms are provided. The presentation/interaction form Total presents a teaching/learning case in tabular form. In addition to all the test results, all the suspected/learning diagnoses to be selected and the principles of therapy to be applied are included. The presentation/interaction form Total allows users to construct the medical teaching/learning case in CAMPUS and the author's sample solution. After a student has been able to learn several teaching/learning cases (default value: 2), the presentation/learning system changes to the presentation/learning form.

The presentation of the studies carried out, together with the results in a tabular form, allows students to learn what tests must be requested in order to make certain diagnoses. After sufficient teaching/learning cases have been successfully completed in the presentation/interaction form, the CAMPUS system switches to the presentation/interaction form decision. In this presentation/interaction form, in addition to the choice of suspicion and work diagnoses, users must also decide what information they need. They must therefore conduct the clinical examination themselves and request the necessary technical examinations and laboratory investigations.

The time when the system changes the presentation/interaction form depends on various factors. A fixed number of teaching/learning instances are shown in the presentation/interaction form Total (default value: 2). The change between the other presentation/interaction forms occurs when certain travelling values are exceeded sufficiently often (see below).

Decision Score Correct suspicion diagnosis / occupational diagnosis +1 Missing suspicion diagnosis / occupational diagnosis -1 Totally false suspicion diagnosis / occupational diagnosis -1 To specific suspicion diagnosis / occupational diagnosis -0.25 To general suspicion diagnosis / occupational diagnosis -0.25 Decision on acute therapy (correct / false) +1 / -1 Decision on type of care (correct / false) +1 / -1 Correct tests Therapy principle +1 Missing therapy principle -1 False therapy principle Contraindicated therapy principle -2 Correct contraindication question +0.25 Unnecessary contraindication -25 Correct clinical examination +0.25 Unnecessary clinical examination -0.25 Unnecessary clinical examination -0.25 Unnecessary technical examination -0.25 Unnecessary technical examination -0.25 Unnecessary technical examination -0.25 -10, unnecessary laboratory examination -0.25 -10, unnecessary technical examination -0.25 -10, unnecessary laboratory examination -0.25 -10, unnecessary technical examination -0.25 -10, unnecessary laboratory examination -0.

Table 4: Assessment points for decisions

In the presentation/interaction form complete, a minimum score must be reached for the sum of all previous case studies of a point (default value: a = 5). Then the teaching/learning instances are presented in the presentation/interaction form decision. The further conversion to the presentation/interaction form is compact when a user has received 2a points. The difficulty level of teaching/learning instances is determined accordingly as the difficulty level of questions (see Figure below 13).

The assignment of individual questions to specific situations in the case history or to specific nodes and chapters in the lexicon is done by the authors. The assignments are made in the attributes objectNr and object name in the object types NOTE ORDER and QUESTION. The boolean attribute in the discussion of the object type QUESTION indicates whether or not the appropriate question should be displayed in the case conclusion discussion at the end of a case study.

entityset NOTE assignment (attributes: node assignmentNr l o n g, objectNr l o n g not zero, object name char(50) not zero, identifier: node assignmentNr);

In this case, the value of the value of the underlying asset is the sum of the underlying assets of the underlying asset, the underlying assets of the underlying asset, the underlying assets of the underlying asset, the underlying assets of the underlying asset, the underlying assets of the underlying asset, the underlying assets of the underlying asset, the underlying assets of the underlying asset, the underlying assets of the underlying asset, the underlying assets of the underlying asset, the underlying assets of the underlying asset, the underlying asset, and the underlying assets of the underlying asset, and the underlying assets of the underlying asset.

object name char(50) not zero, inDiscuss bo o l e a n not zero, identifier: query assignmentNr);

(participants: (Notes, (1,1)), (Notes, (0,n))

(participants: (question, (1,1)), (question, (0,n))

3.4.4 Case running model

After a user logs in to the system and decides to process a learning/learning error, a patient is presented with his/her administrative data and history. The patient's name, gender, age, height and weight are displayed, as well as an image that allows the user to get a first visual impression of the patient. The next step depends on which adaptation categories the user has been grouped into by the system or has been involved in himself/herself. In principle, the user must first conduct a thorough history and a thorough clinical examination.

If no acute treatment is necessary, he may decide immediately whether an ambulance, a hospital or an intensive care unit is necessary. After that decision, specific technical examinations and laboratory tests must be requested to confirm or refute the suspected diagnosis. However, technical examinations are carried out only if they are reasonable. This is consistent with the usual procedures at the Heidelberg University clinic. A physician there checks whether the grounds for the need for an examination are sufficient.

In the first case, the user must submit a prognosis and receive a brief summary of the teaching/learning case, in the other case he can change his/her work diagnosis or treatment plan or request new technical tests or laboratory tests. The teaching/learning case is thus continued (see Figure 14).

Patient is presented (name, gender, age, weight, picture)

Targeted examination requirements (technical examinations, laboratory tests)

An overview of the results of technical and laboratory tests

Targeted requirement for control checks

Research results, clinical trials

Information of the decision on system information needs forecast

Final results Summary of decision-making by learners

3.5 Conceptual modelling

In Chapter 2.9, a three-level model of data modeling was introduced. The model provides for the first design of a conceptual model that is completely independent of implementation aspects. The conceptual model of the CAMPUSSystem consists of several submodels, which are presented in the subsequent subchapters. The verbal description of each model explains only those attributes that may not be intuitively understandable.

3.5.1 Normal finding model

Normal findings are excellent for re-use in other teaching/learning systems. This aspect is taken into account in the design of a normal findings model (see Figure 15). The model makes it possible to reuse normal findings at any time without any additional effort. Thus, authors can draw on existing normal findings at any time in the teaching/learning process and do not have to re-create them for each teaching/learning system. The availability of normal findings enables the teaching system to automatically generate inconspicuous findings when a result of a requested study is not available.

Unobtrusive responses to ANAMNESENORMALWORTS to anamnesis questions are also dependent on a patient's sex (GESCHLECHT) and age (ALTERSTRUE). Unobtrusive findings (KLINNORMALBEFUND) when conducting the clinical examination types (KLINNORMALBEFUND) Anamnesis, palpation, exultation and percussion are also dependent on the patient's sex and field of activity. In addition, there is also a body region (KOERPERREGION) where the examination has been performed.

Age level -age levelNr -name 0..1 -abbreviation -from laboratory field of expertise field of expertise field of expertise field of expertise field of expertise field of expertise field of expertise field of expertise field of expertise field of expertise field of expertise field of expertise field of expertise field of expertise field of expertise field of expertise field of expertise field of expertise field of expertise field of expertise field of expertise field of expertise field of expertise field of expertise field of expertise field of expertise field of expertise field of expertise field of expertise field of expertise field of expertise field of expertise field of expertise field of expertise field of expertise field of expertise field of expertise field of expertise field of expertise field of expertise field of expertise field of expertise field of expertise field of expertise field of expertise field of expertise field of expertise field of expertise field of expertise field of expertise field of expertise field of expertise field of expertise field of expertise field of expertise field of expertise field of expertise field of expertise field of expertise field of expertise field of expertise field of expertise field of expertise field of expertise field of expertise field of expertise field of expertise field of expertise field of expertise field of expertise field of expertise field of expertise field of expertise field of expertise field of expertise field of expertise field of expertise field of expertise field of expertise field of expertise field of expertise field of expertise field of expertise field of expertise field of expertise field of expertise field of expertise field of expertise field of expertiseNr Tnr Tnr Tnr Tnr Under-name -procedure -abbreviation -abbreviation of field of expertise field of expertise field of expertise field of expertise field of expertise field of expertise field of expertise field of expertise field of expertise field of expertise field of expertise field of expertise field of expertise field of expertise field of expertise field of expertise field of expertise field of expertise field of expertise field of expertise field of expertise field of expertise field of expertise field of study

In addition, it is important to note that, in the context of the presentation of the results of the study, it is important to note that the results of the study are based on the results of the study and that the results of the study are based on the results of the results of the study.

Types of samples TechnNormal finding_cooperation region -sample typeNr history question_nameNormally answer -name -taking place

ClNormal finding_Gender 1..* LaboratoryNormal finding_Gender historyNormal answer -historyNormal answerNr -infallible_answer

1..* HistoryNormal answer_Gender TechnNormal finding -techNr - finding_text *1 TechnNormal finding_Gender - finding_image_video -sexNr -name -abbreviation

* Aggregation of entities set ANAMNESETYP (attributes: anamnesetypNr l o n g , name char(50) not null, identifier: anamnesetypNrr); entities set ANAMNESEFRAGE (attributes: anamnesetypNr l o n g , question_text charrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrr

(attributes: labNormal findNr l o n g , befund_text ch ar(2000), min r e al , max r e al , identifier: labNormal findNr);

(∀l)(LABORNORMALBEFUND(l) → (l[min] == null l[max] == null) (l[min] ≤ l[max])) (∀l)(LABORNORMALBEFUND(l) → ¬(l[min] == null l[max] == null l[found_text] == null)) (∀l)

the entities set ALTERSSTUFE (attributes: age levelNr l o n g, name char(20) not zero, abbreviation char(5), of int e ger not zero,

up to and including zero, identifier: age levelNr);

(attributes: sexNr l o n g , name char(10) not zero, abbreviation char(5) not zero, identifier: sexNr);

entityset PROBENART (attributes: sample typeNr l o n g, name char(50) not zero, source char(50) not zero, identifier: sample typeNr);

Entityset COERPERREGION (attributes: coerperregionNr l o n g ,

name char(50) not zero, image ch a r (50) not zero, description ch a r(2000), inspection bo o l e a n not zero,

This is the case in the case of the first subparagraph of the first subparagraph of the first subparagraph of the second subparagraph of paragraph 1 of this Article, which is replaced by the second subparagraph of the second subparagraph of the second subparagraph of the second subparagraph of the second subparagraph of the second subparagraph of the second subparagraph of the second subparagraph of the second subparagraph of the second subparagraph of the second subparagraph of the first subparagraph of the second subparagraph of the second subparagraph of the second subparagraph of the second subparagraph of the second subparagraph of the second subparagraph of the second subparagraph of the second subparagraph of the second subparagraph of the second subparagraph of the second subparagraph of the second subparagraph of the second subparagraph of the second subparagraph of the second subparagraph of the second subparagraph of the second subparagraph of the second subparagraph of the second subparagraph of the second subparagraph of the second subparagraph of the second subparagraph of the second subparagraph of the second subparagraph of the second subparagraph of the second subparagraph of the second subparagraph of the second subparagraph of the second subparagraph of the second subparagraph of the second subparagraph of the second subparagraph of the second subparagraph of the second subparagraph of the second subparagraph of the second subparagraph of the second subparagraph of the second subparagraph of the second subparagraph of the second subparagraph of the second subparagraph of the second subparagraph of the second subparagraph of the second subparagraph of the second subparagraph of the second subparagraph of the second subparagraph of the second subparagraph of the second subparagraph of the second subparagraph of the second subparagraph of the second subparagraph of the second subparagraph of the second subparagraph of the second subparagraph of the second subparagraph of the second subparagraph of the second subparagraph of the second subparagraph of the second paragraph of the second paragraph of the second paragraph of the second paragraph of the second paragraph of the second paragraph of the second paragraph of the second paragraph of the second paragraph of the second paragraph of the second paragraph

This appropriation is intended to cover the expenditure incurred by the Member States in the implementation of the programme.

This appropriation is intended to cover expenditure on technical assistance for the implementation of the programme.

This appropriation is intended to cover expenditure on research and technological development in the Member States.

This appropriation is intended to cover expenditure relating to the implementation of the Joint Research Centre (JRC) and the Joint Research Centre (JRC) and the Joint Research Centre (JRC) and the Joint Research Centre (JRC) and the Joint Research Centre (JRC) and the Joint Research Centre (JRC) and the Joint Research Centre (JRC) and the Joint Research Centre (JRC) and the Joint Research Centre (JRC) and the Joint Research Centre (JRC) and the Joint Research Centre (JRC) and the Joint Research Centre (JRC) and the Joint Research Centre (JRC) and the Joint Research Centre (JRC) and the Joint Research Centre (JRC) and the Joint Research Centre (JRC) and the Joint Research Centre (JRC) and the Joint Research Centre (JRC) and the Joint Research Centre (JRC) and the Joint Research Centre (JRC) and the Joint Research Centre (JRC).

This appropriation is intended to cover the expenditure incurred by the Member States in connection with the implementation of the programme.

This appropriation is intended to cover expenditure relating to the implementation of the budget of the European Parliament and of the Council.

(COERPERREGION, UNTERORDined COERPERREGION, (0,1))

This appropriation is intended to cover expenditure on research and technological developments in the field of information and communication technology.

3.5.2 Case model

The case model (see Figure 16) describes the structure of a medical teaching/learning fallacy. Initially, it was thought that the existing approaches to electronic medical records [VAN BEMMEL, MCCRAY (eds.) 95; SAFRAN, RIND et al. 96] would allow the selection of a suitable one and use it for the storage of teaching/learning cases. Unfortunately, there is no universally accepted solution yet for electronic medical records, and all previous approaches were found to be unsuitable.

An anamnesis consists of at least one anamnesis response (ANAMNESEANTWORT), the clinical examination of at least one examination result (CUNTERSERGEBNIS). A technical examination includes exactly one examination result (TUNTERSERGEBNIS). A laboratory examination includes at least one result (LABORTESTERGEBNIS) of a laboratory test (LABORTEST). A teaching/learning case also includes at least one diagnosis (DIAGNESTERGEBNIS) and at least one therapy (THERAPY).

The FALL object type has, among other things, the introductory text, summary and description attributes. The introduction text of the attribute describes briefly the initial situation at the beginning of the case simulation. The summary attribute contains a case review, which is displayed after the completion of the case simulation and summarizes and explains all the essential aspects of the learning/learning case. The attribute description outlines the learning/learning case. Users can then, at their own request, select the learning/learning cases they are interested in from the case database. The entry attribute at the end of the case simulation is displayed and the result of the clinical examination (TERAPETYPE CUNTERTERGERGERGERGERGERGERGERGERGERGERGERGERGERGERGERGERGERGERGERGERGERGERGERGERGERGERGERGERGERGERGERGERGERGERGERGERGERGERGERGERGERGERGERGERGERGERGERGERGERGERGERGERGERGERGERGERGERGERGERGERGERGERGERGERGERGERGERGERGERGERGERGERGERGERGERGERGERGERGERGERGERGERGERGERGERGERGERGERGERGERGERGERGERGERGERGERGERGERGERGERGERGERGERGERGERGERGERGERGERGERGERGERGERGERGERGERGERGERGERGERGERGERGERGERGERGERGERGERGERGERGERGERGERGERGERGERGERGERGERGERGERGERGERGERGERGERGERGERGERGERGERGERGERGERGERGERGERGERGERGERGERGERGERGERGERGERGERGERGERGERGERGERGER

The attribute of care gives information on whether the patient has been cared for in an outpatient, inpatient or in the intensive care unit during the specified period. The boolean attribute of acute therapy indicates whether the therapy performed is acute therapy. The attribute of therapy in the object type THERAPIE_THERAPIEPRINZIP contains information on whether it is a primary, supportive or contraindicated therapy. Contraindicated therapies may not be performed under any circumstances.

entityset FALL (attributes: patientId l o n g, sex ch a r (9) not zero, first name char(20) not zero, surname char(30) not zero, lifespan int e ger not zero, weight in t e ger not zero, size i n t e ger not zero, picture ch a r (50), description ch ar(2000) not zero, introductory text char(2000) not zero, summary char(2000) not zero, date of creation d at e not zero, difficulty level ch ar50) not zero, identification: patientId); entityset ANAMNESE (attributes: anamneseNr l o n g g , date d at e n l o n n g , date d at e n l o n l g , date d at e n l o n l g, date of compilation) not zero, date of identification: date of identification: date of identification; date of identification: date of identification: date of identification; date of identification: date of identification: date of identification; date of identification: date of identification; date of identification: date of identification: date of identification; date of identification: date of identification: date of identification; date of identification: date of identification: date of identification; date of identification: date of identification; date of identification: date of identification; date of the date of identification of the clinical identification of the clinical examination of the clinical examination; date of the date of the clinical examination of the clinical examination of the clinical examination; date of the date of the date of the clinical examination of the clinical examination;

-anamnese responseNr -patient response -entry symptom -therapy_therapyprinciple... -therapy type -therapy principleNr -name -description -clinical courseNr -clinical course_text -prognosisNr -prognosis_text -kunderresultNr -result_text -result_image_video -entry symptom -diagnosisNr -date -diagnosisNr -name listTitel -fourTitel -icd -crosscode -icdScore code -description -treatmentNr -research -substance -experiment_text -treatment -substance -substance -resultsNr -research -substance -research -substance -substance -substance -substance -substance -substance -substance -substance -substance -substance -substance -substance -substance -substance -substance -substance -substance -substance -substance -substance -substance -substance -substance -substance -substance -substance -substance -substance -substance -substance -substance -substance -substance -substance -substance -substance -substance -substance -substance -substance -substance -substance -substance -substance -substance -substance -substance -substance -substance -substance -substance -substance -substance -substance -substance -substance -substance -substance -substance -substance -substance -substance -substance -substance -substance -substance -substance -substance -substance -substance -substance -substance -substance -substance -substance -substance -substance -substance -substance -substance -substance -substance -substance -substance -substance

Clinical examination_Laboratory examination_Laboratory examination_Laboratory examination_Technical examination_Laboratory examination_Laboratory examination_Laboratory examination_Laboratory examination_Laboratory examination_Laboratory examination_Laboratory examination_Laboratory examination_Laboratory examination_K.

Specialized field History Question History Answer Therapy_Therapy Principle Therapy Principle Clinical course Prognosis Sample type KUnter Result Clinical examination Type of diagnosis Diagnosis Therapy TUnters Procedures Lab test TUnter Result Lab Test result Laboratory examination TechnologyExamination Clinical examination Case Anamnese Coer region

Association 1..* Figure 16: Case model aggregation entitieset LABORUNTERSUCHING (attributes: lab testNr l o n g, empfeenerlabor ch ar ar50) entitieset Diagnostics (attributes: diagnosis l o n g, date d o n g, date d o n n g, summary char(2000), control test bo o l e a n n n g, identifier: lab testNr); (artl) entitieset LABORUNTERSUCHING (attributes: lab testNr l o n g, empfeener laboratory ch ar50) entitieset Diagnostics (attributes: diagnosis l o n g, date d o n g, summary char, summary char(2000), control test bo o l e e n n n n g, identifier: lab testNr n r r r r n r r n r r n r n r n r n r n r n r n r n r n r n r n r n r n r n r n r n r n r n r n r n r n r n r n r n r n r n r n r n r n r n r n r n r n r n r n r n r n s) entitieset Diagnostics (attributes: diagnosis l o n r n r n r n r n r n r n r n r n r n r n r n r n r n r n r n r n r n r n r n r n r n r n r n r n r n r n r n r n r n r n r n r n r n r n r n r n r n r n r n r n r n r n r n r n r n r n r n r n r n r n r n r n n n n r n n n n n n r n n n n n n r n r n n n n n r n n n n n n r n n n n n n n n n n n n n n n n r n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n r n n n n n n n n n n n n n n n n n n n n n n n n n

(attributes: clinical courseNr l o n g, clinical course_text char(2000) not zero, identifier: clinical courseNr);

(attributes: anamnese responseNr l o n g, patient response ch a r (2000) not zero, entry symptom boo l e a n not zero, identifier: anamnese responseNr);

(attributes: kunderresultNr l o n g ,

the result_text ch a r (2000) not zero, the result_image_video char(50), entry symptom boo l e a n not zero, identifier: kUnderresultNr);

(attributes: tunderresultNr l o n g, befund_text ch ar(2000) not zero, befund_bild_video char(50), identifier: tunderresultNr);

In addition, it is possible to calculate the number of samples taken by the laboratory.

value of d o u b l e, result_text ch a r (2000), result_image char(50), identifier: laboratory test resultNr);

(∀l) * LABORTESTERGEBNESS* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * *

In addition, it is important to note that, in the context of the presentation of the report, the Commission has adopted a number of recommendations on the basis of which it is able to assess the effectiveness and effectiveness of the programme.

four-letter acronyms: char(255), icdCross code: char(5) not zero, icdSterncode: ch ar(5), diagnosisText: char(255) not zero, identifier: diagnosisNr);

wholepartassociation FALL_PROGNOSE (participants: (FALL, (1,1)), wholepartassociation FALL_KLINVERLAUF (participants: (FALL, (1,1)), wholepartassociation FALL_KLINVERLAUF (participants: (FALL, (1,1)), wholepartassociation FALL_KLINVERLAUF (participants: (FALL, (1,1)), wholepartassociation FALL_KLINVERLAUF (participants: (FALL, (1,1)), wholepartassociation FALL_KLINVERLAUF (participants: (1,1)), wholepartassociation (1,1)), wholepartassociation (1,1) (participants: (1,1)), wholepartassociation (1,1) (participants: (1,1)), wholepartas (participants: (1,1)), wholepartas (participants: (1,1)), wholepartas (participants: (1,2) (participants: (1,1)), wholepartas (participants: (1,bartas), wholepartas (participants: (1,1)), wholepartas (participants: (1,bartas), wholepartas (participants: (1,bartas), wholepartas (participants: (participants:), wholepartas) (participants: (1,), wholepartas (participants: (1,), wholepartas) (participants: (1,), wholepartas (participants: (1,), wholepartas) (participants: (1,), wholepartas (participants: (1,), wholepartas) (participants: (1,), wholepartas (participants: (1,), wholepartas) (participants: (1,), wholepartas (participants: (1,), wholepartas) (participants: (participants: (1,), wholepartas) (participants: (1,), wholepartas) (participants: (1,), wholepartas (participants: (participants: (participants: (particip) (particip) (participants: (1,), wholepart) (participants: (1,), wholes) (participants: (1,), wholes) (participants: (1,), wholes) (participants: (1,

(participants: (FALL, (1,n)), (FALL, (0,n))

(participants: (ANAMNESEFRAGE, (0,n)), (ANAMNESEFRAGE, (1,1)));

(participants: (clinical research group, (0,n)), (clinical research group, (1,1)));

(participants: (TUNTERSERVES, (0,n)), (TUNTERSERVES, (1,1))), and (participants: (TUNTERSERVES, (0,n)), and (participants: (TUNTERSERVES, (1,1))), and (participants: (TUNTERSERVES, (0,n)), and (participants: (TUNTERSERVES, (1,1)));

(participants: (LABORTEST, (0,n)),

(participants: (diagnosis, (0,n)),

(participants: (diagnosis, (1,1)),

This appropriation is intended to cover expenditure on research and technological developments in the field of biotechnology.

Relationship laboratory research_PROBENART (participants: (laboratory research, (1,1)),

Relationship CONTRACTORS_COUERPERREGION (participants: (CONTRACTORS, (1,1)),

(participants: (TUNTERSERGENNIS, (1,1)), (KOERPERREGION, (0,n)) and (participants:

3.5.3 Case-known model

The case-knowledge model (see Figure 17) describes the structure of the case-related knowledge available in the CAMPUS system.Authors must specify for all investigative results whether the result is inconspicuous, whether the investigative result is a lead symptom, and whether the associated conduct of the investigation was necessary at all (boolean attributes are normal, lead symptom and necessary in the object types ANSWERDIVERDIVERDIVERDIVERDIVERDIVERDIVERDIVERDIVERDIVERDIVERDIVERDIVERDIVERDIVERDIVERDIVERDIVERDIVERDIVERDIVERDIVERDIVERDIVERDIVERDIVERDIVERDIVERDIVERDIVERDIVERDIVERDIVERDIVERDIVERDIVERDIVERDIVERDIVERDIVERDIVERDIVERDIVERDIVERDIVERDIVERDIVERDIVERDIVERDIVERDIVERDIVERDIVERDIVERDIVERDIVERDIVERDIVERDIVERDIVERDIVERDIVERDIVERDIVERDIVERDIVERDIVERDIVERDIVERDIVERDIVERDIVERDIVERDIVERDIVERDIVERDIVERDIVERDIVERDIVERDIVERDIVERDIVERDIVERDIVERDIVERDIVERDIVERDIVERDIVERDIVERDIVERDIVERDIVERDIVERDIVERDIVERDIVERDIVERDIVERDIVERDIVERDIVERDIVERDIVERDIVERDIVERDIVERDIVERDIVERDIVERDIVERDIVERDIVERDIVERDIVERDIVERDIVERDIVERDIVERDIVERDIVERDIVERDIVERDIVERDIVERDIVERDIVERDIVERDIVERDIVERDIVERDIVERDIVERDIVERDIVERDIVERDIVERDIVERD

An object of the type DIAGNOSIS (suspect or working diagnosis) may be related to the different test results of the anamnesis (object type ANAMNESEANTWORT), clinical examination (CUNTERSERGEBNIS), technical examination (TUNTERSERGEBNIS) and laboratory examination (LABORTESTERGEBNIS) (through the object types DIAGANAMNESTERGEBNIS, DIAGUNTERSERGEBNIS, DIAGUNTERSERGEBNIS, DIAGUNTERSERGEBNIS and DIAGLABORTESTERGEBNIS). Positive or negative evidence (attributive evidence) may be provided. Possible categories of evidence are listed in Chapter 4.2 of the Establishment.

the boolean attribute suspicious diagnosis, which indicates whether it is a suspicious diagnosis. The attribute category determines whether it is a main diagnosis, whether the diagnosis is related to the main diagnosis, or whether there is no or no relevant connection to the main diagnosis. The boolean attribute past indicates whether it is a diagnosis that has already been made in the past (before the start of the case simulation).

The results of the study were evaluated in accordance with the results of the study and the results of the study were evaluated in accordance with the results of the study and the results of the study were evaluated in accordance with the results of the study and the results of the study were evaluated in accordance with the results of the study and the results of the study and the results of the study were evaluated in accordance with the results of the study and the results of the study.

Lab test Lab test result_LUEEvaluation of results DiagnosisTherapy principle_Therapy principle

Case_Labortest DiagTherapy principle DiagLaborTest result_Labor test result -case_Labor testNr -diagTherapy principleNr -reason for rejection -type of therapy -course Case_FL -prognosis -comment DiagLaborTest result -diagLaborTest resultNr -evidence DiagTherapy principle_Diagnose -comment Case_Diagnose Case 1..* DiagLaborTest result_Diagnose

Case_Tunderprocedure -case_TunderprocedureNr DiagTunderresult_diagnosis -reason for refusal

FTU_Tunderprocess Diagnamesresponse_diagnosis DiagTunderresult -diagTunderresultNr DiagKunderresult -evidence -diagKunderresultNr -comment Tunderprocess -evidence -comment

DiagTunderresult_Tunderresult DiagKunderresult_Kunderresult

Diagnosis -diagnosis -diagnosis -diagnosis -diagnosis -diagnosis -diagnosis -diagnosis -diagnosis -diagnosis -diagnosis -diagnosis -diagnosis -diagnosis -diagnosis -diagnosis -diagnosis -diagnosis -diagnosis -diagnosis -diagnosis -diagnosis -diagnosis -diagnosis -diagnosis -diagnosis -diagnosis -diagnosis -diagnosis -diagnosis -diagnosis -diagnosis -diagnosis -diagnosis -diagnosis -diagnosis -diagnosis -diagnosis -diagnosis -diagnosis -diagnosis -diagnosis -diagnosis -diagnosis -diagnosis -diagnosis -diagnosis -diagnosis -diagnosis -diagnosis -diagnosis -diagnosis -diagnosis -diagnosis -diagnosis -diagnosis -diagnosis -diagnosis -diagnosis -diagnosis

Kunderresult_KUEresult evaluation Diagnosis response_Name response Tunderresult_TUEresult evaluation

In addition, it is important to take into account the fact that, for the purposes of this Regulation, the Member State concerned is not entitled to make use of the information provided by the Member State in which it is situated.

Diagnostic test... -diagnostic test... -commentary -suspicious diagnosis -category - past entitieset DIAGLABORTESTERGEBNIS (attributes: diagLabor test resultNr l o n g , evidence ch a r (3) not null, comment ch a r (2000), identifier: Laboratory test resultNr; (∀dlt) identifier: Laboratory test resultNr; (∀dlt) identifier: Laboratory test resultNr; (∀dlt) identifier: (∀dlt) identifier; (∀dlt) identifier: (∀dlt) identifier; (∀dlt) identifier; (∀dlt) identifier; (●dlt) identifier; (●dlt) identifier; (●dlt) identifier; (●dlt) identifier; (●dlt) identifier; (●dlt) identifier; (●dlt) identifier; (●dlt) identifier; (●dlt) identifier; (●dlt) identifier; (●dlt) identifier; (●dlt) identifier; (●dlt) identifier; (●dlt) identifier; (●dlt) identifier; (●dlt) identifier; (●dlt) identifier; (●dlt) identifier; (●dlt) identifier; (●dlt) identifier; (●dlt) identifier; (●dlt) identifier; (●dlt) identifier; (●dlt) identifier; (●dlt) identifier; (●dlt) identifier (●dlt) identifier; (●dlt) identifier; (●dlt) identifier; (●dlt) identifier; (●dlt) identifier (●dlt) identifier; (● (●) identifier) identifier; (● (●) identifier; (●) identifier (●d) identifier; (●) identifier; (●d) identifier (●d) identifier (●) identifier) identifier; (● (●) identifier; (●) identifier (●) identifier (● (●) identifier; (●) identifier (●) identifier; (●

In addition, it is important to take into account the specific needs of the patient and the specific needs of the patient.

In addition, it is important to be aware of the importance of this approach.

(∀dt) ((DIAGTHERAPY PRINCIPLE(dt) → ¬(dt[type of therapy] == null dt[course] == null dt[prognosis] == null dt[commentary] == null))

(attributes: results evaluationNr l o n g, normal bo o l e n not zero, necessary b o l e n not zero, lead symptom bo o l e n not zero,

In addition, it is important to ensure that the results of the evaluation are consistent with the results of the evaluation and the results of the evaluation.

(attributes: evaluation of results, normally not zero, necessary not zero, lead symptom not zero, comment ch a r (2000), identifier: evaluation of results;

In addition , it is possible to calculate the value of the investment in the same way as the value of the investment in the same way as the value of the investment in the same way as the value of the investment in the same way as the value of the investment in the same way as the value of the investment in the same way as the value of the investment in the same way as the value of the investment in the same way as the value of the investment in the same way as the value of the investment in the same way as the value of the investment in the same way as the value of the investment in the same way as the value of the investment in the same way as the value of the investment in the same way as the value of the investment in the same way .

In addition to the above, it is important to note that the results of the evaluation are based on the results of the evaluation and that the results of the evaluation are based on the results of the evaluation and that the results of the evaluation are based on the results of the evaluation and that the results of the evaluation are based on the results of the evaluation and the results of the evaluation and the results of the evaluation and the results of the evaluation and the results of the evaluation.

In addition to the above, the following information is also available:

(b) identifier: diagnostic assessmentNr; identifier: diagnostic assessmentNr; identifier: diagnostic assessmentNr; attribute: diagnostic assessmentNr; attribute: diagnostic assessmentNr; comment: ch a r (2000), suspicious diagnosis bool; category i n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n

(participants: (DIAGANAMNESWORD, (1,1)), (ANAMNESWORD, (0,n))

This appropriation is intended to cover expenditure relating to:

(participants: (diagnosis, (1,1)), (diagnosis, (0,n))

(participants: (FALL, (1,n)), (DIAGNOSE, (0,n))

the relationship FALL_FTU (participants: (FALL, (0,n)),

the relationship FALL_FL (participants: (FALL, (0,n)),

(participants: (FALL_TUNTERS Conduct, (1,1)),

the relationship FL_LABORTEST (participants: (FALL_LABORTEST, (1,1)),

(participants: (Laboratory, (1,1)), (Laboratory, (1,1)) and (Legal, (1,1));

The Commission shall adopt delegated acts in accordance with the opinion of the European Parliament and of the Council, acting in accordance with the opinion of the Standing Committee of the Committee of the Regions, and in accordance with the opinion of the Standing Committee of the European Parliament and of the Council.

This appropriation is intended to cover expenditure relating to the implementation of the budget of the European Parliament and of the Council in accordance with the opinion of the Economic and Social Committee of the European Parliament and of the Council.

The Commission shall adopt delegated acts in accordance with the opinion of the European Parliament and of the Council, acting in accordance with the opinion of the Standing Committee on the Environment, Public Health and Consumer Protection, and in accordance with the opinion of the Standing Committee on the Environment, Public Health and Consumer Protection, and with the opinion of the Standing Committee on the Environment, Public Health and Consumer Protection, and with the opinion of the Standing Committee on the Environment, Public Health and Consumer Protection.

3.5.4 Lexicon model

In the CAMPUS system, there are different types of domain knowledge. The informal textbook knowledge contained is made available to users in the form of a hypertext [KUHLEN 91]. The lexicon model (see Figure 18) describes the structure of this hypertext. A generator [PELZER 98] allows you to create a hypertext in HTML format that can be read from the database content at any time with common web browsers. Using a parser [PELZER 98] existing HTML documents can be broken down into individual parts and included in the CAMPUS system database.

The resulting lexicon is uniform for all CAMPUS teaching/learning systems, but each system contains specific references to individual pages or chapters of the lexicon.

A node (object type NOTE) is composed of at least one information element (object type INFOELEMENT) and exactly one navigation bar (NAVIGATIONSLEISTE). Information elements can be, for example, text, images, sounds or videos. Each node is part of exactly one chapter (CAPITEL). Each node is exactly one object of the type KNOTENTYP. A node contains any number of anchors (ANKER) which are the starting point for references (VERWEYPIST) to HTML nodes. A reference can be exactly one reference type (VERWEYPIST). Navigation lists are composed of at least one navigation node (NAVIGATIONS). A position in a typical navigation element or a navigation object (POSENTYLE) can be determined by the location of the information in the navigation code, where either the attributes or the attributes of the object (POSENTYLE) can be added to the navigation code, or the information can be added to the navigation code (POSENTYLE) by the user.

The advantage of this solution is that regardless of the HTML editor used and the HTML version used, it is always ensured that an imported HTML document can be restored in its original layout [PELZER 98]. The attribute element type in the ANKER object type indicates whether the anchor is anchored to an information element or to a navigation element. The attribute target anchor, rel, rev and title are optional attributes of the <A> tag of HTML. The attribute orientation in the object type NAVIGATIONSLEISTE includes information on whether the navigation bar is quoted, left- or right-handed. The attribute orientation determines whether the navigation bar is quoted or right-handed.

-referenceNr -knotNr -construction date -url -ankerNr -construction date -element type -elementNr -ankerposition1 -ankerposition2 -target anchor -rel -rev -title -infoElementNr -construction date -name -path -element type -format -short description -navigationselementNr description -icon -reference typeNr -name description -positionNr sequence -chapterNr -chapterInfo -name -knotNr -name -date -direction -knot type -navigation barNr -notes -direction -knot typeNr -name -knot typeNr - description of anchor_anker_anker_anker_anker_anker_anker_anker

Knot_Navigation bar Knot_Anker Knot_InfoElement entityset KNOTEN (attributes: knotNr l o n g, name char(255), created date d at e not zero, path char(50) not zero, knotart char(50) not zero, identifier: knotNr); (∀k) KNOTEN(k) → k[knart] = RestHTML k[knart] = Sonstiges) entityset KNOTENTYP (attributes: knotent nr l o ng , name char not zero, description ch50) not zero, identifier: knotortype r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r

entityset KAPITEL (attributes: chapter Nr l o n g, chapter heading i n t e r , name char(80) not zero, identifier: chapter Nr);

(∀k1, k2)(CAPITAL(k1) CAPITAL(k2) k1[capital position] = k2[capital position] → k1 == k2)

the entityset NAVIGATIONSLIST (attributes: navigation barNr l o n g, orientation char(1) not zero,

the orientation level char(1) not zero, identifier: navigation barNr);

(∀n)(NAVIGATION LIST(n) → n[direction] = l n[direction] = r n[direction] = c)

(∀n) NAVIGATION LISTn) → n[level of orientation]= h n[level of orientation]= v)

entityset POSITION (attributes: positionNr l o n g ,

sequence position i n t ege r not zero, identifier: positionNr;

(∀p1, p2) POSITION(p1) POSITION(p2) p1[sequence position] = p2[sequence position] → p1 == p2)

In addition to the above, it is possible to specify the following characteristics for each navigation element:

(∀n) (NAVIGATIONSELEMENT(n) → ¬(n[description] == zero n[icon] == zero) ¬(¬n[description] == zero) ¬(n[icon] == zero)))

entityset INFOELEMENT (attributes: infoElementNr l o n g, date of creation char(10) not zero,

name char(30), path char(50) not zero, elementar ch ar(15) not zero, format char(15) not zero, abbreviation ch a r (2000), identifier: infoElementNr); wholepartassociation KAPITEL_KNOTEN (participants: (KAPITEL, (0,n)), (KNOTEN, (1,1)); wholepartassociation KAPITEL_KAPITEL (participants: (KAPITEL, (0,n)), (KAPITEL, (0,1))); wholepartassociation KNOTEN_ANVERKER (participants: (KAPITEL, (0,n)), (ANKER, (1,1)); wholepartassociation KNOTEN_ANVERKER (participants: (0,n)); wholepartassociation KNOTEN_ANVERKER (participants: (0,n)); wholepartassociation KNOTEN_ANVERKER (participants: (0,n)), wholepartassociation (0,n), (1,n) (1,n), (1,n), (1,n), (1,n), (1,n), (1,n), (1,n) (1,n), (1,n), (1,n), (1,n), (1,n), (1,n), (1,n), (1,n), (1,n), (1,n), (1,n), (1,n), (1,n), (1,n), (1,n), (1,n), (1,n), (1,n), (1,n), (1,n), (1,n), (1,n), (1,n), (1,n), (1,n), (1,n), (1,n), (1,n), (1,n), (1,n), (1,n), (1,n), (1,n) (n) (n), (1, (n), (1, (n), (1, (n) (n) (n), (1, (n), (1, (n), (1, (n), (1, (n), (1, (n), (1, (n), (n), (1, (n), (n), (n), (n), (1, (n), (n), (n), (n), (n), (n), (n), (n), (n), (n), (n), (n), (n), (n), (n), (n), (n), (n), (n), (n), (n), (n), (n), (n), (n), (n), (n), (n),

-layoutNr -headline -footline -background colour -technologyFormularNr -production date -form head -background colour -form spreadsheet... -lab formNr -production date -form head -background colour -form spreadsheet... -column number -form positionNr -column position -order position -part formNr -lab inscription 1..* 1..* WBT_System Layout TechnologyExamination TechnologyExamination Laboratory Examination Subform Form Position

3.5.5 Layout model

Authors can define their own layouts for lab forms (object type LABORFORMULAR) and for technical forms (object type TECHNFORMULAR). Lab forms can be made up of several subforms (TEILFORMULAR). The position of a subform in a lab form is described by objects of the type FORMULARPOSITION. This object type has the attributes split position and order position. The split position attribute indicates which column of the lab form the subform is located in. The order position determines which point in the column the subform is attributed to. Behind each column, it is possible to identify the CAMPUS teacher/Layout system (LAYOUT system) attributes with the hypertext attributes above and beyond.

Form position_Part form Laboratory form_Form position

However, the appearance of the teaching/learning system windows (e.g. button layout, colour layout, partitioning, etc.) cannot be influenced. This has been done for two reasons: firstly, the relevant user interface guidelines have been taken into account in the design. Most medical practitioners do not usually have detailed knowledge about them and would not be able to define the basic screen layouts at this time, even without difficulty.

entityset LABORFORMULAR (attributes: labformNr l o n g , date of creation char((2000) not zero, form head char(50), background color c h a r (15), form inscription char(80) not zero, splitting number i t e g e r r r n n n n n n , identifier: labformNr); entityset TECHNFORMULAR (attributes: technFormularNr l o n g, date of creation char(2000) not zero, form head char(50), background color c h a r r r (15), form inscription char80) not zero, identifier: technFormularNr == ==== entityset FORMYOARPOSON (attributes: formula g l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l

(participants: (technology research, (1,1)), (technology research, (0,n))

The following information is provided for in the Annex to Implementing Regulation (EU) No 1308/2013:

the relationship FORMULARPOSITION_TEILFORMULAR (participants: (FORMULARPOSITION, (1,1)), (TEILFORMULAR, (1,n));

(participants: (Laboratory research, (1,1)), (Laboratory research, (0,n))

This appropriation is intended to cover expenditure on technical assistance for the implementation of the Joint Research Centre (JRC) and the Joint Research Centre (JRC) for the implementation of the Joint Research Centre (JRC) and the Joint Research Centre (JRC) for the implementation of the Joint Research Centre (JRC) and the Joint Research Centre (JRC) for the implementation of the Joint Research Centre (JRC) and the Joint Research Centre (JRC) for the implementation of the Joint Research Centre (JRC) and the Joint Research Centre (JRC) for the implementation of the Joint Research Centre (JRC) and the Joint Research Centre (JRC) for the implementation of the Joint Research Centre (JRC) and the Joint Research Centre (JRC).

3.5.6 User model

The user model (see Figure 20) describes the preferences of users and their previous use of the CAMPUS system and is a prerequisite for adapting the system to its users.

A user-type object consists of any number of case edits (object-type FALLEDITY), query edits (QUESTIONEDITY), help protocols (HILFEPROTOKOLL) and node visits (NOTENBESUCH). Each HILFEPROTOKOLL type object is exactly assigned to a HILFETEXT type object. The attribute event in the HILFETEXT object-type determines the event at which the help text string (attributes) is displayed. Each user has a unique prospective attribute identifier (attributes) and an attributes identifier (attributes). The adaptive adaptive adaptive adaptive adaptive adaptive adaptive adaptive adaptive system can't automatically identify the user's date of use, and if the adaptive adaptive adaptive adaptive adaptive adaptive system can't be used, the adaptive adaptive adaptive adaptive adaptive adaptive system can't automatically determine whether or not the adaptive adaptive adaptive adaptive adaptive adaptive adaptive adaptive adaptive adaptive system is used.

The totalNurPatho attribute contains information on whether the user only gets the noticeable findings displayed in the Total presentation/interaction form. The user model is a simple assignment model [BODENDORF 90 p. 132]. Depending on the number of correctly processed teaching/learning instances, correctly answered questions and the current number of semesters, the user is divided into different categories (attribute instruction manual, pre-sentation form, questions, runtime).

User -user -identification -password -e-mail -case handling -help protocol -signup date -case handling -help protocolNr -success -semester number -date -processing duration -loginDate -talk -time -operation manual -praise form -questions -reporting time -adaptationActivated -prospective loading -totalNurPatho help protocol_helptext

Question processing Help text - Question processingNr - Help textNr - Success event - Processing duration - Help text - Time of visiting nodes - Visiting nodesNr - Time of stay

On the basis of all this information, the instructional subsystem can select appropriate teaching/learning cases and questions and, if necessary, offer appropriate help. At the node visit, time and length of stay (attribute time, length of stay) are determined. At the help pages, the date (attribute date) is recorded. On the basis of all this information, the instructional subsystem can select appropriate teaching/learning cases and questions and, if necessary, offer appropriate help.

(g, real output not zero, processing time int e ger not zero, time date not zero, identifier: case processingNr); entity set QUESTION (attributes: query processingNr l o n g, output b o l e a n not zero, processing time int e ger not zero, time date not zero, identifier: query processingNr); entet KNOTUSION (attributes: node visitNr l o n g , time date not zero, length of stay entities if not zero, identifier: node visitNr);

(attributes: aid protocolNr l o n g , date d at e not zero, identifier: aid protocolNr);

(attributes: helptextNr l o n g, event char(50) not zero, helptext char(2000) not zero, identifier: helptextNr);

(participants: (HILFEPROTOKOLL, (1,1)), and (participants: (HILFEPROTOKOLL, (1,1)), and (participants: (HILFEPROTOKOLL, (1,1)), and (participants: (HILFEPROTOKOLL, (1,1)), and (participants: (HILFEPROTOKOLL, (1,1)), and (participants: (HILFEPROTOKOLL, (1,1)), and (participants: (HILFEPROTOKOLL, (1,1)), and (participants: (HILFEPROTOKOLL,

This appropriation is intended to cover:

This appropriation is intended to cover expenditure on technical assistance for the implementation of the programme, including expenditure on technical assistance for the implementation of the programme, including expenditure on technical assistance for the implementation of the programme, including expenditure on technical assistance for the implementation of the programme, including expenditure on technical assistance for the implementation of the programme.

This appropriation is intended to cover expenditure on technical assistance for the implementation of the programme.

The following information shall be provided in accordance with the provisions of this Regulation:

3.5.7 Question model

The questionnaire model (see Figure 21) describes questions and the corresponding types of answers.

Difficulty level -difficulty levelNr -name Question -delimitation -questionNr -question text -date of creation Question_Difficulty level -image -max Response time

Answer type -response typeNr -name question_question category question_response -advantages -disadvantages

Question category Answer_Answer type 1 .* -Question categoryNr -name Answer -description -responseNr -comment

AnswerImage labelling -label number AnswerMC -correct_response -response -correctness

Answer Location text -correct_response -number of locations Answer sort -type -position Answer Selection -concept_icon -response -correctness

AnswerMatching AnswerAlternative -concept_a -true_response -concept_b -false_response An object of the type QRAGE has the attributes date of creation, query text, image (reference to an image possibly associated with the question) and max Response time (maximum response time). Each question includes at least one answer (object type ANTWORT) exactly one of the following types of answers (see also Chapter 4.2):

• Free entry (FREE to ANSWER)

• Alternative answers (ANTWORTALTERNATIVE)

• Selection menu (Answer selection)

• Multiple choice (ANTWORTMC)

• matching (AntWORTMATCHING)

• image description (response image description)

• arranging terms/icons (RESPONS)

• Gap text (ANTWORTLUECKENTEXT) Each question is also assigned a precise difficulty level (SERVITY STUDY), a precise question category (QUESTION CATEGORY) and a precise answer type (ANTWORTTYP).

Through the eight different types of responses supported by the system, authors are given the opportunity to create knowledge-control questions and questions to support case studies that are specific to their specific needs.

In addition to this, it is important to note that the Commission's proposal for a regulation does not preclude the adoption of the regulation.

Question text: 2000) not zero, date of creation d at e not zero, image: 50), maximum response time i n t e r , identifier: questionNr;

entityset ANTWORTTYP (attributes: reply typeNr l o n g ,

name char(30) not zero, advantages char(2000) not zero, disadvantages char(2000) not zero, identifier: answer typeNr);

(attributes: difficulty levelNr l o n g, name char(30) not zero,

In addition to the above, the following definitions are used: (i) the following definitions are used: (ii) the following definitions are used: (ii) the following definitions are used: (iv) the following definitions are used: (iv) the following definitions are used: (iv) the following definitions are used: (iv) the following definitions are used: (iv) the following definitions are used: (iv) the following definitions are used: (iv) the definitions are used: (iv) the definitions are used: (iv) the definitions are used: (iv) the definitions are used: (iv) the definitions are used: (iv) the definitions are used: (iv) the definitions are used: (iv) the definitions are used: (iv) the definitions are used: (iv) the definitions are used: (iv) the definitions are used: (iv) the definitions are used: (iv) the definitions are used: (iv) the definitions are used: (iv) the definitions are used: (iv) the definitions are used: (iv) the definitions are used: (iv) the definitions are used: (iv) the definitions are used: (iv) the definitions are used: (iv) the definitions are used: (iv) the definitions are used: (iv) the definitions are used: (iv) the definitions are used: (iv) the definitions are used: (iv) the definitions are used: (iv) the definitions are used: (iv) the definitions are used: (iv) the definitions are (iv) the definitions are used: (iv) the definitions are (iv) the definitions are (iv) the definitions are (iv) the definitions are (iv) the definitions are (iv) the definitions are (iv) the definitions are (iv) the definitions are (iv) the definitions are (iv) and (iv) the definitions are (iv) the definitions are (iv) the definitions are (iv) the definitions are (iv) the definitions are (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv

entityset ANTWORTALTERNATIV (subset of ANTWORT, attributes: correct_response ch ar(200) not zero false_response ch ar(200) not zero)

(participants: (ANTWORT, (1,1)), (ANTWORTTYP, (0,n))

(participants: (Question, (1,1)), (Question, (0,n))

In addition to this, it is important to note that the information provided by the competent authorities in the Member State in which they are located should be kept up-to-date.

This appropriation is intended to cover expenditure relating to the implementation of the programme.

Only one type of answer is permitted per question: (∀f,a1,a2) (FRAGE(f) f[ANTWORT(a1)] f[ANTWORT(a2)) ¬(a1==a2) → ( aat1, at1) (ANTWORT_ANTWORTTYP(at1) ANTWORTTYP(at1) aat1:ANTWORT==a1 aat1:ANTWORT_ANTWORYP == at1 TT aat2, at2) (ANTWORT_ANTWORTTYP(aat2) ANTWORTTYP2) 2:==ANTWORT==a2 2:ANTWORT_ANTWORT at2

3.5.8 WBT system model

The WBT system model (see Figure 22) describes which components a CAMPUS teaching/learning system consists of and is related to.Only the interaction forms simulation (case simulation), browsing (systematic textbook knowledge) and drill & practice (questions) have been taken into account.

A WBT system (object type WBT_SYSTEM) is assigned exactly one author (object type AUTOR) and exactly one layout (LAYOUT). On the other hand, an author can create or edit any number of WBT systems and a layout can be used for any number of WBT systems. A WBT system can contain any number of teaching/learning events (FALL) and questions (FRAGE) and must have at least one node (NOTE) attached to its area. Teaching events/learning events and questions are always contained in at least one WBT system and a node is always assigned to at least one WBT system. A WBT system can be used by at least one WBT user, but at least one WBT user can be assigned to any number of WBT users.

WBT_System_Nodes WBT_System_User 1..* WBT_System_Layout

WBT_System WBT_System_Author 1..* -wBT_SystemNr AUTHOR (attributes: autornr lartas o n g, name charnr) -not null, password entityset WBT_SYSTEM (attributes: wBT_SystemNr l o n g, name charn80) not null, date of creation d at e not zero, identifier: wBT_SystemNr); entityset AUTHOR (attributes: autornr lartas o n g, name charn50) -not zero, identification ch(15) not zero, pass h a r (15) not zero, relationship identifier: rUTNr); WBT_SYSTEM_AUTHOR (participation: (0,), (0,), (0,), (1,), (1,), (1,), (1,), (1,), (1,), (1,), (1,), (1,), (1,), (1,), (1,), (1,), (1,), (1,), (1,), (1,), (1,), (1,), (1,), (1,), (1,), (1,), (1,), (1,), (1,), (1,), (1,), (1,), (1,), (1,), (1,), (1,), (1,), (1,), (1,), (1,), (1,), (1,), (1,), (1,), (1,), (1,), (1,), (1,), (1,), (1,), (1,), (1,), (1,), (1,), (1,), (1,), (1,), (1,), (1,), (1,), (1,), (1,), (1,), (1,), (1,), (1,), (1,), (1,), (1,), (1,), (1,), (1,), (1,), (1,), (1,), (1,), (1,), (1,), (1,), (1,), (1,), (1,), (1,), (1,), (1,), (1,), (1,), (1,), (1,), (1,), (1,), (1,), (1,), (1,), (1,), (1,), (1,), (1,), (1,), (1,), (1,), (1,), (1,), (1,), (1,), (1,), (1,), (1,), (1,), (1,), (1,), (1,), (1,), (1,), (1,), (1,), (1,), (1,), (1,), (1,), (1,), (1,), (1,), (1,), (1,), (1,), (1,), (1,), (1,), (1,), (1,), (1,), (1,), (1,), (1,), (1,), (1,), (1,), (1,), (1,), (1,), (1,), (1,), (1,), (1,), (1,), (1,), (1,), (1,), (1,), (1,), (1,), (1,), (1,), (1,), (1,), (1,), (), (), (), (), (), (

4 Implementation

4.1 Tools and basic techniques

The design of the system has focused on the widest possible use of standards. The development environment includes Symantec Café and Symantec Visual Café [SYMANTEC] as well as the JDK (Java Development Kit) from Sun. The implementation of the instructional and learning subsystems is easily possible. The object-oriented programming language Java [GOSLING, YlattIN et al. 97a,b] is used as a programming language. The development environment includes Symantec Café and Symantec Visual Café [SYMANTEC] as well as the JDK (Java Development Kit) from Sun. The implementation of the instructional and learning subsystems 1.1 is used as a full-fledged programming language, which is implemented in JPLUS 1.1 with JPLUS 1.

DBMS CAMPUS (e.g. Oracle RMI registry teaching/learning 7.3) CAMPUS systemclient ICD-10 server

Figure 23: Embedding the CAMPUS teaching and learning subsystems into a standard software environment

Data and knowledge are stored in the relational database management system ORACLE 7.3 [HERRMAN, LENZ et al. 97]. The choice of ORACLE was made because it is reliable and very powerful. In addition, ORACLE is available for a wide variety of different hardware platforms. In addition, an object-relational successor is now available with ORACLE 8. ORACLE 8 offers the ability to provide an object-oriented view of existing relationships. The DBMS can be set to complex objects based on requests. The access of object-oriented programming languages such as Java to the database is simplified.

4.2 Autonomous subsystem

The authors' subsystem enables specialists to create teaching/learning systems in a convenient way. They do not have to have any computer skills and can focus entirely on content and didactic aspects. Implementation was started in a software practice of the medical computer science programme and continued in two dissertations [SINGER 98; PELZER 98] resulting in a prototype, which still needs further development. In the first stage of development of the authors' subsystem, the system components are realised which will be used for the creation of case simulations, for the creation of the CAMPUS lexicon and for the creation of questions.

The categories of evidence listed in Table 5 are available in the author subsystem for the indication of differential diagnostic knowledge.As discussed in Chapter 3.5.3, the indication of differential diagnostic knowledge is not a prerequisite for the functionality of a CAMPUS teaching/learning system.

p3 = secure n3 = closes out of p2 = speaks strongly for n2 = speaks strongly against p1 = speaks strongly against n1 = speaks strongly against

Table 5: Categories of evidence in the CAMPUS system

The CAMPUS lexicon has the following (rough) layout (each with subheadings):

• description of the disease [KNAUP 94]: definition, epidemiology, general information, pathogenesis, etiology, history, symptoms, apparent diagnosis, laboratory, histological findings, differential diagnosis, therapy, course of action, prognosis, prophylaxis

• therapies (description of therapies)

• Anamnese (presentation of various anamnesis techniques and anamnesis questions)

• clinical investigation (explanations on the clinical investigation)

• technical examination (description of technical examination procedures)

• Laboratory analysis (explanations on various laboratory tests) Based on this breakdown, the authors of the subject can provide textbook knowledge. Of course, the authors are free to further refine and supplement the breakdown proposed above.

Authors can comfortably create knowledge control questions and questions to support the processing of teaching/learning cases using the author subsystem.There are a total of eight different types of answers available.Each of these types of answers has characteristic strengths and weaknesses (see Table 6).

Answer type Advantages Disadvantages Free input Learners do not become problematic by answer analysis, as response parameters in their frequently different correct answers

The author must take into account as much as possible of these limitations as possible.

AlternativeOptimal answer type for Only for a very limited number answer questions to which only two of the questions are suitable.

A selection menu suitable for questions to be answered

In addition, it is important to note that the answer to the question can be given in the form of a short answer.

Multiple-choice response settings can be created by specifying responses

It also included longer texts, which made it easier to reply.

Matching well suited to the counteronly for a very limited number of lateral assignment of moving questions.

It is difficult to ask questions (e.g. since an image (possibly only one of the anatomy) must be scanned by the author with help from the authors.

A graphic tool must be equipped with labels.

For a very limited number of searches/icons, work steps, etc. of questions suitable.

It is suitable only for a very limited number of questions.

Table 6: Question/answer types in the CAMPUS system

All questions must be assigned by the authors to one of three levels of difficulty. The difficulty level easily includes basic subjects which every medical student should be able to answer from a particular semester and which do not require a deeper understanding of a field.

For the current state of development of the CAMPUS system, the author can assign questions to a wide variety of situations and objects. For each question, it is necessary to specify explicitly whether it refers to a chapter, subchapter or node in the lexicon, to a specific teaching/learning case or whether it can be used interchangeably.

4.3 Learning subsystem

The learning subsystem provides the user interface of the CAMPUS system for learners and is fully located on the client computer. Before working with CAMPUS, a user must log into the system and select one of the available CAMPUS teaching/learning systems. Users can then decide on the current state of the project, whether to edit case simulations, search for teaching/learning instances, answer questions or read in the CAMPUS lexicon.

Figure 24: Adaptation of the CAMPUS system

The lexicon is a structured (hypertext) textbook for learners. It is typically used to quickly read individual details when processing case simulations or answering questions (e.g. about symptom-diagnosis relationships, the frequency of certain diagnoses or the advantages and disadvantages of certain investigative procedures). Users have access to systematic knowledge at all times. Authors can provide references to specific points in the lexicon at any point in the user's case history, thus guiding users to specific information and thus supporting the systematic processing of cases.

In order to address the problem of free-text input of diagnoses, an ICD-10 server was implemented in a dissertation [RIEDEL 98]. This server allows you to enter diagnoses as free-text and then select the desired diagnosis from the three and four ICD-10s found. The assessment of the diagnoses selected by users is thus much better than it would be possible with a pure free-text input. It can give feedback whether a selected suspicious or working diagnosis is correct, incorrect, overly general or too specific. The ICD-10 server is of course available not only in the learning system but also in the author's system.

Figure 25: Dialogue on the encryption of diagnoses according to ICD-10

4.4 Teaching subsystem

The teaching subsystem generates appropriate feedback on user actions and is responsible for the adaptation of the CAMPUS system to its users. It also ensures the correct case history on the basis of the case history model presented in Chapter 3.4.4. An instance of the LEHRER class is the central object of the CAMPUS teaching subsystem. A teacher (LEHRER class) consists of various objects each responsible for specific tasks, located partly on the CAMPUS teaching/learning system server and partly on the CAMPUS teaching/learning system client.

Assessors Assessors Assessors Assessors Assessors Assessors Assessors Assessors Assessors Assessors Assessors Assessors Assessors Assessors Assessors Assessors Assessors Assessors Assessors Assessors Assessors Assessors Assessors Assessors Assessors Assessors Assessors Assessors Assessors Assessors Assessors Assessors Assessors Assessors Assessors Assessors Assessors Assessors Assessors Assessors Assessors Assessors Assessors Assessors Assessors Assessors Assessors Assessors Assessors Assessors Assessors Assessors Assessors Assessors Assessors Assessors Assessors Assessors Assessors Assessors Assessors Assessors Assessors Assessors Assessors Assessors Assessors Assessors Assessors Assessors Assessors Assessors Assessors Assessors Assessors Assessors Assessors Assessors Assessors Assessors Assessors Assessors Assessors Assessors Assessors Assessors Assessors Assessors Assessors Assessors Assessors Assessors Assessors Assessors Assessors Assessors Assessors Assessors Assessors Assessors Assessors Assessors Assessors Assessors Assessors Assessors Assessors Assessors Assessors Assessors Assessors Assessors Assessors Assessors Assessors Assessors Assessors Assessors Assessors Assessors Assessors Assessors Assessors Assessors Assessors Assessors Assessors Assessors Assessors Assessors Assessors Assessors Assessors Assessors Assessors Assessors Assessors Assessors Assessors Assessors Assessors Assessors Assessors Assessors Assessors Assessors Assessors Assessors Assessors Assessors Assessors Assessors Assessors Assessors Assessors Assessors Assessors Assessors Assessors Assessors Assessors Assessors Assessors Assessors Assessors Assessors Assessors Assessors Assessors Assessors Ass

Rueckmelder -cAnamnese Help Selector -cAnamnese types +helpTests (long nId, string event) -cAnamnese questions +helpprocessing (long nId, string event) -cAnamnese replies +helpsearching (long nId, string event) -cDiagnostics +helptextsLoading () -cTherapy principles -cClinical description -cPrognose +getFall () +getAnamnese () +helpprocessing (long nId, string event) +helpprocessing (long nId, string event) -cAnamnese replies +helpprocessing (long nId, string event) -cAnamnese replies (long nId, string event) +helpprocessing (long nId, string event) +helpprocessing (long nId, string event)

The help selector selects the associated help texts for specific events and transmits them to the client. In addition, it logs each display of a help text at the start of the CAMPUS instructional system. The criteria by which the selected Selectors are selected are based on the characteristics contained in an object of the SELECTORSTRATEGIE type (see also Chapter 3.4.3). These are derived from a parameterizable file which is read at the start of the CAMPUS instructional system server and can be modified by the authors. All other objects of the instructional system (see Figure 26) are located on the client.

If a required question has not yet been forwarded prospectively to the teaching/learning system client, the questioner requests an appropriate question from the query selector on the server. The presenter (PRAESENTATOR) is responsible for the presentation of a teaching/learning according to the preset class/interaction form set. In the case of user actions, the respondent (RUECKMELDER) is responsible for giving an immediate forward-looking response, in addition to the current retrospective response of the user (RUECKMELDER) is required to start registering in the NZN system (NZN) in the case of user actions (RUECKMELDER) without affecting the time of the user's activity.

The logging of all user activities is taken over by an object of the type PROTOKOLLIER. It displays in its window all the actions carried out by the user. This gives users a better overview of the course of a case simulation. Figure 26 shows for reasons of clarity not all the features and methods present in each class. For a more detailed description, refer to the software development documentation on CAMPUS.

4.5 CAMPUS/paediatrics and CAMPUS/infectiology

In order to test the concepts developed in this work, teaching/learning systems for paediatrics (CAMPUS/paediatrics) and infectiology (CAMPUS/infectiology) are being developed.

The prototype CAMPUS teaching/learning system server currently comprises about 5000 lines of code and is made up of instances of 20 different classes that have about 120 methods.The CAMPUS ICD-10 server consists of about 1400 lines of code (10 classes).The code of the CAMPUS teaching/learning systemclient has a scope of

The client is made up of instances of about 160 classes (of which about 70 are

The client classes have about 250 methods plus about 220 methods of the caching layer. If the implementation is based on a remote data & knowledge architecture instead of a distributed teaching architecture, the size of the client increases from 14000 to about 20400 lines of code, i.e. in this case, about 45% more code would have to be transmitted over the network. This would also increase the waiting time for the system to load by 45%.

CAMPUS/Pediatrics is developed in cooperation with the Heidelberg University Children's Clinic Part 1 and Part 2 (OA PD Dr. B. Tönshoff) and the University Children's Clinic in Freiburg (OA PD Dr. Zimmerhackl).The aim of the project is to provide paediatric teaching/learning experiences, learning experiences and textbook knowledge.The use of the system is planned in Heidelberg as part of the Heidelberg University Pediatrics Practice Part 1 and Part 2.CAMPUS/Infectiology is developed in collaboration with the Heidelberg University Institute of Hygiene (Prof. Dr. H.K.USUSUS).

Figure 27: Search for teaching/learning events in CAMPUS

5 Summary and discussion

The focus of research in the field of computer-based training in medicine has shifted in recent years towards internet-based teaching/learning systems.A number of very interesting and innovative applications have emerged in the course of research (e.g. [BITTORF, BAUER et al. 97; HAYES, LEHMANN 96; THE WHOLE BRAIN ATLAS]).However, the possibilities of the Internet and its building applications and standards are far from being exhausted so far [FRIEDMAN 96].

The aim of this work was to create an innovative concept for the implementation of the teaching/learning systems used in medical education and training and its prototypical implementation.

Question 1.1: What conceptual characteristics must a teaching/learning system have?

to solve the problems described in Chapter 1.2 of conventional CBTS systems?

The classical problems of conventional CBT systems (platform dependence, need for installation, complex update) are solved by choosing an internet-based approach using WWW standards and the programming language Java. On the user side, all that is required is Internet access and an installed WWW browser with JDK 1.1 support. Another problem addressed in Chapter 1.2 is that students are left alone when self-study with conventional CBT systems, when they cannot solve questions with the knowledge available in a teacher/learning system, is outsourced by a conventional WWW approach.

The lack of adaptation of the system to the user or the adaptability of the system by the user in many existing teaching/learning systems was also taken into account in the concept. Adaptation of the presentation/interaction forms in case simulations, the difficulty level of questions and teaching/learning instances, the re-logging point of user actions and system assistance is automatic. The individual parameters can be adapted at any time by the users themselves. The user's dissatisfaction with a model or inadequate system adaptation performance can be prevented by doing so. The major problem of the lack of usability of teaching/learning content and demographic/learning functionality in many systems is that the system can be adapted to the needs of the user. The system is designed to facilitate the re-use of object-oriented programming/learning and thus the system has been made easier to use.

In this context, the presence of an intuitive authoring system is of particular importance. The Shell approach can also address the last problem discussed in Chapter 1.2, which is the critical attitude of many lecturers towards CBT systems not developed by them. Lecturers can create their systems that meet precisely their personal requirements, relying on existing content and the functionality of Shell.

Question 1.2:How can students make more frequent use of teaching/learning systems?

In order for students to use CBT systems, two conditions must be met: they must be convinced that they will benefit from the use of such systems in their exams and that they must be able to use such systems without great organizational difficulties. Ideally, the use of CBTS systems should be embedded in the curriculum and students should be able to use such systems on their own computer at home.

Question 1.3:How can the acceptance of teaching/learning systems by medical teachers be improved?

Self-developed CBT systems, or systems in which lecturers were actively involved in the creation, have a significantly higher acceptance of commercial products. Unfortunately, the development of complete teaching/learning systems is very complex and expensive.

Question 1.4:How can teachers be encouraged to use CBT systems more effectively in their lessons and to recommend that their students work with CBT systems?

A change in the current approval rules could ensure that students have more time for self-study, and teachers would then be able to give their students stronger self-study recommendations in the courses, including through teaching/learning systems. However, such a change is not expected at the moment, although all parties agree that medical education is in dire need of reform.

In any case, teaching/learning systems need to be much more widely available than they have been in the past. The approach presented in this paper makes teaching/learning systems available on a wide range of connected computers, even for students and lecturers at home. The proposed teaching/learning system shell has an internet-based, platform-independent author subsystem, allowing lecturers to develop their own teaching/learning systems comfortably in their own workplace.

Question 1.5:To what extent can the concept be kept independent of the field?

The concept has been largely subject-independent. The CAMPUSLexikon allows individual lecturers to present domain knowledge according to their own wishes and according to the specific requirements of a subject area. The question model developed enables the creation of questions for any subject area. In the normal subject area model, the requirements of different subject areas have been taken into account by allowing the classification of annotation questions for each subject area. If necessary, individual laboratory tests or technical examination procedures can also be assigned to the subject area. The normal subject area model is therefore largely independent of the subject area. The case model is in its basic structure (a teaching/learning case consists of an annotation, clinical examination, technical examination for the most important areas of the subject area, etc.) It is also possible to classify individual subject areas of the subject area.

The CAMPUS system is currently in the prototype stage. A demo version of the teaching and learning subsystem is available at the URL http://www.hyg.uni-heidelberg.de/campus. Participating in the national research project VIROR ensures that further development is ensured for three years and that a thorough evaluation can be prepared and carried out. A final evaluation of the concepts can only be made after the system has been evaluated through systematic evaluation with the support of medical users and medical students. Particular attention is given to the further development of the CAMPUS system. Finally, the CAMPUS subsystem can be used by active users of the CAMPUS system to achieve a high degree of user-friendliness, only if it is possible to make a comparison with the CAMPUS system without the use of the CAMPUS system.

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It is also important to note that, for the purposes of this Directive, it is necessary to ensure that users are able to communicate effectively with each other and to communicate effectively with each other.

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In addition, it is important to be aware of the importance of the use of radiology in the healthcare system and to be aware of the importance of the use of radiology in the healthcare system.

VENTER, H.: EBNF. http://www.cs.upe.ac.za/slim/ebnf.html. VIROR. Joint project VIROR: Virtual University of the Upper Rhine.

It is also important to note that the Commission's proposal for a regulation of the European Parliament and of the Council is based on the principle of proportionality.

Annex to this Regulation

I Symbols and Notation

The following typefaces (sometimes in combination) are used in the work:

Figures fat f(x) Data types s p e r r t d a t e quantities underlined M object types GROUP BOOKS QUESTION Types .21785 $77 Variables in italics Date of creation

The following operators shall be used:

logical AND logical OR NOT ⇒Implication equivalence existential quantity ∀All quantity ∈... is an element of ... particle quantity unit quantity A → B

II Logical model

The three-level model for data modelling presented in Chapter 2.9 provides for the creation of the logical model after the conceptual model has been created (see Chapter 3.5) which takes into account the use of a relational DBMS and combines the conceptual models into a single logical model for reasons of faster and more efficient access and simpler implementation and maintainability.

The cardinality data defined in the conceptual modelling must of course also be fulfilled in the logical model, since compliance with these integrity conditions (level 2) is monitored by the author subsystem and no specification is made in the DBMS, a specification of the cardinality in the logical model is omitted.

The logical model is presented below. For simpler understanding, comments on all attributes are given. The formal description is made using the formalism presented in Chapter 2.10.1.

) Primary key

(b1fg,1(x) = truth : PS(Faculty#, x), sib1fg,2(x) = truth : nf({Faculty_Name}, x), sib2fg,1(v) = truth : FS(((FACulty#), (FACulty#),

AUTHOR: 5(/(({author#, author_name, ID, password} ➡️{sib1aut,1, sib1aut,2}), with author#: $77(l o ng ➡️) Primary key Author_name: $77(char(50) ➡️) Full name of the author ID: $77(char15) ➡️ User ID Author password: $77(ch ar15) ➡️ Password of the author

(b1aut,1(x) = truth : PS(author#, x), sib1aut,2(x) = truth : nf({author_name, identification, password}, x).

LAYOUT: 5 (/(({Layout#, header, footer, background color} Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga Kga

Page 1 (x) = truth : PS: layout#, x), sib1lay,2(x) = truth : nf1({headline, footline, background colour}, x).

WBT_SYSTEM: 5(/(({WBT_System#, layout#, author#, WBT_System_Name, date of creation} 🔴 {sib1ws,1, sib1ws,2, sib2ws,1, sib2ws,2}), with WBT_System#: $77(lo n g ) Primary key layout#: $77(l o ng ) Foreign key Author#: $77l o ng ) Foreign key WBT_System_Name: $77((80 ) Name of the WBT_System Date of creation: $77 e ) Foreign key Author#: $77l o ng ) Foreign key WBT_System_Name: $77(80 )

(b1ws,1(x) = truth: PS(WBT_System#, x), sib1ws,2(x) = truth: nf({Layout#, author#, WBT_System_Name, date of creation}, x), sib2ws,1(v) = truth: FS(((WBT_SYSTEM, layout#), (LAYOUT, layout#) , v), sib2ws,2(v) = truth: FS(((WBT_SYSTEM, author#), (AUTOR, author#), v).

WBT_SYSTEM_FACHGEBIET: 5(/({WBT_System_Specialist#, WBT_System#, specialist#} {sib1wsfg,1, sib1wsfg,2, sib2wsfg,1, sib2wsfg,2}), with WBT_System_Specialist#: $77(l o n g ) Primary key WBT_System#: $77lo n g ) Foreign key specialist: $77(lo n g ) Foreign key

(b) (b) (x) = (b) (b) (x) = (b) (x) = (b) (x) = (b) (x) = (b) (x) = (c) = (c) = (d) = (f) = (f) = (f) = (f) = (f) = (f) = (f) = (f) = (f) = (f) = (f) = (f) = (f) = (f) = (f) = (f) = (f) = (f) = (f) = (f) = (f) = (f) = (f) = (f) = (f) = (f) = (f) = (f) = (f) = (f) = (f) = (f) = (f) = (f) = (f) = (f) = (f) = (f) = (f) = (f) = (f) = (f) = (f) = (f) = (f) = (f) = (f) = (f) = (f) = (f) = (f) = (f)

(WBT_SYSTEM, WBT_System#), x), sib2wsfg,2(v) = true: FS: FS: WBT_SYSTEM_FACHGEBIET, field of expertise#), (FACHGE- 5(/{Patient#, gender, surname, surname, age, weight, height, image, description, difficulty level, introduction text, summary, start date, with sibent#: FS: FS: Description Key gender: $77 Gender: Gender: Gender: Gender:

FALL_FACT: 5 (/) {FALL_FACT: Patient: $77 (l o n g ) Foreign key: $77 (l o n g ) Foreign key: $77 (l o n g ) Foreign key: $77 (l o n g ) Foreign key: $77 (l o n g ) Foreign key: $77 (l o n g ) Foreign key

If the patient is not present at the clinical examination, the patient must be able to obtain the following information: (FALL, patient, v), (FALL, patient, v), (FALL, v), (FALL, v), (FALL, v) = (FALL, v) = (FALL, v) = (FALL, v) = (FALL, v) = (FALL, v) = (FALL, v) = (FALL, v) = (FALL, v) = (FALL, v) = (FALL, v) = (FALL, v) = (FALL, v) = (FALL, v) = (FALL, v) = (FALL, v) = (FALL, v) = (FALL, v) = (FALL, v) = (FALL, v) = (FALL, v) = (FALL, v) = (FALL, v) = (FALL, v) = (FALL, v) = (FALL, v) = (FALL, v) = (FALL, v) = (FALL, v) = (FALL, v) = (FALL, v) = (FALL, v) = (FALL, v) = (FALL, v) = (FALL, v) = (FALL, v) = (FALL, v) = (FALL, v) = (FALL, v) = (FALL, v) = (Fall, v) = (Fall, v) = (Fall, v) = (Fall, v) = (Fall, v) = (Fall, v) = (Fall, v) = (Fall, v) = (Fall, v) = (Fall, v) = (Fall, v) = (Fall, v) = (Fall, v) = (Fall, v) = (Fall, v) = (Fall, v. (Fall, v. (Fall, v. (Fall, v.Fall, v.Fall, v.Fall, v.Fall, v.Fall, v.Fall, v.Fall, v.Fall, v.Fall, v.Fall, v.

Anonymous: 5 (/(({names#, patient#, date, summary}  {sib1a,1, sib1a,2, sib2a,1}), with a history#: $77 ((lo n g ) Primary key Patient#: $77 ((l o ng ) External key Date: $77 ((date ) Date of anamnesis execution summary: $77 (((char 200 0)) ) Summary of the entire history

(b1a,1(x) = true: PS(Anamnese#, x), sib1a,2(x) = true:nf({Patient#, date}, x), sib2a,1(v) = true: FS(((ANAMNESE, Patient#), (FALL, Patient#), v).

Clinical Investigation: $77 (Primary Key) Patient: $77 (French Key) Date: $77 (French Key) Date: $77 (French Key) Date: $77 (French Key) Date: $77 (French Key) Date: $77 (French Key)

This is a summary of the entire history.

In the case of clinical trials, the results of the clinical trials are given in the following sections: (i) (i), (ii) (ii) (ii) (iii) (iii) (iii) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv)

Technical examination: 5*/* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * *

Technical research procedures, co-operation area, research and development

I'm going to have to do this. I'm going to have to do this again. I'm going to have to do this again. I'm going to have to do this again. I'm going to have to do this again. I'm going to have to do this again. I'm going to have to do this again.

With technical research#: $77 (lo n g ) Primary key Patient#: $77 (l o ng ) Foreign key TechnForm#: $77 (l o n g ) Foreign key $77 (lo n g ) Foreign key Techn Investigation#: Business region#: $77 (l o n g ) Foreign key Findings_Text: $77 (l o n g ) ) Text of the findings_Image_Video: $77 (l o n g ) ) Date of image or video request_D: $77 (l o n g ) Date of completion of the technology.

Exam findings date: $77 date ) Date on which the result

It's usually delivered: $77 (about a n) Test results are normal? Necessary: $77 (about a n) Test requirements are necessary?

Comment: $77.000 Comment on the investigation

What's the lead symptom? What's the lead symptom?

(b1tu,1(x) = truth: PS(Technical examination#, x), sib1tu,2(x) = truth: nf({Patient#, TechnForm#, TechnInvestigation methods#,

In addition, it is important to note that, for the purposes of this Regulation, the following conditions are fulfilled: (i) (i) (i) (i) (ii) (ii) (ii) (ii) (ii) (iii) (iii) (iii) (iii) (iii) (iv) (iii) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (

Formal,technicalForm#), v), sib2tu,3(v) = truth: FS

(TECHNOLOGICAL CONSERVATION: 5*), (TECHNOLOGICAL CONSERVATION: 5*), (TECHNOLOGICAL CONSERVATION: 5*), (TECHNOLOGICAL CONSERVATION: 5*), (TECHNOLOGICAL CONSERVATION: 4*), (TECHNOLOGICAL CONSERVATION: 5*), (TECHNOLOGICAL CONSERVATION: 5*), (TECHNOLOGICAL CONSERVATION: 5*), (TECHNOLOGICAL CONSERVATION: 5*), (TECHNOLOGICAL CONSERVATION: 5*), (TECHNOLOGICAL CONSERVATION: 5*), (TECHNOLOGICAL CONSERVATION: 5*), (TECHNOLOGICAL CONSERVATION: 5*), (TECHNOLOGICAL CONSERVATION: 5*), (TECHNOLOGICAL CONSERVATION: 5*), (TECHNOLOGICAL CONSERVATION: 5*), (TECHNOLOGICAL CONSERVATION: 7*), (TECHNOLOGICAL CONSERVATION: 7*), (TECHNOLOGICAL CONSERVATION: 7*), (T) (TECHNOLOGICAL CONSERVATION: 7*), (T) (TECHNOLOGICAL CONSERVATION: 7*), (T) (Tended with the first key) and (Tended by the first day of the first day of the day of the day of the day of the day of the day of the day of the day of the day of the day of the day of the day of the day of the day of the day of the day of the day of the day of the day of the day of the day of the day of the day of the day, the day of the day of the day of the day of the day of the day of the day of the day of the day of the day of the day of the day of the day of the day of the day of the day of the day of the day of the

$77(l o ng )French key lab test#: $77(lo n g )French key result_Text: $77(char(2000) )French key result_Text result_Image_Video: $77(char50) )Path to image or video value: $77(r e al )Fundamental result Normal: $77(bo o l e a n )Lab result normal? Necessary: $77b o o l ean )Test required?

(b2lte,2(v) = truth : FS((LABORTEST, lab test#), (LABORTEST,

Clinical examination results, Clinical examination, the results of the clinical examination, the results of the clinical examination, the results of the clinical examination, the results of the clinical examination, the results of the clinical examination, the results of the clinical examination, the results of the clinical examination, the results of the clinical examination, the results of the clinical examination, the results of the clinical examination, the results of the clinical examination, the results of the clinical examination, the results of the clinical examination, the results of the clinical examination, the results of the clinical examination, the results of the clinical examination, the results of the clinical examination, the results of the clinical examination, the results of the clinical examination, the results of the clinical examination, the results of the clinical examination, the results of the clinical examination,

Clinical research type, co-operative region, result_text,

Results_Picture_Video, Normal, incoming symptom, necessary, comment, lead symptom ➡️ {sib1kue,1, sib1kue,2, sib2kue,1, sib2kue,2, sib2kue,3}), with $77 ((lo n g ) Primary key ClinicResults#: ClinicResults#: $77 ((l o n g ) Foreign key ClinicResults#: $77 ((l o n g ) Foreign key ClinicResults#: $77 ((lo n g ) Foreign key Correspondence region: $77 ((l o n g ) Foreign key Results_Text: $77 ((2000)) ) Foreign key Results_Text Results_Video_Image: $77 (((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((

Need: $77 ((b o l ean ) Was the investigation necessary? Comment: $77 ((char ((2000)) ) Comment on the investigation finding Lead symptom: $77 ((bool e a n ) Is the investigation lead symptom?

The results of the clinical examination are as follows: (i) the results of the clinical examination, (ii) the results of the clinical examination, (iii) the results of the clinical examination, (iv) the results of the clinical examination, (iv) the results of the clinical examination, (iv) the results of the clinical examination, (iv) the results of the clinical examination, (iv) the results of the clinical examination, (iv) the results of the clinical examination, (iv) the results of the clinical examination, (iv) the results of the clinical examination, (iv) the results of the clinical examination, (iv) the results of the clinical examination, (iv) the results of the clinical examination, (iv) the results of the clinical examination, (iv) the results of the clinical examination, (iv) the results of the clinical examination, (iv) the results of the clinical examination, (iv) the results of the clinical examination, (iv) the results of the clinical examination,

On#, result_text, normal, input symptom, necessary, lead symptom}, x), sib2kue,1(v) = true: FS(((Clinical examination, clinical examination#),

(Clinical examination, clinical examination#), v), sib2kue,2(v) = truth: FS

(c) (c) (c) (c) (c) (c) (c) (c) (c) (c) (c) (c) (c) (c) (c) (c) (d) (c) (d) (d) (d) (d) (d) (d) (d) (d) (d) (e) (d) (d) (e) (e) (e) (e) (e) (e) (e) (e) (e) (e) (e) (e) (e) (e) (e) (e) (e) (e) (e) (e) (e) (e) (e) (e) (e) (e) (e) (e) (e) (e) (e) (e) (e) (e) (e) (e) (e) (e) (e) (e) (e) (e) (e) (e) (e) (e) (e) (e) (e) (e) (e) (e) (e) (e) (e) (e) (e) (e) (e) (e) (e) (e) (e) (e) (e) (e) (e) (e) (e) (e) (e) (e) (e) (e) (e) (e) (e) (e) (e) (e) (e) (e) (f) (f) (f) (e) (e) (f) (e) (f) (f) (f) (f) (f) (f) (f) (f) (f) (f) (f) (f) (f) (f) (f) (f) (f) (f) (f) (f) (f) (f) (f) (f) (f) (f) (f) (f) (f) (f) (f) (f) (f) (f) (f) (f) (f) (f) (f) (f) (f) (f) (f) (f) (f) (f) (f) (f) (f) (f) (f) (

I'm going to tell you what I'm going to do.

Patient response, normal, incoming symptom, necessary, comment, lead symptom }♪ (sib1aa,1, sib1aa,2, sib2aa,1, sib2aa,2, sib2aa,2}), with medical history response#: $77(l o n g ) Primary key Medical history #: $77 ((lo n g ) Foreign key Medical history question#: $77 ((lon g g ) Foreign key Medical history response: $77 ((char 20 0 0)) ) Patient response: $77 ((bo o l e a n g ) Patient response inconspicuous?

Coming in symptom: $77 Become a symptom from the patient

It's necessary: $77 (b o l e an ) Name question needed? Comment: $77 (char) 2000 ) Comment on patient response Key symptom: $77 (bool e a n ) Patient response Key symptom?

(b1aa,1(x) = true: PS(name answer#, x), sib1aa,2(x) = true: nf({namnese#, history question#, patient answer, normal,

Input symptom, necessary, lead symptom}, x), sib2aa,1(v) = true : FS(((ANAMNESENTWORD, Anamnese#), (ANAMNESE, Anam-

In addition, it is important to note that the Commission's proposal for a regulation of the European Parliament and of the Council is based on the principle of proportionality.

This is the first time that I've been able to answer this question. I've been able to answer this question for a long time.

(b1af,1(x) = truth : PS(name question#, x), sib1af,2(x) = truth : nf({name type#, question text}, x), sib2af,1(v) = truth : FS((ANAMNESEFRAGE, anamnesetyp#), (ANAMNESETYP,

I'm not sure if I'm going to be able to do that, but I'm sure I'm going to be able to do that.

$77 (lo n g ) Primary key History question_Professional question#: History question#: $77 (lo n g ) Foreign key

(b1aff,1(x) = truth : PS(laboratory examination#, x), sib1aff,2(x) = truth : nf({name question#, field of expertise#, x), sib2aff,1(v) = truth : FS((ANAMNESEFRAGE_FACHGEBIET, history question#),

(ANAMNESEFRAGE, ANAMNESETYPE_NAME#), v), sib2aff,2(v) = truth: FS(((ANAMNESEFRAGE_FACHGEBIET, field of expertise#), ANAMNESETYP: 5(/({namesetyp#, anamnesetyp_Name} ↓ {sib1at,1, sib1at,2}), with anamnesetyp#: $77(lon g ) Primary key Anamnesetyp_Name: $77((char30) ↓ ) Names of anamnesetyp1at,1x) = truth PS Laboratory examination#, x), sib1at,2x:

CLINICAL TEST CARD: 5(/({clinical examination type, clinical examination type_Name} ▷ {sib1kua,1, sib1kua,2}), with clinical examination type#: $77(lo n g ) Primary key $77(char30) ▷ ) Name of clinical examination Type_Name: chungs type: sib1kua,,1x) = truth PS(clinical examination type, x), nf1kua,,2x) = truth :{clinical examination type_Name}, x).

In addition, it is important to note that the Commission's proposal for a regulation of the European Parliament and of the Council is based on the principle of proportionality.

$77 (lo n g ) Primary keys Techn Investigative procedure#: $77 (char) 30) ) Name of the technical examination procedure_Name: Ch procedure Strength: $77 (ch a r) ) Strengths of a technical examination procedure Slumps: $77 (char) 20 (char) ) Weaknesses of a technical examination procedure

(b1tuv,1(x) = truth: PS(Technical investigation procedure#, x), sib1tuv,2(x) = truth: nf({Tresearch procedure_Name}, x).

LABORTEST: 5(/({Labortest#, Labortest_Name, Labortest_Shortcut, Unit} ➡️ {sib1lt,1, sib1lt,2}), with Labortest#: $77(lo n g ) Primary key Labortest_Name: $77(char(50)) ) Labortest_Name Labortest_Shortcut: $77(char20) ) Labortest unit shortcut: $77(char10) ) Unit of test result

(b1lt,1(x) = truth : PS(Labor test#, x), sib1lt,2(x) = truth : nf({Labor test_name, unit}, x).

LABORATORY FORM: 5 (/) {LABORATORY FORM: 5} {LABORATORY FORM: 5} {LABORATORY FORM: 5} {LABORATORY FORM: 5} {LABORATORY FORM: 5} {LABORATORY FORM: 5} {LABORATORY FORM: 5} {LABORATORY FORM: 5} {LABORATORY FORM: 5} {LABORATORY FORM: 5} {LABORATORY FORM: 5} {LABORATORY FORM: 5} {LABORATORY FORM: 5} {LABORATORY FORM: 5} {LABORATORY FORM: 5} {LABORATORY FORM: 5} {LABORATORY FORM: 4} {LABORATOR: 5} {LABORATOR: 5} {LABORATOR: 5} {LABORATOR: 5} {LABORATOR: 5} {LABORATOR: 5} {LABORATOR: 5} {LABOR: 5} {LABORATOR: 5} {LABORATOR: 5} } } {LABOR: $7} {LABOR: $7} {LABORATOR: $7} {LABOR: $7} {LABOR: $7} {0} {0} {0} {0} {0} {0} {0} {0} {0} {0} {0} {0} {0} {0} {0} {0} {0} {0} {0} {0} {0} {0} {0} {0} {0} {0} {0} {0} {0} {0} {0} {0} {0} {0} {0} {0} {0} {0} {0} {0} {0} {0} {0} {0} {0} {0} {0} {0} {0} {0} {0} {0} {0} {0}

(b1lf,1(x) = true : PS(Lab form#, x), sib1lf,2(x) = true : nf({date of creation, type of form, number of columns}, x).

I'm not sure if I'm going to be able to do that.

with TechnForm#: $77(l o n g ) Primary key Date of creation: $77 ((that e ) Date of creation of the techn. Form head: $77 ((char)) ) Form head Background color: $77 ((char 15) ) Form background color: $77 ((char0) ) Form headline: $77 ((char0)

(b1tf,1(x) = true : PS(Technical form#, x), sib1tf,2(x) = true : nf({date of creation, form writing}, x).

LABORF_TEILFORM: 5 (/) {Labor_subform#, lab form#, lab form#, subform#, column position, sequence position} {sib1lftf,1, sib1lftf,2, sib2lftf,1, sib2lftf,2}), with lab_subform#: $77 ((l n g ) Primary key lab form#: $77 ((l n g ) Front key subform#: $77 ((l n g ) Front key column position: $77 (i n t r ) Number of column position: $77 in sequence ) Sequences in columns

(b1lftf,1(x) = truth: PS(lab_subform#, x), sib1lftf,2(x) = truth: nf({lab form#, subform#, column position, rowfollow

In addition to the above, it is important to note that the Commission's proposal for a regulation of the European Parliament and of the Council is based on the principle of proportionality.

LAR, lab form#), v), sib2lftf,2(v) = truth: FS(((LABORF_TEILFORM, subform#), (TEILFORMAR, TEILFORMAR: 5(/({TEILFORM#, subtitle} {sib1tef, sib1tef,2}), with sub-form#: $77l o n g ) Primary key subtitle: $77(((ch ar50) ) Title of sub-form sib1tef,1 (x) = truth: PS Sub-form#, x), sib1tef,2 (x) = truth

Part-key part-key part-key part-key part-key part-key part-key part-key part-key part-key part-key part-key part-key part-key part-key part-key part-key part-key part-key part-key part-key part-key part-key part-key part-key part-key part-key part-key part-key part-key part-key part-key part-key part-key part-key part-key part-key part-key part-key part-key part-key part-key part-key part-key part-key part-key part-key part-key part-key part-key part-key part-key part-key part-key part-key part-key part-key part-key part-key part-key part-key part-key part-key

In addition, it is important to note that, for the purposes of this Regulation, the Commission has to take the necessary measures to ensure that the results of the work carried out by the Member States are consistent with the objectives of this Regulation.

For the purposes of this Regulation, the following definitions shall apply:

ProBENART: 5(/({sample type#, sample type_name, collection point} ➡️ {sib1pa,1, sib1pa,2}), with sample type#: $77(l o n g ➡️) Primary key sample type_name: $77(ch ar(50) ➡️ ) Name of sample type collection point: $77 ((ch a r (5 0) ➡️

(b1pa,1(x) = true: PS(Probenart#, x), sib1pa,2(x) = true: nf({Probenart_Name}, x).

COERPERREGION: 5(/({coerperregion#, coerperregion_name, description,

Image, inspection, palpation, exculpation, percussion, tuner search }♪ (sib1kr,1, sib1kr,2}), with corporeal region#: $77(l o n g ) Primary key corporeal region_Name: $77(ch a r (5 0) ) Name of sample type Description: $77(ch a r (5 0) ) Description Image: $77(char50) ) Reference to image of the body re-

Can you inspect a body region?

Palpation: $77 can the body region be palpation: $77 can the body region be palpation: $77 can the body region be palpation: $77 can the body region be palpation: $77 can the body region be palpation: $77 can the body region be palpation: $77 can the body region be palpation: $77 can the body region be palpation: $77 can the body region be palpation: $77 can the body region be palpation: $77 can the body region be palpation: $77 can the body region be palpation:

Percussion: $77. Can you percut the body region?

Can you do a technical examination on the body region?

(b1kr,1(x) = truth: PS(Coerperregion#, x), sib1kr,2(x) = truth: nf({Coerperregion_Name, inspection, palpation, excavation,

ALTERSSTUFE: 5 ((/((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((

(b1as,1(x) = true PS(Age#, x), sib1as,2(x) = true : nf({Age_Name, From, Until}, x), sib1as,3(x) = true : ∀ a ∈ x: a {From} < a {Until }.

LABORNORMALBEFUND: 5(((({LaborNormal finding, Lab test, Sample type, Gender, Find_Text, Min, Max} {sib1lnb,1, sib1lnb,2, sib1lnb,3, sib1lnb,4, sib2lnb,1, sib2lnb,2}), with Lab Normal finding#: $77(lo n g ) Primary key Lab test#: $77 ((lo n g ) Foreign key Sample type: $77 (((l o n g ) Foreign key Gender: $77 (((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((

Rich Max: $77

sib1lnb,1(x) = PS

(ALTERSSTUFE, CLINNORMALBEFUND: 5(((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((

(b2knb,2(v) = truth: FS(((KLINNORMALFUND, co-operative region#)

(b) (b) (c) (c) (f) (f) (f) (f) (f) (f) (f) (f) (f) (f) (f) (f) (f) (f) (f) (f) (f) (f) (f) (f) (f) (f) (f) (f) (f) (f) (f) (f) (f) (f) (f) (f) (f) (f) (f) (f) (f) (f) (f) (f) (f) (f) (f) (f) (f) (f) (f) (f) (f) (f) (f) (f) (f) (f) (f) (f) (f) (f) (f) (f) (f) (f) (f) (f) (f) (f) (f) (f) (f) (f) (f) (f) (f) (f) (f) (f) (f) (f) (f) (f) (f) (f) (f) (f) (f) (f)

The following is a list of questions which have been asked by the Commission.

It's the first time I've ever been in a relationship with a woman.

$77 (lo n g ) Primary keys History Normal answer #: History question #: $77 (lo n g ) Foreign key Cooperation region #: $77 (lo n g ) Foreign key Age level #: $77 (lo n g ) Foreign key Gender: $77 (char) ) Gender irrefutable

sib1anno,1(x) = truth: PSname Normal answer#, x), sib1anno,2(x) = truth: nf({name question#, age group#, gender,

In addition to the above, it is important to note that the Commission's proposal for a regulation of the European Parliament and of the Council is based on the principle of proportionality.

(NAME QUESTION, NAME QUESTION#), v), sib2anno,2(v) = truth: FS((NAME NORMALWORD, co-operative region#),

ERPERREGION, Coerperregion#), v), sib2anno,3(v) = truth : FS(((NORMAL WORD, age level#), (ALTERS)

CLINICAL CLINICAL CLICAL CLICAL CLICAL CLICAL CLICAL CLICAL CLICAL CLICAL CLICAL CLICAL CLICAL CLICAL CLICAL CLICAL CLICAL CLICAL CLICAL CLICAL CLICAL CLICAL CLICAL CLICAL CLICAL CLICAL CLICAL CLICAL CLICAL CLICAL CLICAL CLICAL CLICAL CLICAL CLICAL CLICAL CLICAL CLICAL CLICAL CLICAL CLICAL CLICAL CLICAL CLICAL CLICAL CLICAL CLICAL CLICAL CLICAL CLICAL CLICAL CLICAL CLICAL CLICAL CLICAL CLICAL CLICAL CLICAL CLICAL CLICAL CLICAL CLICAL CLICAL CLICAL CLICAL CLICAL CLICAL CLICAL CLICAL CLICAL CLICAL CLICAL CLICAL CLICAL CLICAL CLICAL CLICAL

If the patient is not present at the clinical clinical trial, the patient will be able to obtain the results of the clinical trial and the results of the clinical trial.

This is the first time I've seen this, and I'm not sure if it's the last time I've seen this, but it's the last time I've seen this.

In the case of patients who have been diagnosed with a medical condition, the following conditions should be observed: (i) (i) (i) (i) (ii) (ii) (ii) (ii) (iii) (iii) (iii) (iii) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv)

Therapeutic chain: from, to, from, to, from, to, from, to, from, to, from, to, from, to, from, to, from, to, from, to, from, to, from, to, from, to, from, to, from, to, from, to, from, to, to, from, to, to, from, to, to, from, to, to, to, from, to, to, to, from, to, to, to, from, to, to, to, to, from, to, to, to, to, to, to, from, to, to, to, to, to, to, to, to, to, to, to, to, to, to, to, to, to, to, to, to, to, to, to, to, to, to, to, to, to, to, to, to, to, to, to, to, to, to, to, to, to, to, to, to, to, to, to, to, to, to, to, to, to, to, to, to, to, to, to, to, to, to, to, to, to, to, to, to, to, to, to, to, to, to, to, to, to, to, to, or to, to, to, to, to, to, to, or to, to, to, to, to, to, to, to, to, to, or to, to, to, to, to, to, or to, to, to, to, to, to, to, or to, to, to, to, to, to, or to, to, to, to, to, or, to, to, to, to, to, or to, to, to, to, to, to, or to, to, to, to, to, or to, to, to, to, to, to, or to, to, to, to, or to, to, to, to, or, to, to, to, to, to, to, or, to, to, to, to, to, or, to, to, to, to, to, to, to, to, to, to, to, to, to, or, to, to,

on, therapy_text, new_diagnosis, new_therapy, new_care, acute_therapy, comment } {sib0tk,1, sib1tk,1, sib1tk,2, sib2tk,1}), with therapy chain#: $77 (lo n g ) Primary key Patient#: $77 (l o ng ) Remote key From: $77 (date )

New_therapy: $77(boolean ) Is there a need for a new therapy based on the results of the examination or the clinical course? $77(char(40) ) outpatient, inpatient or intensive care type: sib0tk,3(w) = truesivstation w ∈ {ambulant, static-

Oner, Intensive Care Unit, acute care: $77 Boolean.

Comment: $77 2000 Comment from the lecturer on the therapy performed

(b1tk,1(x) = truth : PS(therapy chain#, x), sib1tk,2(x) = truth : nf({patient#, From, By, sequence position, therapeutic text,

New diagnosis, new therapy, type of care, acute therapy

(x), sib2tk,1(v) = truth : FS((Therapeutic chain, patient#), (FALL, patient#), v).

This is the first time I've ever had a problem with this type of therapy. This is the second time I've had a problem with this type of therapy. This is the second time I've had a problem with this type of therapy.

In addition, it is important to take into account the fact that, in order to achieve the objectives of this Directive, the Member States are required to ensure that the treatment provided for in this Directive is consistent with the principles laid down in the Directive.

(i) the number of patients who have been diagnosed with the disease, the number of patients who have been diagnosed with the disease, the number of patients who have been diagnosed with the disease, the number of patients who have been diagnosed with the disease, the number of patients who have been diagnosed with the disease, the number of patients who have been diagnosed with the disease, the number of patients who have been diagnosed with the disease, the number of patients who have been diagnosed with the disease, the number of patients who have been diagnosed with the disease, the number of patients who have been diagnosed with the disease, the number of patients who have been diagnosed with the disease, the number of patients who have been diagnosed with the disease, the number of patients who have been diagnosed with the disease, the number of patients who have been diagnosed with the disease, the number of patients who have been diagnosed with the disease.

I'm going to try to find out what's going on here. I'm going to try to find out what's going on here.

$77 (lo n g ) Primary key Therapy Chain_Searching#: Therapy Chain#: $77 (lo n g ) Foreign key laboratory test#: $77 (l o n g ) Foreign key control test: $77 (b o l e an ) Is this a control test?

(b1tlu,1(x) = truth: PS(Therapeutic chain_Therapeutic chain#, x), sib1tlu,2(x) = truth: nf({therapeutic chain#, laboratory testing#, control testing

In this case, it is important to note that this is not the case in the United States, but it is the case in the United States.

(Therapeutic chain, therapeutic chain#), v), sib2tlu,2(v) = truth

In addition, it is important to ensure that the results of the studies are consistent with the results of the studies.

I'm not sure if I'm going to be able to do that, but I'm sure I'm going to be able to do that.

$77 (lo n g ) Primary key Therapy chain_examination#: Therapy chain#: $77 (lo n g ) Foreign key technology investigation#: $77 (lo n g ) Foreign key control investigation: $77 (b o l e an ) Is this a control investigation?

This is the main reason why it is important for the Commission to take into account the fact that, in the light of the above-mentioned findings, it is possible to determine whether or not the Member States are in a position to adopt a decision on the basis of the results of the evaluation.

THERAPKETTE_THERAPP PRINCIP: 5(/({therapkette_therapprinciple#, therapeutic chain#, therapeutic principle#, therapeutic type of therapy } {sib0tktp,1, sib1tktp,1, sib1tktp,2, sib2tktp,1, sib2tktp,2}), with $77 ((lo n g ) Primary key Therapkette_therapeutic principle#: $77lo n g ) Foreign key Therapeutic principle#: $77lo n g ) Foreign key Treatment type: $7750) : foreign key, supportive, primary, indistinguishable, w w w w w w w w w w w w w w w w w w w w w w w w w w w w w w w w w w w w w w w w w w w w w w w w w w w w w w w w w w w w w w w w w w w w w w w w w w w w w w w w w w w w w w w w w w w w w w w w w w w w w w w w w w w w w w w w w w w w w w w w w w w w w w w w w w w w w w w w w w w w w w w w w w w w w w w w w w w w w w w w w w w w w w w w w w w w w w w w w w w w w w w w w w w w w w

(x) (x) (x) (x) (x) (x) (x) (x) (x) (x) (x) (x) (x) (x) (x) (x) (x) (x) (x) (x) (x) (x)) (x) (x) (x) (x) (x) (x) (x) (x) (x) (x) (x) (x) (x) (x) (x) (x) (x) (x) (x) (x) (x) (x) (x) (x) (x) (x) (x) (x) (x) (x) (x) (x) (x) (x) (x) (x) (x) (x) (x) (x) (x) (x) (x) (x) (x) (x) (x) (x) (x) (x) (x) (x) (x) (x)), (x) (x) (x) (x)), (x) (x) (x) (x) (x) (x) (x) (x)), (x) (x) (x) (x) (x) (x) (x) (x) (x) (x) (x) (x) (x) (x) (x) (x) (x) (x) (x) (x)), (x) (x) (x) (x) (x) (x) (x) (x) (x) (x) (x) (x) (x) (x) (x) (x) (x) (x) (x) (x) (x) (x) (x) (x) (x) (x) (x) (x) (x)), (x) (x) (x) (x) (x) (x) (x) (x) (x) (x) (x) (x) (x) (x) (x) (x) (x) (x) (x) (x) (x) (x) (x) (x) (x) (x) (x) (x) (x) (x) (x) (

(Therapeutic chain, therapeutic chain#), v), sib2tktp,2(v) = truth : FS((Therapeutic chain_Therapeutic principle, therapeutic principle#),

(Therapeutic Principle, Therapeutic Principle)

This is the first time I've ever seen a therapeutic principle. This is the first time I've seen a therapeutic principle. This is the first time I've seen a therapeutic principle.

In the case of patients who are unable to obtain a medical certificate, the following information should be provided:

I'm not going to be able to do that. I'm not going to be able to do that. I'm not going to be able to do that.

ICD-10 ICD-10 Cross code: $77 (((char5) ) ICD-10 ICD star code: $77 ((char5) ) ICD-10 ICD-10 Diagnostic text: $77 ((char5)

This is not the case in the United Kingdom, but in the United Kingdom, the United Kingdom, the United Kingdom, the United Kingdom, the United Kingdom, the United Kingdom, the United Kingdom, the United Kingdom, the United Kingdom, the United Kingdom, the United Kingdom, the United Kingdom, the United Kingdom, the United Kingdom, the United Kingdom, the United Kingdom, the United Kingdom, the United Kingdom, the United Kingdom, the United Kingdom, the United Kingdom, the United Kingdom, the United Kingdom, the United Kingdom, the United Kingdom, the United Kingdom, the United Kingdom, the United Kingdom, the United Kingdom, the United Kingdom, the United Kingdom, the United Kingdom and the United Kingdom.

FALL_DIAGNOSIS: 5 (/) {Fall_Diagnosis, Patient#, Diagnosis#, Date, Suspect Diagnosis, Comment, Category, Past} {sib0fd,1, sib1fd,1, sib1fd,2, sib2fd,1, sib2fd,2} , with case_Diagnosis#: $77 (l o g ) Primary key Patient#: $77 (l o ng )

I'm going to tell you what I'm going to do.

$77(in t e ger ) 1=main diagnosis, 2=shg. for category: sib0fd,1(w) = true:main diagnosis given , 3=no w ∈ {1, 2, 3} Shg. For main diagnosis or unimportant?

Past: $77 Diagnosis from the past

(before the start of the case)? sib1fd,1(x) = truth : PS(diagnosis#, x), sib1fd,2(x) = truth : nf({patient#, diagnosis#, date, suspected diagnosis, category,

(FALL_DIAGNOSIS, Patient#), (FALL, Patient#), (v), sib2fd,2(v) = true : FS((((FALL_DIAGNOSIS, Diagnosis#), (DIAGNOSIS, Diagnosis#),

I'm not sure if I'm going to be able to do that. I'm not going to be able to do that. I'm not going to be able to do that. I'm not going to be able to do that.

$77 (lo n g ) Primary key Diagnosis_therapy principle#: Diagnosis#: $77 (lo n g ) Primary key Therapy principle#: $77 (lo n g ) Primary key Therapy type: $77 (char30) ) Primary, supportive sib0dtp,1 (w) = truth : w ∈ { primary , supportive }, course: $77 (char200 ) ) Typical course of the disease at best.

If the patient is not aware of any of the symptoms of the disease, he or she may not be aware of any of the signs or symptoms of the disease, and may not be aware of any of the signs or symptoms associated with the disease.

It's the first time I've ever had a diagnosis, and it's the second time I've had a diagnosis, and it's the second time I've had a diagnosis, and it's the second time I've had a diagnosis, and it's the second time I've had a diagnosis, and it's the second time I've had a diagnosis, and it's the second time I've had a diagnosis, and it's the second time I've had a diagnosis, and it's the second time I've had a diagnosis, and it's the second time I've had a diagnosis, and it's the second time I've had a diagnosis, and it's the second time I've had a diagnosis, and it's the second time I've had a diagnosis.

$77 (lo n g ) Primary key Diagnosis_Anonymous Answer#: Diagnosis#: $77 (l n g ) Foreign key Anonymous Answer#: $77 (l n g ) Foreign key Evidence: $77 (ch a r)

(b1daa,1(x) = truth: PS(diagnosis_name answer#, x), sib1daa,2(x) = truth: nf({diagnosis#, history answer#, evidence}, x), sib2daa,1(v) = truth: FS((DIAGNOSE_ANAMNESEANWORT, diagnosis#), (DIA-

Gnosis, diagnosis#), v), sib2daa,2(v) = truth : FS((DIAGNOSE_ANAMNESENTWORD, history answer#),

(AnomnesesWord, answer to anomneses#), v).

Diagnosis, diagnosis, clinical investigation, evidence, commentary, with $77 primary key Diagnosis, clinical investigation, evidence for clinical investigation, evidence for pre-diagnosis, evidence for pre-diagnosis, evidence for pre-diagnosis, evidence for pre-diagnosis, evidence for pre-diagnosis, evidence for pre-diagnosis, evidence for pre-diagnosis, evidence for pre-diagnosis, evidence for pre-diagnosis, evidence for pre-diagnosis, evidence for pre-diagnosis, evidence for pre-diagnosis, evidence for pre-diagnosis, evidence for pre-diagnosis, evidence for pre-diagnosis, evidence for pre-diagnosis, evidence for pre-diagnosis

I'm not sure if this is true, but I'm sure it's true, and I'm sure it's not true, but it's true.

In the case of a clinical investigation, the results of the evaluation shall be based on the results of the evaluation of the results of the clinical investigation and the results of the evaluation of the results of the clinical investigation.

Gnosis, diagnosis#), v), sib2dkue,2(v) = truth

(Clinical research, Clinical research and development)

DIAGNOSIS_TECHNOLOGY: 5*/*DIAGNOSIS_TECHNOLOGY: 7*/*DIAGNOSIS_TECHNOLOGY: 7*/*DIAGNOSIS_TECHNOLOGY: 7*/*DIAGNOSIS_TECHNOLOGY: 7*/*DIAGNOSIS_TECHNOLOGY: 7*/*DIAGNOLOGY: 7*/*DIAGNOLOGY: 7*/*DIAGNOLOGY: 7*/*DIAGNOLOGY: 7*/*DIAGNOLOGY: 7*/*DIAGNOLOGY: 7*/*DIAGNOLOGY: 7*/*DIAGNOLOGY: 7*/*DIAGNOLOGY: 7*/*DIAGNOLOGY: 7*/*DIAGNOLOGY: 7*/*DIAGNOLOGY: 7*/*DIAGY: 7*/*DIAGY: 7*/*DIAGY: 7*/*/*DIAG*****DIAG***************************************************************************************************************************************************************************************************************************

It's the result of a technical investigation. Comment: $77.00 ) Comment on the relationship between diagnosis and technical outcome.

In addition to the above, it is important to note that, in the context of the presentation of the results of this study, it is important to note that the results of this study are based on the results of the previous study.

(diagnosis, diagnosis#), v), sib2dtu,2(v) = truth

In addition, it is important to note that the Commission's proposal for a regulation of the European Parliament and of the Council was adopted by the European Parliament and the Council.

DIAGNOSIS_LABORTESREBORTES: 5(/({diagnosis_lab test result#, diagnosis#, laboratory test result#, evidence, comment} ➡️{sib1dlte,1, sib1dlte,2, sib2dlte,1, sib2dlte,2}), with $77 ((lo n g ) Primary key Diagnosis_lab test#: $77 ((l n g ) External key laboratory test result: $77 ((lon g ) External key evidence: $77 ((ch a r (1 0) ) Evidence for diagnosis in the presence of the laboratory test

Laboratory tests sib1dlte,1(x) = truth : PS(Diagnose_Labor test result#, x), sib1dlte,2(x) = truth : nf({diagnose#, laboratory test result#, evidence}, x), sib2dlte,1(v) = truth : FS(((DIAGNOSE_LABORTESTERGEBENNIS, diagnosis#), (DIA-

Gnosis, diagnosis#), v), sib2dlte,2(v) = truth: FS((DIAGNOSE_LABORTESTERGENCY, laboratory test results

(LATERATORY CONSIDERING, laboratory test result)

ERROR: 5(/({Errer#, errer_name, errer_genus, genus_root} ∙ {sib1err,1, sib1err,2}), with errer#: $77(l o n g ) Primary key errer_name: $77(ch a r (2 0 0 0)) ) Name of the errer errer_genus: $77(ch ar(200)) ) Genus which of the errer

It's called "Gender root" and it's called "Gender root" and it's called "Gender root" and it's called "Gender root" and it's called "Gender root" and it's called "Gender root" and it's called "Gender root" and it's called "Gender root" and it's called "Gender root" and it's called "Gender root" and it's called "Gender root" and it's called "Gender root" and it's called "Gender root" and it's called "Gender root" and it's called "Gender root" and it's called "Gender root".

(b1err,1(x) = true: PS: Erreger#, x), sib1err,2(x) = true: nf({Erreger_Name}, x),

FALL_ERREGER: 5*/*{Fall_ERREGER: 5*/*{Fall_ERREGER: 5*/*{Fall_ERREGER: 5*/*}{Fall_ERREGER: 5*/*{Fall_ERREGER: 5*/*{Fall_ERREGER: 5*/*}{Fall_ERREGER: 5*/*{Fall_ERREGER: 5*/*{Fall_ERREGER: 5*/*}{Fall_ERREGER: 5*/*{Fall_ERREGER: 5*/*{Fall_ERREGER: 5*/*}{Fall_ERREGER: 5*/*{Fall_ERREGER: 5*/*}{Fall_ERREGER: 5*/*}{Fall_ERREGER: 5*/*}{Fall_ERREGER: 5*}{Fall_ERREGER: 5*}{Fall_ERREGERREGER: 7*}{Fall_ERREGERREGER: 7*}{F}{Fall_ERREGERREGER: $7}{F}{F}}{Fall_ERREGERREGERREGER: $7}{F}{F}{L}{L}{L}{L}{L}{L}{L}{L}{L}{L}{L}{L}{L}{L}{L}{L}{L}{L}{L}{L}{L}{L}}{L}{L}{L}{L}{L}{L}{L}{L}{L}}{L}{L}{L}{L}{L}{L}{L}{L}}{L}{L}{L}{L}}{L}{L}{L}{L}{L}}{L}{L}{L}{L}}}{L}{L}}{L}{L}{L}}{

If the patient is not satisfied with the results of the test, the test shall be carried out in accordance with the following conditions: (i) (i) (i) (ii) (ii) (ii) (ii) (ii) (iii) (iii) (iii) (iii) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv), (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv)

FALL_LABORTEST: 5 (/) {Fall_LABORTEST#, Patient#, Lab Test#, Rejection reason} (sib1fla,1, sib1fla,2, sib2fla,1, sib2fla,2}), with case_LABORTEST#: $77 (l o n g ) Primary key Patient#: $77 (l o n g )

If the patient is not able to obtain the correct answer to the question, the patient may be given the correct answer to the following questions: (i) (i) (i) (ii) (ii) (ii) (ii) (ii) (ii) (iii) (iii) (iii) (iii) (iii) (iii) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv)

(Primary key $77*) (Name of the difficulty level: $77*) (Name of the difficulty level: $77*) (Name of the difficulty level: $77*) (Name of the difficulty level: $77*) (Name of the difficulty level: $77*) (Name of the difficulty level: $77*) (Name of the difficulty level: $77*) (Name of the difficulty level: $77*) ) (Name of the difficulty level: $77*) (Name of the difficulty level: $77*) (Name of the difficulty level: $77*) (Name of the difficulty level: $77*) (Name of the difficulty level: $77*) (Name of the difficulty level: $77*) (Name of the difficulty level: $77*) (Name of the difficulty level: $77*)

(b1sst,1(x) = true: PS(difficulty level#, x), sib1sst,2(x) = true: nf({difficulty level_name, demarcation}, x).

Question Category: $77, with Question Category: $77, with Question Category: $77, with Question Category: $77, with Question Category: $77, with Question Category: $77, with Question Category: $77, with Question Category: $77, with Question Category:

This is the same as the number of cases in which the number of cases in which the number of cases is less than or equal to the number of cases in which the number of cases is less than or equal to the number of cases in which the number of cases is less than or equal to the number of cases in which the number of cases is less than or equal to the number of cases in which the number of cases is less than or equal to the number of cases in which the number of cases is less than or equal to the number of cases in which the number of cases is less than or equal to the number of cases in which the number of cases is less than or equal to the number of cases in which the number of cases is less than or equal to the number of cases.

QUESTION: 5*/*{question#, author#, answer type#, difficulty level#,

Question #, Date of creation, Question text, Image, Max Answer Time }♪ {sib1fra, 1, sib1fra, 2, sib2fra, 1, sib2fra, 2, sib2fra, 3, sib2fra, 4}), with question #: $77 ((l o n g ) Primary key Author: $77 ((l o n g ) Key Key Answer Type: $77 ((lo n g ) Key Difficulty Level #: $77 ((l o n g ) Key Key Question Time #: $77 ((ma g ) Key Date of creation: $77 ((ma g ) Date of creation of the question Answered: $77 (l o n g )

(b1fra,1(x) = truth: PS: Question#, x), sib1fra,2(x) = truth: nf({author#, answer type#, difficulty level#, question category#,

(author, author#), (author, author#), (v), sib2fra,2(v) = reality: reality: reality: reality: reality: reality: reality: reality: reality: reality: reality: reality: reality: reality: reality: reality: reality: reality: reality: reality: reality: reality: reality: reality: reality: reality: reality: reality: reality: reality: reality: reality: reality: reality: reality:

Problem level#), v), sib2fra,4(v) = truth: FS((((QURAGE, QUESTION Category#), (QURAGE, QUESTION QUESTION QUESTION QUESTION QUESTION QUESTION QUESTION QUESTION QUESTION QUESTION QUESTION QUESTION QUESTION QUESTION QUESTION QUESTION QUESTION QUESTION QUESTION QUESTION QUESTION QUESTION QUESTION QUESTION QUESTION QUESTION QUESTION QUESTION QUESTION QUESTION QUESTION QUESTION QUESTION QUESTION QUESTION QUESTION QUESTION QUESTION QUESTION QUESTION QUESTION QUESTION QUESTION QUESTION QUESTION QUESTION QUESTION QUESTION QUESTION QUESTION QUESTION QUESTION QUESTION QUESTION QUESTION QUESTION QUESTION QUESTION QUESTION QUESTION QUESTION QUESTION QUESTION QUESTION QUESTION QUESTION QUESTION QUESTION QUESTION QUESTION QUESTION QUESTION QUESTION QUESTION QUESTION QUESTION QUESTION QUESTION QUESTION QUESTION QUESTION QUESTION QUESTION QUESTION QUESTION QUESTION QUESTION QUESTION QUESTION QUESTION QUESTION QUESTION QUESTION QUESTION QUESTION QUESTION QUESTION QUESTION QUESTION QUESTION QUESTION QUESTION QUESTION QUESTION QUESTION QUESTION QUESTION QUESTION QUESTION QUESTION QUESTION QUESTION QUESTION QUESTION QUESTION QUESTION QUESTI

I'm going to tell you what I'm going to do.

with answerselectionMC#: $77(l o n g ) Primary key question#: $77(l o n g ) Foreign key type: $77(char(1) ) Selection MC question? sib0aam,1(w) = truth w ∈ {a, m}, answer: $77(ch ar(2 0 0 0)) ) Text of the correct answer: $77(bool e a n ) Answer correct? Comment: $77(2000) )

This is the case in the case of the European Parliament and of the Council, where the European Parliament and the Council have been consulted on a number of issues relating to the European Parliament and the Council.

ANSWERTALTERNATIVE: 5 (/) {ResponseAlternative, question, right_response, wrong_response, comment} (sib , sib , sib }), with answerAlternative#: $77 (lo n g ) Primary key question#: $77 (l o n g ) Foreign key correct_response: $77 (char 20 0) ) Text of a correct answer Wrong_response: $77 (char 200) Answer Text of a wrong comment: $77 (char 2000) )

(b1aal,1(x) = true: PS(responseAlternative, x), sib1aal,2(x) = true: nf({question#, right_response, wrong_response}, x), sib2aal,1(v) = true FS(((

Answer: $77 (lo n g ) Primary key question #: $77 (l n g ) Foreign key correct_ Answer: $77 (char) 20 0) ) Text of a correct answer Comment: $77 (char) 2000 ) Comment

(b1aaf,1(x) = true : PS(responseFREE#, x), sib1aaf,2(x) = true : nf({question#, correct_response}, x), sib2aaf,1(v) = true : FS((ANTWORTFREI, question#), (QUESTION, question#), v).

) This term is the same as that term )

This is the same as the number of questions to be answered by the Commission in the following cases: (i) (i) (i) (ii) (ii) (ii) (ii) (iii) (iii) (iii) (iii) (iii) (iii) (iii) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv)

I'm going to have to ask you a few questions, and I'm going to have to ask you a few questions.

with answerArrangements#: $77(l ong ) Primary key question#: $77(l o n g )Foreign key type: $77(char 1) ) Concepts=b, or icons = i sib0anan,1(w) = true: w ∈ {b, i} Concept_icon: $77(ch50) ) Concept or path on icon position: $77 ((i n t ege r ) Position in the order order of order Comment: $77 (char 2000) ) Sib Comment: ananan1,1x) : ananan1 n :

WBT_SYSTEM_QUESTION: 5(/({WBT_System_Question#, WBT_System#, Question#} ♬ {sib1wsf,1, sib1wsf,2, sib2wsf,1, sib2wsf,2,}), with WBT_System_User#: $77(l on g ) Primary keys WBT_System#: $77(lo n g ) Foreign key Question #: $77l o n g ) Foreign key

This is the same as in the previous paragraphs of this paragraph. The following paragraphs shall be amended as follows: (i) (i) (i) (i) (i) (ii) (ii) (ii) (ii) (ii) (ii) (ii) (ii) (ii) (iii) (iii) (iii) (iii) (iii) (iii) (iii) (iii) (iii) (iii) (iii) (iii) (iii) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) and (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv) (iv)

In this case, it is possible to calculate the value of the system as a whole.

Users: 5(/({User#, ID, password, e-mail, talk, loginDa-

In addition, the Commission considers that the Commission should take the necessary measures in order to ensure that the measures are implemented in accordance with the principle of proportionality and proportionality.

Date of withdrawal, date of registration, number of semesters, Adaptation Activated, Prospective Loading, TotalNurPatho} ▷ {sib1nu,1, sib1nu,2}), with user#: $77(l ong ) Primary key identifier: $77char20) (User login password: $77char) (User login password: $77char) (User login email address: $77char: $50 ) User email address: $77

How does a case show up to the user?

Questions: $77 What are the categories of questions?

When do you get system feedback?

When did the user get the semester number: $77? Full. What semester was the user in when they first signed up?

Adaptation enabled: $77 ((boo l a n ) is the automatic systeman-

Prospective loading: $77 ((bo o l ean ) Is the prospective loading of case data and domain knowledge enabled?

TotaleNurPatho: $77 ((b o l ean ) Should the presentation/interaction form Totale only show pathological evidence?

(b1nu,1(x) = truth : PS(User#, x), sib1nu,2(x) = truth : nf({recognition, password, email, talk, operating manual,

In the case of the applicant, the application must be submitted in writing to the Commission.

In addition to this, it is important to note that the number of years in which you have completed your studies has increased significantly since the beginning of the academic year.

WBT_SYSTEM_User: 5(/({WBT_System_User#, WBT_System#, user#} ♬ {sib1wsn,1, sib1wsn,2, sib2wsn,1, sib2wsn,2}), with WBT_System_User#: $77(l o n g ) Primary keys WBT_System#: $77

This is the total number of users who have access to the system. This is the total number of users who have access to the system. This is the total number of users who have access to the system. This is the total number of users who have access to the system. This is the total number of users who have access to the system. This is the total number of users who have access to the system. This is the total number of users who have access to the system. This is the total number of users who have access to the system. This is the total number of users who have access to the system. This is the total number of users who have access to the system. This is the total number of users who have access to the system.

(b) (b) (c) (b) (c) (c) (c) (d) (d) (e) (e) (e) (e) (e) (e) (e) (e) (e) (e) (e) (e) (e) (e) (e) (e) (e) (e) (e) (e) (e) (e) (e) (e) (e) (e) (e) (e) (e) (e) (e) (e) (e) (e) (e) (e) (e) (e) (e) (e) (e) (e) (e) (e) (e) (e) (e) (e) (e) (e) (e) (e) (e) (e) (e) (e) (e) (e) (e) (e) (e) (e) (e) (e) (e) (e) (e) (e) (e) (e) (e) (e) (e)

It's the first time I've ever had a problem with this.

with case editing#: $77(l o n g ) Primary key Users#: $77(l ong ) Foreign key Patient#: $77(l o ng ) Foreign key Success: $77(real ) Foreign key editing time: $77(long )

(b1fab,1(x) = truth : PS(Case editing#, x), sib1fab,2(x) = truth : nf({User#, Patient#, Success, Processing Duration, Timing}, x), sib2fab,1(v) = truth : FS((Case editing, User#), (User, User#), v), sib2fab,2(v) = truth FS:TRUTH, Patient#), (FALL, Patient#), v).

QUESTION REPORT: 5 (/) {question processing#, user#, patient#, success, duration of editing, time} {sib1frb,1, sib1frb,2, sib2frb,1, sib2frb,2}), with query processing#: $77l o n g ) Primary key Users#: $77l ong ) Foreign key Question #: $77l o n g ) Foreign key Success: $77bo o l e a n ) Question processing duration: $77l o n ) Processing duration in seconds: $77l o n g ) Time of editing

(b1frb,1(x) = truth : PS(question processing#, x), sib1frb,2(x) = truth : nf({user#, question#, success, duration of processing, timing}, x), sib2frb,1(v) = truth : FS(QUTION, user#), (User, user#), v), sib2frb,2(v) = truth : FS(QUTION, question#), (QUTION, question#), v).

(b1knb,1(x) = truth : PS(node visit#, x), sib1knb,2(x) = truth : nf({user#, knots#, length of stay, time}, x), sib2knb,1(v) = truth : FS((NOTEUX, user#), (User, user#), v), sib2knb,2v) = truth: FS((NOTEUX, knots#), (Notes, knots#), v).

HELP TEXT: 5(/({HELP TEXT#, Event, HELP TEXT} ♬ {sib1hit,1, sib1hit,2}), with HELP TEXT#: $77(l o n g ♬ ) Primary key event: $77(char(50) ♬ ) Event in which the HELP TEXT is added

I'm going to show you the help text: $77 Help text: $77

This is the same as the reference to the first paragraph of the first paragraph of the second paragraph of the second paragraph of the second paragraph of the second paragraph of the second paragraph of the second paragraph of the second paragraph of the second paragraph of the second paragraph of the second paragraph of the second paragraph of the second paragraph of the second paragraph of the second paragraph of the second paragraph of the second paragraph of the second paragraph of the second paragraph of the second paragraph of the second paragraph of the second paragraph of the second paragraph of the second paragraph of the second paragraph of the second paragraph of the second paragraph of the second paragraph of the second paragraph of the second paragraph of the second paragraph of the second paragraph of the second paragraph of the second paragraph of the second paragraph of the second paragraph of the second paragraph of the second paragraph of the second paragraph of the second paragraph of the second paragraph of the second paragraph of the second paragraph of the second paragraph of the second paragraph of the second paragraph of the second paragraph of the second paragraph of the second paragraph of the second paragraph.

HELP PROTOCOL: 5 (/) HELP PROTOCOL#, User#, HELP TEXT#, DATE (sib1hp,1, sib1hip,2, sib2hip,1, sib2hip,2}), with HELP PROTOCOL#: $77 (l ong ) Primary key User#: $77 (l ong ) Foreign key HELP TEXT#: $77 (l o n g ) Foreign key Date: $77 (l ong ) Date of assistance

(b1hip,1(x) = truth: PS(help protocol#, x), sib1hip,2(x) = truth: nf({User#,helptext#,date}, x), sib2hip,1(v) = truth: FS((HELPROTOKOLL,user#), (User,user#), v), sib2hip,2v) = truth: FS((HELPROTOKOLL,helptext#), (HELPETEXT,helptext#), (HELPETEXT,helptext#),

QUESTION: 5 (/) Question assignment #, Question #, Object #, Object name (sib1fzu,1, sib1fzu,2, sib2fzu,1, sib2fzu,2, sib2fzu,1, sib2fzu,2}), with Question assignment #: $77 (l o n g ) Primary key question #: $77 (l o n g ) Foreign key object #: $77 (l o n g ) Foreign key object name: $77 (l o n g ) Question: $77 (l o n g ) ) Name of the referenced object In discussion: $77bool ean ) Should be included in the case discussion?

This is the same as the reference to the first subparagraph of Article 4 (1) of Regulation (EU) No 1303/2013 of the European Parliament and of the Council ('the Regulation'), as amended by Regulation (EU) No 1303/2013 of the European Parliament and of the Council ('the Regulation'), as amended by Regulation (EU) No 1303/2013 of the European Parliament and of the Council ('the Regulation'), as amended by Regulation (EU) No 1303/2013 of the European Parliament and of the Council ('the Regulation'), as amended by Regulation (EU) No 1303/2013 of the European Parliament and of the Council ('the Regulation'), as amended by Regulation (EU) No 1303/2013 of the European Parliament and of the Council ('the Regulation'), as amended by Regulation (EU) No 1303/2013 of the European Parliament and of the Council ('the Regulation'), as amended by Regulation (EU) No 1303/2013 of the European Parliament and of the Council ('the Regulation').

NOTE: 5(/({knots#, chapter#, knot type#, navigation bar#, date of creation, knot_name, path, knot map} {sib0kn,1, sib1kn,1, sib1kn,2, sib2kn,1, sib2kn,2, sib2kn,3}), with knots#: $77 (l o ng ) Primary key chapter#: $77 (lo n g g g g g g g g g g g g ) Foreign key key note: $77 (l o n g g g g g g g g g ) Foreign key navigation bar#: $77 (lo n g g g g g g g g ) Foreign key sib_note: $77 (French key sib_note: $77: $77 (knot sib_note): $77 (l o n g g g g g g g g g g g) ), with knot sib_note: $77 (l o n g g g g g g) ), with knot sib_note: $77 (l o n g g g g g g g g ) ), with knot sib_note: $77 (l )

typenames sib1kzu,1(x) = true : PS(knot assignment#, x), sib1kzu,2(x) = true : nf({knots#, object#, object name}, x), sib2kzu,1(v) = true : FS((Notes order, knots#), (Notes, knots#),

(v), sib2kzu,2(v) = true: FS(((Notes alignment, object#), (object name, whether or not

ANKER: 5 (/) with anchor #: $77 (lo n g ) Primary key nodes: $77 (lo n g ) Key element element element element element #: $77 (lo n g ) Key element element element element #: $77 (lo n g ) ) Key element element (i) or navigation element, w) =

This is the first time that I've ever seen this feature, and I'm not sure if it's the first time I've seen this feature.

(b1ank,1(x) = true: PS(anchor#, x), sib1ank,2(x) = true: nf({nodes#, element#, date of creation, type of element, anchor position

On1, anchor position2}, x), sib2ank,1(v) = true : FS((ANKER, node#), (Notes, node#), v), sib2ank,2(v) = true : FS((ANKER, element#), (ELEMENT, element#), v).

(Ses) Date of creation: $77 ((that e ) Date of creation URL: $77 ((char 80) ) Uniform Resource Locator

(b1ver,1(x) = truth PS: Reference#, x), sib1ver,2(x) = truth: nf({reference type#, anchor#, node#, date of creation, URL }, x), sib2ver,1(v) = truth: FS: Reference type#), (VERWEISTYP, reference type#), v), sib2ver,2(v) = truth: FS: Reference, anchor#), (ANKER, anchor#), v), sib2ver,3v) = truth FS: Reference type, nodes#), (Notes, nodes), v)

(b1vert,1(x) = true: PS(Reference type#, x), sib1vert,2(x) = true: nf({Reference type_name, description}, x).

Chapter #, Chapter #, Chapter #, Chapter #, Title #, Chapter #, Chapter #, Chapter #, Chapter #, Chapter #, Chapter #, Chapter #, Chapter #, Chapter #, Chapter #, Chapter #, Chapter #, Chapter #, Chapter #, Chapter #, Chapter #, Chapter #, Chapter #, Chapter #, Chapter #, Chapter #, Chapter #, Chapter #, Chapter #, Chapter #, Chapter #, Chapter #, Chapter #, Chapter #, Chapter #, Chapter #, Chapter #, Chapter #, Chapter #, Chapter #, Chapter #, Chapter #, Chapter #, Chapter #, Chapter #, Chapter #, Chapter #, Chapter #, Chapter #, Chapter #, Chapter #, Chapter #, Chapter #, Chapter #, Chapter #, Chapter #, Chapter #, Chapter #, Chapter #, Chapter #, Chapter #, Chapter #, Chapter #, Chapter #, Chapter #, Chapter #, Chapter #, Chapter #, Chapter #, Chapter #, Chapter #, Chapter #, Chapter #, Chapter #, Chapter #, Chapter #, Chapter #, Chapter #, Chapter #, Chapter #, Chapter #, Chapter #, Chapter #, Chapter #, Chapter # #, Chapter # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # #

Chapter Chapter_Name: $77

(CAPITAL, Chapter #), (CAPITAL, Chapter #), (V) = (CAPITAL, Chapter #), (CAPITAL, Chapter #), (CAPITAL, Chapter #), (CAPITAL, Chapter #), (CAPITAL, Chapter #), (CAPITAL, Chapter #), (CAPITAL, Chapter #), (CAPITAL, Chapter #)

NAVIGATIONSLIST: 5(/({navigation bar#, alignment, alignment level} 🔴 { sib0nale,1, sib0nale,2, sib1nale,1, sib1nale,2}), with navigation bar#: $77(lo n g ) Primary key alignment: $77(char 1) ) left (l), right (r) or centered sib0nale,1(w) = true (c) w ∈ {l, r, c} alignment: $771) ) horizontal (h) or vertical (v) v, w) = wwwwwwwwwwwww

In addition to this, it is possible to calculate the number of routes in which the routes are to be operated.

NAVILEISTE_NAVIELEMENT: 5 ((/({NaviLeiste_NaviElement#, navigation bar#, navigation element#, sequence position}

$77 ((lo n g ) Primary key NaviLeiste_NaviElement#: Navigation bar#: $77 ((lo n g ) Front key Navigation element#: $77 ((l o n g ) Front key Sequence position: $77 ((in t e ger ) Position of an element in the bar

In addition to the above, it is important to note that the number of navigation elements in the navigation system is the same as the number of navigation elements in the navigation system, and that the number of navigation elements in the navigation system is the same as the number of navigation elements in the navigation system, and that the number of navigation elements in the navigation system is the same as the number of navigation elements in the navigation system, and that the number of navigation elements in the navigation system is the same as the number of navigation elements in the navigation system, and that the number of navigation elements in the navigation system is the same as the number of navigation elements in the navigation system, and that the number of navigation elements in the navigation system is the same as the number of navigation elements in the navigation system.

In addition to the above, it is also possible to calculate the value of the data in the same way as the value of the data in the same way as the value of the data in the same way as the value of the data in the same way as the value of the data in the same way as the data in the same way as the data in the same way as the data in the same way as the data in the same way as the data in the same way as the data in the same way as the data in the same way as the data in the same way as the data in the same way as the data in the same way as the data in the same way as the data in the same way as the data in the same way as the data in the same way as the data in the same way as the data in the same way as the data in the same way as the data in the same way as the data in the same way as the data in the same way as the data in the data.

VIGATIONSLIST, navigation bar#), v), sib2nana,2(v) = true : FS(((NAVILEISTE_NAVIELEMENT, navigation element#), NA-

VIGATIONSELEMENT, navigation element (v)

This is the first time I've ever seen the icon. This is the second time I've seen the icon. This is the second time I've seen the icon.

In addition to this, it is possible to calculate the total number of users in the network.

I'm not going to tell you what I'm going to do.

with InfoElement#: $77(lo n g ) Primary key Date of creation: $77(that e ) Date of recording in DB InfoElement_Name: $77(ch ar(3 0) ) etc. Name of the element Path: $77(char50) ) Path to InfoElement Element: $77(ch ar(15) ) Text, image, video, sound... format: $77(char15) ) Storage format short description: $77((2000) Text description of the element

In addition to the information provided by the manufacturer, it is possible to use the information provided by the manufacturer in order to verify the quality of the product.

KNOTEN_INFOEEMENT: 5 (/) {KNOTEN_INFOEEMENT: $77}{KNOTEN_INFOEEMENT: $77}{KNOTEN_INFOEEMENT: $77}{KNOTEN_INFOEEMENT: $77}{KNOTEN_INFOEEMENT: $77}{KNOTEN_INFOEEMENT: $77}{KNOTEN_INFOEEMENT: $77}{KNOTEN_INFOEEMENT: $77}{KNOTEN_INFOEEMENT: $77}{KNOTEN_INFOEEMENT: $77}{KNOTEN_INFOEEMENT: $77}{KNOTEN_INFOEEMENT}{KNOTEN_INFOEEMENT: $77}{KNOTEN_INFOEEMENT}{KNOTEN_INFOEEMENT}{KNOTEN_INFOEEMENT}{KNOTEN_INFOEEMENT}{KNOTEN}{KNOTEN}{KNOTEN_INFOEEMENT: $77}{KNOTEN}{KNOTEN}{T}{T}{T}{T}{T}{T}{T}{T}{T}{T}{T}{T}{T}{T}{T}{T}{T}{T}{T}{T}{T}{T}{T}{T}{T}{T}{T}{T}{T}}{T}{T}{T}}{T}}{T}}{T}}{T}{T}}{T}}{T}}}{T}}{T}}{T}}}}}}}{T {Thrist with "Thrist with "Thrist with "Thrist with his words and his words and his words and his words and his words and his words and his words and his words and his words and his words and his words and his words and his work and his work and his work and his work and his work and his

In addition to this, it is important to note that, in order to achieve the objectives of this Regulation, the Commission has to take into account the specificities of this Regulation and the specifications of this Regulation.

(InfoElement#), (InfoElement#), (InfoElement#), (InfoElement#), (InfoElement#), (InfoElement#), (InfoElement#), (InfoElement#), (InfoElement#), (InfoElement#), (InfoElement#), (InfoElement#), (InfoElement#), (InfoElement#), (InfoElement#), (InfoElement#), (InfoElement#), (InfoElement#), (InfoElement#), (InfoElement#), (InfoElement#), (InfoElement#), (InfoElement#), (InfoElement#), (InfoElement#), (InfoElement#), (InfoElement#), (InfoElement#), (InfoElement#), (InfoElement#), (InfoElement#), (InfoElement#), (InfoElement#), (InfoElement#), (InfoElement#), (InfoElement#) (InfoElement#), (InfoElement#) (InfoElement#), (InfoElement#) (InfoElement#), (InfoElement#) (InfoElement#), (InfoElement#) (InfoElement#), (InfoElement#) (InfoElement#) (InfoElement#), (InfoElement#) (InfoElement#), (InfoElement#) (InfoElement#) (InfoElement#), (InfoElement#) (InfoElement#), (InfoElement#) (InfoElement#) (InfoElement#), (InfoElement#) (InfoElement#), (InfoElement#) (InfoElement#), (InfoElement#) (InfoElement#), (InfoElement) (InfoElement) (InfoElement) (InfoElement) (InfoE) (InfoElement) (InfoElement) (InfoE) (InfoE) (InfoElement) (InfoE) (

III List of abbreviations

Approval Order for Physicians ANSI American National Standards Institute ATI Aptitude-Treatment Interactions CAD Computer-Aided Design CAMPUS Computer-Aided Exercise and Training in Medicine by Platform-independent Software CASE Computer-Aided Software Engineering CBT Computer-Based Training CGI Common Gateway Interface COM Component Object Model CORBA Common Object Request Broker Architecture DBMS Database Management System DDL Data Definition Language DML Manipulation Language DOMINIE Data Domain Independent Instructional Environment EBNF Computer-Aided Exercise and Training in Medicine by Platform-independent Software CASE Computer-Aided Software Engineering CBT Computer-Based Training CGI Common Gateway Interface COM Component Object Model CORBA Common Object Request Broker Architecture DBMS Database Management System DDL Data Definition Language DML Manipulation Language DOMINIE Data Domain Independent Instructional Environment EBNF Computer-Aided Exercise and Training in Medicine by Platform-independent Software ERM Entity-Relationship Modelling ERM Entity Entity-Relationship Modelling ERM Entity Entity-Relationship Calculus et al. et al. and Altering Computer-Based Training CGI Common Gateway Interface COM Component Object Model CORBA Common Object Model DBMS Database Management System DDL Database Definition Language DML Database Interface Manipulation Language DMINIE Database Domain Database Domain Database is an independent instructional environment that is supported by computer-aided design and computer-aided design and computer-aided design and computer-aided design, and computer-aided design and computer-aided design, and computer-aided design, and computer-aided design, and computer-aided design, and computer-aided design, and computer-aided design, and computer-aided design, and computer-aided design, and computer-aided design, and computer-aided design, and computer-aided design, and computer-aided design, and computer-aided design, and computer-aided design, and computer-aided design, and computer-aided design, and computer-aided design, and computer-aided by computer-aided design, and computer-aided by computer

IV List of drawings

Form 2: Interaction forms and architecture forms CBT-Systems 12 Form 3: Schematic programming structure A case study/learning form 15 Form 4: Architecture forms CBT-Systems 21 Form 5: RMI-SYSTEMARCHITY Form 25 Form 6: COMMELATION OBJECTIVE COMMELATION COMMELATION COMMELATION COMMELATION COMMELATION COMMELATION COMMELATION COMMELATION COMMELATION COMMELATION COMMELATION COMMELATION COMMELATION COMMELATION COMMELATION COMMELATION COMMELATION COMMELATION COMMELATION COMMELATION COMMELATION COMMELATION COMMELATION COMMELATION COMMELATION COMMELATION COMMELATION COMMELATION COMMELATION COMMELATION COMMELATION COMMELATION COMMELATION COMMELATION COMMELATION COMMELATION COMMELATION COMMELING COMMELATION COMMELING COMMELING COMMELATION COMMELING COMMELING COMMENTATION COMMELING COMMELING COMMENTING COMMELING COMMENTING COMMENTING COMMENTING COMMENTING COMMELING COMMENTING COMMENTING COMMENTING COMMENTING COMMELING COMMENTING COMMENTING COMMENTING COMMENTING COMMENTing with the first form of the first form of the third form of the fourth form of the fourth form of the fourth form of the fourth form of the fourth form of the fourth form of the fourth form of the fourth form of the fourth form of the fourth form of the fourth form of the fourth form of the fourth form of the fourth form of the fourth form of the fourth form of the fourth form of the sixth of the sixth of the fourth of the sixth of the sixth of the sixth of the sixth of the sixth of the sixth of the sixth of the sixth of the sixth of the sixth of the sixth of the sixth of the sixth of the sixth of the sixth of the sixth of the sixth of the sixth of the sixth of the sixth of the sixth of the sixth of the sixth of the six

V Table directory

TABLE 1: Classification of adaptation measures 34 TABLE 2: Basic techniques for the replacement of WBT systems 55 TABLE 3: Distribution of an ideal distributed teaching architecture 57 TABLE 4: Assessment points for selection 71 TABLE 5: Categories of evidence in the campus system TABLE 6: 113 questions/answers in the campus system 114

Index VI

ActiveX 32 D3 42 Adaptability 33 Database level 19 Functionality 35 Data and knowledge collection 62 User Interface 36 Database 50 Adaptation measure 34 Databases 48 Adaptation rate 34 Object-oriented 52 Adaptation purpose 35 Object-relational 52 Adaptation 33; 36 Data modelling See Semantic requirement analysis 58 Data modelling Working group Medical training 8 DB-scheme 49 Architectural types See WBT systems Diagnostics ATI-effects 42 set covering"- 42 Attributes 48 Training functional 42 Berlin-based course 10 heuristic 42 BMG-based course 9 Statistical 42 Teaching 8 Educational studies 58 Reformed and CBT 11 Assessment 40 Discoveries

Backtrack 19 Backus-Naur Form Introduction 1 extended 44 Entity relationship Calculus 46 Basic technology 7 Entity relationship scheme 44 Basic techniques 31; 55 Evaluation 62 Definitions of the term 7 Berlin reform course See: training Bookmarks 19 Browsing See interaction form Case running model 73

Case model 81 Case model 88 fisheye view 20 CAMPUS 64 Fragment model 105 CAMPUS/Infectiology 119 Question 5 CAMPUS/Pediatrics 119 Frames 38 CASUS 15 Foreign keys 51 CBT 7 Interaction forms 11 CBT system 7 Development 14 Granularity problem 28 conventional 7 Guided tours 19 CGI 32 Client/Server Communication 25 Client-based architecture 22 Cognitive Apprenticeship 39 History lists 19 Cognitive overhead 20 HTML 31 Computer-based training 7; 11 HTTP 17 Constraints 38 Hyperface 18 Cookies 17 Hypertext 18 CORBA 26 Nights 19 Object Request Broker 26 Overview Diagrams 20 Implementation 62 Integration 27 29 Intelligent prototyping systems 36 37 Supporting client-based architecture 39 Cognitive apprenticeship 39 History lists 19 Cognitive overhead 20 HTML 31 Computer-based training 7; 11 HTTP 17 Constraints 38 Hyperface 18 Cookies 17 Hypertext 18 CORBA 26 Interface 19 Requests 19 Object Requests 26 Interface 20 Implementation 26 Integration 27 29 Intelligent prototyping systems 29 Intelligent prototyping systems 36 Supporting systems 39 Supporting systems 39 Modeling 11 Modeling 11 Modeling 11 Interface 31 Interface 31 Interface 31 Interface 31 Interface 31 Interface 31 Interface and Interface 31 Interface Interface Interface Interface Interface and Interface Interface Interface Interface Interface Interface Interface Interface Interface Interface Interface and Interface Interface Interface Interface Interface Interface Interface Interface Interface Interface Interface Interface Interface Interface Interface Interface Interface Interface Interface Interface Interface Interface Interface Interface Interface Interface Interface Interface Interface Interface Interface Interface Interface Interface Interface Interface Interface Interface Interface Interface Interface Interface Interface Interface Interface Interface Interface Interface Interface Interface Interface Interface Interface Interface Interface Interface Interface Interface Interface Interface Interface Interface Interface Interface Interface Interface Interface Interface Interface Interface Interface Interface Interface Interface Interface Interface Interface Interface Interface Interface Interface Interface Interface Interface Interface Interface Interface Interface Interface

Conceptual modelling 75 Relational data model 48 Relationship scheme 49 Remote data & knowledge architecture 22 Remote procedure Call 25 Representation concepts 28 Language mapping 27 Resource 28 Layout model 99 Resource quality 29 Teaching/learning systemclient 7 RMI 25 Teaching/learning system functionality 7 Teaching/learning system servers 7 Teaching/learning system shell 7; 64 Teaching/learning system shell concept 63 Teaching function modelling 61 Layers Model 67 Teaching model 68 Semantic data system modelling 43 Teaching subsystems 117 Semantic integrated learning subsystems 50 Semantic networks 37 Lexicon model 94-based architecture 24 Teaching/learning system servers 7 Teaching/learning system shell 7; 64 Teaching/learning system shell concept 63 Teaching function modelling 61 Layers Model 67 Teaching model 68 Semantic data system modelling 43 Teaching subsystems 117 Semantic subsystems 50 Semantic networks 37 Lexicon model 94-based architecture 24 Teaching/learning system servers 24 Teaching/learning system shell model 64 Teaching/learning system shell concept 63 Teaching function modelling 61 Layers Model 67 Teaching model 68 Semantic data modelling model 67 Teaching model 67 Semantic data modelling network modelling 117 Semantic networking subsystems 115 Semantic subsystems 50 Semantic subsystems 115 Semantic subsystems 37 Semantic subsystems Semantic subsystems Semantic subsystems 37 Semantically based on the basis of semantically based learning and semantically based on semantically based approaches

Teaching module See Intelligent tutorials WBT system model 109 Web-based systems Training 7 Scientific Council 2 WWW 16 Dynamics 29 Distribution design 61 Weaknesses 17 Strengths 17 WWW resources 27

WBT 7 WBT system 7 WBT systems 20 Objective 5 Requirements 53 Two-tiered model 67 Architectural types 20

Curriculum vitae

Name Martin Ernst Haag Street Finkenweg 25 Residence 69214 Eppelheim Birthday 04.12.1969 Birthplace 74585 Red at the lake - Brettheim Nationality German family status single religion evangelical

Primary school 1976 - 1980 Primary school Brettheim Gymnasium 1980 - 1989 Gymnasium Gerabronn Date of completion 10 May 1989 Type of completion General higher education maturity

Medical computer science at the University of Heideldauer Berg / Heilbronn University of Science and Technology from WS 1990/91 - SS 1995 Diploma examination (Diploma - 28 June 1995 Medical computer scientist)

Scientific assistant from November 1993 to June 1995 in the laboratory Computer-assisted training in medicine at the University of Heidelberg Scientific background October 1995 in the laboratory Computer-assisted training in medicine and at the Institute of Medical Biometrics and Informatics, Department of Medical Informatics at the University of Heidelberg

- Thank you. - Thank you.

At this point I would like to thank all those who have contributed to the successful completion of my doctorate.

Prof. Dr. R. Haux, I thank you very much for taking over the care of this doctorate.

I would like to thank the managers of the computer-aided medical training laboratory, Prof. Dr. h.c. H.G. Sunday and Prof. F.J. Leven for allowing me to use the entire infrastructure of the laboratory.

Mr Dipl.-Inform. Med. G. Pelzer, Mr Dipl.-Inform. Med. J. Riedel and Mr Dipl.-Inform.

I would like to thank Mr PD Dr. B. Tönshoff and Mr AiP T. Ullinski from the University Children's Hospital and Mr Prof. Dr. H.-K. Geiss and Mrs E. Müller from the Institute of Hygiene for their technical support and the provision of teaching/learning.

Mr Chevreux and Mr Pfisterer have kindly agreed to read this paper, and I thank them very much for their thorough work.

Mr Dipl.-Inform. Med. W. Thank you all for the years of good cooperation in setting up and operating the computer-aided medical training laboratory.

To all my friends, acquaintances, and parents, I thank you for your mental support over the past three years.