Managing healthcare workflows in a multi-agent system environment

Whilst Multi-Agent System (MAS) architectures appear to offer a more flexible model for designers and developers of complex, collaborative information systems, implementing real-world business processes that can be delegated to autonomous agents is still a relatively difficult task. Although a range of agent tools and toolkits exist, there still remains the need to move the creation of models nearer to code generation, in order that the development path be more rigorous and repeatable. In particular, it is essential that complex organisational process workflows are captured and expressed in a way that MAS can successfully interpret. Using a complex social care system as an exemplar, we describe a technique whereby a business process is captured, expressed, verified and specified in a suitable format for a healthcare MAS.</p

Enhancing layered enterprise architecture development through conceptual structures

Enterprise Architecture (EA) enables organisations to align their information technology with their business needs. Layered EA Development (LEAD) enhances EA by using meta-models made up of layered meta-objects, interconnected by semantic relations. Organisations can use these meta-models to benefit from a novel, ontology-based, object-oriented way of EA thinking and working. Furthermore, the meta-models are directed graphs that can be read linearly from a Top Down View (TDV) or a Bottom Up View (BUV) perspective. Conceptual Structures through CG-FCA (where CG refers to Conceptual Graph and FCA to Formal Concept Analysis) is thus used to traverse the TDV and BUV directions using the LEAD Industry 4.0 meta-model as an illustration. The motivation for CG-FCA is stated. It is discovered that CG-FCA: (a) identifies any unwanted cycles in the ‘top-down’ or ‘bottom-up’ directions, and (b) conveniently arranges the many pathways by which the meta-models can be traversed and understood in a Formal Concept Lattice. Through the LEAD meta-model exemplar, the wider appeal of CG-FCA and directed graphs are also identified

Conceptions and perceptions of student initiative held by elementary school teachers and students

The aim of this study is to provide empirical analysis of teachers' and students' understanding of the term student initiative and their perceptions of its manifestations in school environment. A total of 182 teachers and 223 8th grade students were asked to (1) provide associations to the term 'initiative', (2) to specify personal characteristics and behaviors of students with high initiative and (3) to report on the importance and levels of student initiative manifested in different domains of school functioning. Both teachers' and students' associative fields for the term initiative are extremely large and with weak associative strength, implying various diverse meanings. However, both groups consider student initiative as an important feature for school functioning and report on student initiative being manifested in different domains of school life. While there are some differences, both groups connect student initiative with success in school but not with the gender of the student, pointing out prosocial behavior in the school environment and dedication to learning, as well as readiness for additional engagement in the class. Implications for school practice are discussed in terms of changing teacher - student patterns of conversational activities and inclusion of complex and challenging tasks connected to learning material

Knowledge management and human trafficking: using conceptual knowledge representation, text analytics and open-source data to combat organized crime

Globalization, the ubiquity of mobile communications and the rise of the web have all expanded the environment in which organized criminal entities are conducting their illicit activities, and as a result the environment that law enforcement agencies have to police. This paper triangulates the capability of open-source data analytics, ontological knowledge representation and the wider notion of knowledge management (KM) in order to provide an effective, interdisciplinary means to combat such threats, thus providing law enforcement agencies (LEA’s) with a foundation of competitive advantage over human trafficking and other organized crime

Active Semantic Relations in Layered Enterprise Architecture Development

Enterprise Architecture (EA) metamodels align an organisation’s business, information and technology resources so that these assets best meet the organisation’s purpose. The Layered EA Development (LEAD) Ontology enhances EA practices by a metamodel with layered metaobjects as its building blocks interconnected by semantic relations. Each metaobject connects to another metaobject by two semantic relations in opposing directions, thus highlighting how each metaobject views other metaobjects from its perspective. While the resulting two directed graphs reveal all the multiple pathways in the metamodel, more desirable would be to have one directed graph that focusses on the dependencies in the pathways. Towards this aim, using CG-FCA (where CG refers to Conceptual Graph and FCA to Formal Concept Analysis) and a LEAD case study, we determine an algorithm that elicits the active as opposed to the passive semantic relations between the metaobjects resulting in one directed graph metamodel. We also identified the general applicability of our algorithm to any metamodel that consists of triples of objects with active and passive relations

Clinical Study Relation of Biomarkers of Inflammation and Oxidative Stress with Hypertension Occurrence in Lone Atrial Fibrillation

We compared plasma levels of biomarkers of inflammation (CRP) and oxidation (oxLDL), determined at study inclusion in lone atrial fibrillation (LAF) patients (48.6 ± 11.5 years; 74.0% men) and sinus rhythm controls (49.7 ± 9.3 years; 72.7% men, &gt; 0.05), and investigated the association of baseline CRP and oxLDL levels with the risk for vascular disease (VD) development (hypertension, cerebrovascular disease, coronary/peripheral artery disease, and pulmonary embolism) during prospective followup. Baseline CRP (1.2 [0.7-1.9] mg/L versus 1.1 [0.7-1.6] mg/L) and oxLDL levels (66.3 ± 21.2 U/L versus 57.1 ± 14.6 U/L) were higher in LAF patients (both &lt; 0.05). Following a median of 36 months, incident VD occurred in 14 (28.0%) LAF patients, all of whom developed arterial hypertension, and in 5 (11.4%) controls (hypertension, = 4; coronary artery disease, = 1), &lt; 0.05. LAF patients developed VD more frequently and at a younger age. Both CRP (HR, 2.54; 95% CI, 1.26-5.12; = 0.009) and oxLDL (HR, 2.24; 95% CI, 1.14-4.40; = 0.019) were multivariate predictors of incident hypertension in LAF patients, but not in the controls. Further research should clarify clinical relevance of investigated biomarkers for risk stratification and treatment of LAF patients

Medical Treatment of Heart Failure with Reduced Ejection Fraction in the Elderly.

The aging population, higher burden of predisposing conditions and comorbidities along with improvements in therapy all contribute to the growing prevalence of heart failure (HF). Although the majority of trials have not demonstrated age-dependent heterogeneity in the efficacy or safety of medical treatment for HF, the latest trials demonstrate that older participants are less likely to receive established drug therapies for HF with reduced ejection fraction. There remains reluctance in real-world clinical practice to prescribe and up-titrate these medications in older people, possibly because of (mis)understanding about lower tolerance and greater propensity for developing adverse drug reactions. This is compounded by difficulties in the management of multiple medications, patient preferences and other non-medical considerations. Future research should provide a more granular analysis on how to approach medical and device therapies in elderly patients, with consideration of biological differences, difficulties in care delivery and issues relevant to patients' values and perspectives. A variety of approaches are needed, with the central principle being to 'add years to life - and life to years'. These include broader representation of elderly HF patients in clinical trials, improved education of healthcare professionals, wider provision of specialised centres for multidisciplinary HF management and stronger implementation of HF medical treatment in vulnerable patient groups

Oceanography : plankton in a warmer world

Author Posting. © Nature Publishing Group, 2006. This is the author's version of the work. It is posted here by permission of Nature Publishing Group for personal use, not for redistribution. The definitive version was published in Nature 444 (2006): 695-696, doi:10.1038/444695a.Satellite data show that phytoplankton biomass and growth generally decline as the oceans’ surface waters warm up. Is this trend, seen over the past decade, a harbinger of the future for marine ecosystems

Expect the Unexpected in the Medical Treatment of Heart Failure with Reduced Ejection Fraction: between Scientific Evidence and Clinical Wisdom.

Over the past three decades, pharmacological treatment of heart failure (HF) with reduced ejection fraction (HFrEF) has witnessed a significant progress with the introduction of multiple disease-modifying therapies with a proven benefit on morbidity, mortality and quality of life. Recently, several novel medications (sacubitril/valsartan, sodium-glucose contransporter-2 [SGLT2] inhibitors, vericiguat and omecamtiv mecarbil) have shown to provide further improvement in outcomes in patients already receiving standard therapy for HFrEF. Available evidence suggests that sacubitril/valsartan and SGLT2 inhibitors (dapagliflozin and empagliflozin) are beneficial and well-tolerated in the majority inpatients and could be the mainstay treatment of HFrEF. Another group of medications (vericiguat and omecamtiv mecarbil) has shown promising results in reducing the risk of the composite of HF hospitalisation or cardiovascular mortality in patients with the more severe or advanced HF requiring recent hospitalisation. Therefore, these medications may be considered for the treatment of select group of patients with HFrEF with persisting or worsening symptoms despite optimal treatment. In addition, advances in pharmacological management of comorbidities frequently seen in HFrEF patients (diabetes, iron deficiency/anaemia, hyperkalaemia) provide further opportunities to improve outcomes. Given the increasing complexity of evidence-based therapies for HFrEF, there is a growing need to provide a practical perspective to their use. The purpose of this review is to summarise scientific evidence on the efficacy and safety of new and emerging medical therapies in HFrEF, with a focus on the clinical perspective of their use