Medically Unexplained Oropharyngeal Dysphagia at the University Hospital ENT Outpatient Clinic for Dysphagia: A Cross-Sectional Cohort Study

Medically unexplained oropharyngeal dysphagia (MUNOD) is a rare condition. It presents without demonstrable abnormalities in the anatomy of the upper aero-digestive tract and/or swallowing physiology. This study investigates whether MUNOD is related to affective or other psychiatric conditions. The study included patients with dysphagic complaints who had no detectible structural or physiological abnormalities upon swallowing examination. Patients with any underlying disease or disorder that could explain the oropharyngeal dysphagia were excluded. All patients underwent a standardized examination protocol, with FEES examination, the Hospital Anxiety and Depression Scale (HADS), and the Dysphagia Severity Scale (DSS). Two blinded judges scored five different FEES variables. None of the 14 patients included in this study showed any structural or physiological abnormalities during FEES examination. However, the majority did show abnormal piecemeal deglutition, which could be a symptom of MUNOD. Six patients (42.8%) had clinically relevant symptoms of anxiety and/or depression. The DSS scores did not differ significantly between patients with and without affective symptoms. Affective symptoms are common in patients with MUNOD, and their psychiatric conditions could possibly be related to their swallowing problems

Early treatment versus expectative management of patent ductus arteriosus in preterm infants

_Background:_ Much controversy exists about the optimal management of a patent ductus arteriosus (PDA) in preterm infants, especially in those born at a gestational age (GA) less than 28weeks. No causal relationship has been proven between a (haemodynamically significant) PDA and neonatal complications related to pulmonary hyperperfusion and/or systemic hypoperfusion. Although studies show conflicting results, a common understanding is that medical or surgical treatment of a PDA does not seem to reduce the risk of major neonatal morbidities and mortality. As the PDA might have closed spontaneously, treated children are potentially exposed to iatrogenic adverse effects. A conservative approach is gaining interest worldwide, although convincing evidence to support its use is lacking. _Methods:_ This multicentre, randomised, non-inferiority trial is conducted in neonatal intensive care units. The study population consists of preterm infants (GA1.5mm. Early treatment (between 24 and 72h postnatal age) with the cyclooxygenase inhibitor(COXi) ibuprofen (IBU) is compared with an expectative management (no intervention intended to close a PDA). The primary outcome is the composite of mortality, and/or necrotising enterocolitis (NEC) Bell stage ≥ IIa, and/or bronchopulmonary dysplasia (BPD) defined as the need for supplemental oxygen, all at a postmenstrual age (PMA) of 36weeks. Secondary outcome parameters are short term sequelae of cardiovascular failure, comorbidity and adverse events assessed during hospitalization and long-term neurodevelopmental outcome assessed at a corrected age of 2 years. Consequences regarding health economics are evaluated by cost effectiveness analysis and budget impact analysis. _Discussion:_ As a conservative approach is gaining interest, we investigate whether in preterm infants, born at a GA less than 28weeks, with a PDA an expectative management is non-inferior to early treatment with IBU regarding to the composite outcome of mortality and/or NEC and/or BPD at a PMA of 36weeks

Properties that influence business process management maturity and its effect on organizational performance

Abstract BPM maturity is a measure to evaluate how professionally an organization manages its business processes. Previous research provides evidence that higher BPM maturity leads to better performance of processes and of the organization as a whole. It also claims that different organizations should strive for different levels of maturity, depending on their properties. This paper presents an empirical investigation of these claims, based on a sample of 120 organizations and looking at a selection of organizational properties. Our results reveal that higher BPM maturity contributes to better performance, but only up to a point. Interestingly, it contradicts the popular belief that higher innovativeness is associated with lower BPM maturity, rather showing that higher innovativeness is associated with higher BPM maturity. In addition, the paper shows that companies in different regions have a different level of BPM maturity. These findings can be used as a benchmark and a motivation for organizations to increase their BPM maturity

Message from the EDOC 2017 workshop chairs

Presents the introductory welcome message from the conference proceedings. May include the conference officers' congratulations to all involved with the conference event and publication of the proceedings record

Business process architecture : use and correctness

Becoming more and more process oriented, companies develop collections of hundreds or even thousands of business process models that represent the complex system of cooperating entities that form an organization. Designing and analyzing the structure of this system of business process models emerges as a new challenge, which is covered by the field of business process architecture. This paper presents a formal conceptual framework for representing and analyzing business process architectures. It identifies patterns of relations between process models, and it introduces anti-patterns that represent erroneous relations between them. The conceptual framework and the patterns are evaluated using a real-world process model collection. The evaluation shows that explicitly representing and analyzing relations between process models can help improving the correctness and consistency of the business process architecture as a whole

Business process model merging : an approach to business process consolidation

This article addresses the problem of constructing consolidated business process models out of collections of process models that share common fragments. The article considers the construction of unions of multiple models (called merged models) as well as intersections (called digests). Merged models are intended for analysts who wish to create a model that subsumes a collection of process models -- typically representing variants of the same underlying process -- with the aim of replacing the variants with the merged model. Digests, on the other hand, are intended for analysts who wish to identify the most recurring fragments across a collection of process models, so that they can focus their efforts on optimizing these fragments. The article presents an algorithm for computing merged models and an algorithm for extracting digests from a merged model. The merging and digest extraction algorithms have been implemented and tested against collections of process models taken from multiple application domains. The tests show that the merging algorithm produces compact models and scales up to process models containing hundreds of nodes. Furthermore, a case study conducted in a large insurance company has demonstrated the usefulness of the merging and digest extraction operators in a practical setting

Predicting Remaining Useful Life with Similarity-Based Priors

Prognostics is the area of research that is concerned with predicting the remaining useful life of machines and machine parts. The remaining useful life is the time during which a machine or part can be used, before it must be replaced or repaired. To create accurate predictions, predictive techniques must take external data into account on the operating conditions of the part and events that occurred during its lifetime. However, such data is often not available. Similarity-based techniques can help in such cases. They are based on the hypothesis that if a curve developed similarly to other curves up to a point, it will probably continue to do so. This paper presents a novel technique for similarity-based remaining useful life prediction. In particular, it combines Bayesian updating with priors that are based on similarity estimation. The paper shows that this technique outperforms other techniques on long-term predictions by a large margin, although other techniques still perform better on short-term predictions