Transformation einer EPK in eine formalisierte Methode

Dieser Beitrag untersucht die Transformation einer Ereignisgesteuerten Prozesskette in diverse formalisierte Modellierungsmethoden. Die hierfür gewählten formalen Methoden sind Business Process Model and Notation, Unified Modeling Language, Subjektorientiertes Business Process Management und Petrinetze. Das Ziel dieser Arbeit ist es, die Vor- und Nachteile der Methoden zu definieren und eine geeignete Methode für sowohl Modellierung als auch Automatisierung von Geschäftsprozessen zu finden. Zunächst werden theoretische Grundlagen der Geschäftsprozessmodellierung dargestellt. Des Weiteren wird auf die gesonderten Charakteristika der vorgestellten Methoden eingegangen. Ein besonderer Fokus liegt hier auf dem Thema Syntax und Semantik der Methoden. Nachfolgend werden die Ergebnisse der Transformation sowie die Vorteile und Nachteile der gewählten Methoden kritisch betrachtet. Als Grundlage für den Vergleich wurde das Beispiel eines Bewerbungsverfahrens als Ereignisgesteuerte Prozesskette entwickelt

Serological Protection 5-6 Years Post Vaccination Against Yellow Fever in African Infants Vaccinated in Routine Programmes.

Introduction: Although effective live attenuated yellow fever (YF) vaccines have been available for over 9 decades sporadic outbreaks continue to occur in endemic regions. These may be linked to several factors including epidemiological factors such as vector and intermediate host distribution or vaccine coverage and efficacy. The World Health Organization's research priorities include gathering systematic evidence around the potential need for booster vaccination with YF vaccine whether this follows full or fractional doses in children. Knowledge on the longevity of response to YF vaccine and the implications of this response needs to be consolidated to guide future vaccination policy. Methods: We measured anti-YF IgG by microneutralization assay in a group of 481 African infants who had received YF vaccine as part of routine EPI programmes, to explore serological protection from YF 5-6 years post YF vaccination, as well as the effect of co variates. Findings: Notably, 22.2% of the cohort had undetectable antibody concentrations, with another 7.5% revealing concentrations below the threshold of seropositivity of 0.5 IU/mL. Sex, season, country and time since vaccination did not affect the longevity of antibody concentration or having antibody concentrations above a defined threshold. Conclusion: Roughly 30% of children in this cohort did not demonstrate anti-yellow fever antibody concentrations above the defined threshold of protection, with 20% having no demonstrable antibody. Knowledge on the longevity of response to YF vaccine and the implications needs to be consolidated to guide future vaccination policy

Origin and geochemical evolution of the Madeira-Tore Rise (eastern North Atlantic)

The Madeira-Tore Rise, located ∼700 km off the NW African coast, forms a prominent ridge in the east Atlantic. The age and origin of the rise are controversial. This study presents major and trace element, Sr, Nd, Pb, Hf isotope and 40Ar/39Ar age determinations from volcanic rocks dredged from different sites along the rise. In addition, isotopic compositions of rock samples from Great Meteor Seamount in the central Atlantic are presented. The new radiometric and paleontologically constrained ages identify two major episodes of volcanism: The first is the base of the rise (circa 80 to >95 Ma) and the second is seamounts on the rise (0.5–16 Ma). It is proposed that interaction of the Canary hot spot with the Mid-Atlantic spreading center formed the deep basement of the Madeira-Tore Rise and the J-Anomaly Ridge west of the Atlantic spreading center in the Mid-Cretaceous. Age and geochemical data and plate tectonic reconstructions suggest, however, that the recovered Late Cretaceous volcanic rocks represent late stage volcanism from the time when the Madeira-Tore Rise was still close to the Canary hot spot. Long after moving away from the influence of the Canary hot spot, the Madeira-Tore Rise was overprinted by late Cenozoic volcanism. Miocene to Pleistocene volcanism at the northern end of the rise can be best explained by decompression mantle melting beneath extensional sectors of the Azores-Gibraltar Fracture Zone (African-Eurasian plate boundary). The geochemical compositions of these volcanic rocks suggest that the magmas were variably contaminated by enriched material within or derived by melting of enriched material underplated at the base of the lithosphere, possibly originating from the Cretaceous Canary plume. Alternatively, these late Cenozoic volcanic rocks may have derived from decompression melting of enriched pyroxenitic/eclogitic material in the upper mantle. Isotopically more depleted Pliocene to Pleistocene volcanism at the southern end of the Madeira-Tore Rise may be related to the nearby Madeira hot spot

Low specificity of determine HIV1/2 RDT using whole blood in south west Tanzania

Objective: To evaluate the diagnostic performance of two rapid detection tests (RDTs) for HIV 1/2 in plasma and in whole blood samples. Methods: More than 15,000 study subjects above the age of two years participated in two rounds of a cohort study to determine the prevalence of HIV. HIV testing was performed using the Determine HIV 1/2 test (Abbott) in the first (2006/2007) and the HIV 1/2 STAT-PAK Dipstick Assay (Chembio) in the second round (2007/2008) of the survey. Positive results were classified into faint and strong bands depending on the visual appearance of the test strip and confirmed by ELISA and Western blot. Results: The sensitivity and specificity of the Determine RDT were 100% (95% confidence interval = 86.8 to 100%) and 96.8% (95.9 to 97.6%) in whole blood and 100% (99.7 to 100%) and 97.9% (97.6 to 98.1%) in plasma respectively. Specificity was highly dependent on the tested sample type: when using whole blood, 67.1% of positive results were false positive, as opposed to 17.4% in plasma. Test strips with only faint positive bands were more often false positive than strips showing strong bands and were more common in whole blood than in plasma. Evaluation of the STAT-PAK RDT in plasma during the second year resulted in a sensitivity of 99.7% (99.1 to 99.9%) and a specificity of 99.3% (99.1 to 99.4%) with 6.9% of the positive results being false. Conclusions: Our study shows that the Determine HIV 1/2 strip test with its high sensitivity is an excellent tool to screen for HIV infection, but that – at least in our setting – it can not be recommended as a confirmatory test in VCT campaigns where whole blood is used

Hookworm Infection and Environmental Factors in Mbeya Region, Tanzania: A Cross-sectional, Population-based study.

Hookworm disease is one of the most common infections and cause of a high disease burden in the tropics and subtropics. Remotely sensed ecological data and model-based geostatistics have been used recently to identify areas in need for hookworm control. Cross-sectional interview data and stool samples from 6,375 participants from nine different sites in Mbeya region, south-western Tanzania, were collected as part of a cohort study. Hookworm infection was assessed by microscopy of duplicate Kato-Katz thick smears from one stool sample from each participant. A geographic information system was used to obtain remotely sensed environmental data such as land surface temperature (LST), vegetation cover, rainfall, and elevation, and combine them with hookworm infection data and with socio-demographic and behavioral data. Uni- and multivariable logistic regression was performed on sites separately and on the pooled dataset. Univariable analyses yielded significant associations for all ecological variables. Five ecological variables stayed significant in the final multivariable model: population density (odds ratio (OR) = 0.68; 95% confidence interval (CI) = 0.63-0.73), mean annual vegetation density (OR = 0.11; 95% CI = 0.06-0.18), mean annual LST during the day (OR = 0.81; 95% CI = 0.75-0.88), mean annual LST during the night (OR = 1.54; 95% CI = 1.44-1.64), and latrine coverage in household surroundings (OR = 1.02; 95% CI = 1.01-1.04). Interaction terms revealed substantial differences in associations of hookworm infection with population density, mean annual enhanced vegetation index, and latrine coverage between the two sites with the highest prevalence of infection. This study supports previous findings that remotely sensed data such as vegetation indices, LST, and elevation are strongly associated with hookworm prevalence. However, the results indicate that the influence of environmental conditions can differ substantially within a relatively small geographic area. The use of large-scale associations as a predictive tool on smaller scales is therefore problematic and should be handled with care

Appraisal of health care: from patient value to societal benefit

Aim: This paper summarizes the deficiencies and weaknesses of the most frequently used methods for the allocation of health-care resources. New, more transparent and practical methods for optimizing the allocation of these resources are proposed. Method: The examples of quality-adjusted life years (QALYs) and efficiency frontier (EF) are analyzed to describe weaknesses and problems in decisions regulating health-care provision. After conducting a literature search and discussions with an international group of professionals, three groups of professionals were formed to discuss the assessment and appraisal of health-care services and allocation of available resources. Results: At least seven essential variables were identified that should be heeded when applying the concept of QALYs for decisions concerning health-care provision. The efficiency frontier (EF) concept can be used to set a ceiling price and perform a cost-benefit analysis of provision, but different stakeholders—a biostatistician (efficacy), an economist (costs), a clinician (effectiveness), and the patient (value)—could provide a fairer appraisal of health-care services. Efficacy and costs are often based on falsifiable data. Effectiveness and value depend on the success with which a particular clinical problem has been solved. These data cannot be falsified. The societal perspective is generated by an informal cost-benefit analysis including appraisals by the above-mentioned stakeholders and carried out by an authorized institution. Conclusion: Our analysis suggests that study results expressed in QALYs or as EF cannot be compared unless the variables included in the calculation are specified. It would be far more objective and comprehensive if an authorized institution made an informal decision based on formal assessments of the effectiveness of health-care services evaluated by health-care providers, of the value assessed by consumers, of efficacy described by biostatisticians, and of costs calculated by economists

Validity of the Clock Drawing Test in predicting reports of driving problems in the elderly

BACKGROUND: This study examined the use of the Folstein Mini Mental Status Exam (MMSE) and the Clock Drawing Test (CDT) in predicting retrospective reports of driving problems among the elderly. The utility of existing scoring systems for the CDT was also examined. METHODS: Archival chart records of 325 patients of a geriatric outpatient clinic were reviewed, of which 162 had CDT results (including original clock drawings). T-test, correlation, and regression procedures were used to analyze the data. RESULTS: Both CDT and MMSE scores were significantly worse among non-drivers than individuals who were currently or recently driving. Among current or recent drivers, scores on both instruments correlated significantly with the total number of reported accidents or near misses, although the magnitude of the respective correlations was small. Only MMSE scores, however, significantly predicted whether or not any accidents or near misses were reported at all. Neither MMSE nor CDT scores predicted unique variance in the regressions. CONCLUSIONS: The overall results suggest that both the MMSE and CDT have limited utility as potential indicators of driving problems in the elderly. The demonstrated predictive power for these instruments appears to be redundant, such that both appear to assess general cognitive function versus more specific abilities. Furthermore, the lack of robust prediction suggests that neither are sufficient to serve as stand-alone instruments on which to solely base decisions of driving capacity. Rather, individuals who evidence impairment should be provided a more thorough and comprehensive assessment than can be obtained through screening tools

Depletion of Human Papilloma Virus E6- and E7-Oncoprotein-Specific T-Cell Responses in Women Living With HIV

Background: Cervical cancer - caused by persistent High Risk Human Papilloma Virus (HR HPV) infections - is the second most common cancer affecting women globally. HIV infection increases the risk for HPV persistence, associated disease progression and malignant cell transformation. We therefore hypothesized that this risk increase is directly linked to HIV infection associated dysfunction or depletion of HPV-oncoprotein-specific T-cell responses. Methods: The 2H study specifically included HIV+ and HIV- women with and without cervical lesions and cancer to analyze HPV oncogene-specific T cell responses in relation to HPV infection, cervical lesion status and HIV status. Oncoprotein E6 and E7 specific T-cell responses were quantified for the most relevant types HPV16, 18 and 45 and control antigens (CMV-pp65) and M.tb-PPD in 373 women, using fresh peripheral blood mononuclear cells in an IFN-γ release ELISpot assay. Results: Overall, systemic E6- and E7-oncoprotein-specific T-cell responses were infrequent and of low magnitude, when compared to CMV-pp65 and M.tb-PPD (p < 0.001 for all HR HPV types). Within HIV negative women infected with either HPV16, 18 or 45, HPV16 infected women had lowest frequency of autologous-type-E6/E7-specific T-cell responses (33%, 16/49), as compared to HPV18 (46% (6/13), p = 0.516) and HPV45 (69% (9/13), p = 0.026) infected women. Prevalent HPV18 and 45, but not HPV16 infections were linked to detectable oncoprotein-specific T-cell responses, and for these infections, HIV infection significantly diminished T-cell responses targeting the autologous infecting genotype. Within women living with HIV, low CD4 T-cell counts, detectable HIV viremia as well as cancerous and precancerous lesions were significantly associated with depletion of HPV oncoprotein-specific T-cell responses. Discussion: Depletion of HPV-oncoprotein-specific T-cell responses likely contributes to the increased risk for HR HPV persistence and associated cancerogenesis in women living with HIV. The low inherent immunogenicity of HPV16 oncoproteins may contribute to the exceptional potential for cancerogenesis associated with HPV16 infections

Seamounts off the West Antarctic margin: A case for non-hotspot driven intraplate volcanism

Highlights: • Marie Byrd Seamounts (MBS) formed off Antarctica at 65-56 Ma in an extensional regime • MBS originate from HIMU-type mantle attached at the base of the Antarctic lithosphere • Continental insulation flow transferred HIMU mantle into the oceanic mantle New radiometric age and geochemical data of volcanic rocks from the guyot-type Marie Byrd Seamounts (MBS) and the De Gerlache Seamounts and Peter I Island (Amundsen Sea) are presented. 40Ar/39Ar ages of the shield phase of three MBS are Early Cenozoic (65 to 56 Ma) and indicate formation well after creation of the Pacific-Antarctic Ridge. A Pliocene age (3.0 Ma) documents a younger phase of volcanism at one MBS and a Pleistocene age (1.8 Ma) for the submarine base of Peter I Island. Together with published data, the new age data imply that Cenozoic intraplate magmatism occurred at distinct time intervals in spatially confined areas of the Amundsen Sea, excluding an origin through a fixed mantle plume. Peter I Island appears strongly influenced by an EMII type mantle component that may reflect shallow mantle recycling of a continental raft during the final breakup of Gondwana. By contrast the Sr-Nd-Pb-Hf isotopic compositions of the MBS display a strong affinity to a HIMU type mantle source. On a regional scale the isotopic signatures overlap with those from volcanics related to the West Antarctic Rift System, and Cretaceous intraplate volcanics in and off New Zealand. We propose reactivation of the HIMU material, initially accreted to the base of continental lithosphere during the pre-rifting stage of Marie Byrd Land/Zealandia to explain intraplate volcanism in the Amundsen Sea in the absence of a long-lived hotspot. We propose continental insulation flow as the most plausible mechanism to transfer the sub-continental accreted plume material into the shallow oceanic mantle. Crustal extension at the southern boundary of the Bellingshausen Plate from about 74 to 62 Ma may have triggered adiabatic rise of the HIMU material from the base of Marie Byrd Land to form the MBS. The De Gerlache Seamounts are most likely related to a preserved zone of lithospheric weakness underneath the De Gerlache Gravity Anomaly