The paper outlines an approach to CSCW systems design based on the concept of 'coordination mechanisms.' The concept of coordination mechanisms has been developed as a generalization of phenomena described in empirical investigations of the use of artifacts for the purpose of coordinating cooperative activities in different work domains. On the basis of the evidence of this corpus of empirical studies, the paper outlines a theory of the use of artifacts for coordination purposes in cooperative work settings, derives a set of general requirements for computational coordination mechanisms, and sketches the architecture of Ariadne, a CSCW infrastructure for constructing and running such malleable and linkable computational coordination mechanisms.A major research issue in CSCW is to understand how computer systems can be instrumental in reducing the complexity of coordinating cooperative activities, individually conducted and yet interdependent.In fact, the issue was identified and defined with admirable precision quite early in the history of CSCW, by Anatol Holt: 'The new capabilities at which coordination technology aims depend on finding and installing appropriate conceptual and structural units with which to express tasks, their diverse relations to each other and to the people who ultimately bear responsibility for them.' 'To be useful, this must be done in a flexible yet well-integrated manner, with plenty of leeway for the unpredictability of real life.' (Holt, 1985, p. 281).Since then, this issue has been investigated by a range of eminent CSCW researchers. The initial results were not encouraging, however, in that coordination facilities were experienced as excessively rigid, either because the underlying protocol was not accessible and could not be modified (e.g., The Coordinator, cf. Winograd, 1986;Winograd and Flores, 1986;Flores et al., 1988), or because the facilities for changing the protocol did not support actors in modifying the protocol (e.g., DOMINO, cf. Kreifelts et al., 1991a;Kreifelts et al., 1991b).

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With the aim of determining the incidence of idiopathic thrombocytopenic purpura (ITP) in adults, we searched all adult ITP patients diagnosed from April 1, 1973 to December 31, 1995 in the County of Funen in Denmark. This county comprises 9% of the total Danish adult population. A total of 221 patients fulfilled the inclusion criteria, yielding an annual standardized incidence rate of 2.68 per 100,000. The median age of the patient population was 56 years, and the female to male ratio was 1.7. Changing the platelet count cut-off point from 100 × 109/L to 50 × 109/L changed the incidence rate to 2.25 per 100,000. Comparing patients less and more than 60 years old, the incidence rate more than doubled and the sex difference was eliminated in the older age group. These two age groups were almost identical regarding platelet count at diagnosis and number of asymptomatic cases. The incidence rate increased in the study period. This increase in particular involved asymptomatic patients and old males who were both symptomatic or not symptomatic. Including additional patients identified by a questionnaire study of the contribution from the primary care physicians and the practicing specialists in the second half of the study period, a reliable estimate of the annual ITP incidence in Danish adults, using a platelet concentration cut-off point of 50 × 109/L, is 3.2 per 100,000 persons.

In their cooperative effort, architects depend critically on elaborate coordinative practices and artifacts. The article presents, on the basis of an in-depth study of architectural work, an analysis of these practices and artifacts and shows that they are multilaterally interrelated and form complexes of interrelated practices and artifacts which we have dubbed 'ordering systems'. In doing so, the article outlines an approach to investigating and conceiving of such practices.

Idiopathic thrombocytopenic purpura is an autoimmune disease which involves opsonization of platelets by autoantibodies directed against different surface glycoproteins, leading to their premature destruction by the reticuloendothelial system. Management of patients with refractory ITP is difficult. Recent studies have shown that rituximab, a chimeric anti‐CD20 monoclonal antibody, is useful in the treatment of these patients, with overall response rates of about 50%. Most published reports have included a small number patients including case reports. The present study reports the results of a retrospective Danish multicenter study of rituximab in the treatment of adult patients with refractory ITP. Thirty‐five patients (median age 52 years, range 17–82 years, 17 males) were included. One patient had immune thrombocytopenia and neutropenia. All patients had received prednisolone (Pred). Next to Pred, 25 patients had been treated with high‐dose IgG, and in 16 patients a splenectomy had been performed. Sixteen patients had been treated with azathioprine. Other treatments included, e.g., cyclosporine, danazol, cyclophosphamide, vincristine, interferon, and dexamethasone. The patients were treated with a dose regimen of 375 mg/m2 i.v. approximately once weekly for 4 consecutive weeks. Six patients received a fixed dose of 500 mg disregarding their weight supplemented by 100 mg of methylprednisone i.v. or 50–100 mg of Pred given as premedication together with an antihistamine just before infusion of rituximab. The large majority of patients also received Pred and, in some cases, other concomitant immunosuppressive treatment during part of their rituximab treatment. A complete response (CR) was defined as a rise in the platelet count > 100 × 109/L, a partial response (PR) as a rise in the platelet count > 50 × 109/L, and a minor response (MR) as a rise in the platelet count < 50 × 109/L. No response (NR) was defined as no increase in the platelet count. Because 4 patients were treated twice, a total of 39 outcomes of rituximab treatment were evaluated. Rituximab proved to be effective in 17 of 39 treatments [overall response 44% with 7 CR (18%) (1 patient showed a CR twice), 6 PR (15%), and 4 MR (10%)]. In 9/13 cases of CR or PR, the response (platelet level > 50 × 109/L) was prompt, 1–2 weeks after the first infusion. The remaining patients responded 3–8 weeks later. Patients with CR and PR have been in remission for a median of 47 weeks. In general the side effects were few. In 2 cases, the treatment was stopped because of side effects either during or after the first infusion. Two fatal outcomes were recorded. A 71‐year‐old female with severe lung disease died 6 days after the first infusion of respiratory failure. The other patient, a 73‐year‐old man also with severe chronic obstructive lung disease, died of pneumonia approximately 13 weeks following the last rituximab treatment. It is concluded that rituximab may be a useful alternative therapy in patients with severe and symptomatic ITP refractory to conventional treatment. Am. J. Hematol. 78:275–280, 2005. © 2005 Wiley‐Liss, Inc.

The title of this paper was chosen to highlight the fact that the label CSCW, although widely adopted as the acronym for the field of Computer Supported Cooperative Work, has been applied to computer applications of very different ilk. It is not at all clear what are the unique identifying elements of this research area. This paper provides a framework for approaching the issue of cooperative work and its possible computer support. The core issues are identified and prospects for the field are outlined.