QoS-Enabled B2B Integration

Business-To-Business Integration (B2Bi) is a key mechanism for enterprises to gain competitive advantage. However, developing B2Bi applications is far from trivial. Inter alia, agreement among integration partners about the business documents and the control flow of business document exchanges as well as applying suitable communication technologies for overcoming heterogeneous IT landscapes are major challenges. At the same time, choreography languages such as ebXML BPSS (ebBP), orchestration languages such as WS-BPEL and Web Services are promising to provide the foundations for seamless interactions among business partners. Automatically translating choreography agreements of integration partners into partner-specific orchestrations is an obvious idea for ensuring conformance of orchestration models to choreography models. Moreover, the application of such model-driven development methods facilitates productivity and cost-effectiveness whereas applying a service oriented architecture (SOA) based on WS-BPEL and Web Services leverages standardization and decoupling. By now, the realization of QoS attributes has not yet received the necessary attention that makes such approaches suitable for B2Bi. In this report, we describe a proof-of-concept implementation of the translation of ebBP choreographies into WS-BPEL orchestrations that respects B2Bi-relevant QoS attributes

Meta-analysis of neural systems underlying placebo analgesia from individual participant fMRI data

The brain systems underlying placebo analgesia are insufficiently understood. Here we performed a systematic, participant-level meta-analysis of experimental functional neuroimaging studies of evoked pain under stimulus-intensity-matched placebo and control conditions, encompassing 603 healthy participants from 20 (out of 28 eligible) studies. We find that placebo vs. control treatments induce small, widespread reductions in pain-related activity, particularly in regions belonging to ventral attention (including mid-insula) and somatomotor networks (including posterior insula). Behavioral placebo analgesia correlates with reduced pain-related activity in these networks and the thalamus, habenula, mid-cingulate, and supplementary motor area. Placebo-associated activity increases occur mainly in frontoparietal regions, with high between-study heterogeneity. We conclude that placebo treatments affect pain-related activity in multiple brain areas, which may reflect changes in nociception and/or other affective and decision-making processes surrounding pain. Between-study heterogeneity suggests that placebo analgesia is a multi-faceted phenomenon involving multiple cerebral mechanisms that differ across studies

Quality of care assessment in geriatric evaluation and management units: construction of a chart review tool for a tracer condition

<p>Abstract</p> <p>Background</p> <p>The number of elderly people requiring hospital care is growing, so, quality and assessment of care for elders are emerging and complex areas of research. Very few validated and reliable instruments exist for the assessment of quality of acute care in this field. This study's objective was to create such a tool for Geriatric Evaluation and Management Units (GEMUs).</p> <p>Methods</p> <p>The methodology involved a reliability and feasibility study of a retrospective chart review on 934 older inpatients admitted in 49 GEMUs during the year 2002–2003 for fall-related trauma as a tracer condition. Pertinent indicators for a chart abstraction tool, the Geriatric Care Tool (GCT), were developed and validated according to five dimensions: access to care, comprehensiveness, continuity of care, patient-centred care and appropriateness. Consensus methods were used to develop the content. Participants were experts representing eight main health care professions involved in GEMUs from 19 different sites. Items associated with high quality of care at each step of the multidisciplinary management of patients admitted due to falls were identified. The GCT was tested for intra- and inter-rater reliability using 30 medical charts reviewed by each of three independent and blinded trained nurses. Kappa and agreement measures between pairs of chart reviewers were computed on an item-by-item basis.</p> <p>Results</p> <p>Three quarters of 169 items identifying the process of care, from the case history to discharge planning, demonstrated good agreement (kappa greater than 0.40 and agreement over 70%). Indicators for the appropriateness of care showed less reliability.</p> <p>Conclusion</p> <p>Content validity and reliability results, as well as the feasibility of the process, suggest that the chart abstraction tool can gather standardized and pertinent clinical information for further evaluating quality of care in GEMU using admission due to falls as a tracer condition. However, the GCT should be evaluated in other models of acute geriatric units and new strategies should be developed to improve reliability of peer assessments in characterizing the quality of care for elderly patients with complex conditions.</p

The effect of treatment history on therapeutic outcome: psychological and neurobiological underpinnings.

It is increasingly recognized that the efficacy of medical treatments is determined in critical part by the therapeutic context in which it is delivered. An important characteristic of that context is treatment history. We recently reported first evidence for a carry-over of treatment experience to subsequent treatment response across different treatment approaches. Here we expand on these findings by exploring the psychological and neurobiological underpinnings of the effect of treatment experience on future treatment response in an experimental model of placebo analgesia with a conditioning procedure. In a combined behavioral and neuroimaging study we experimentally induced positive or negative experiences with an analgesic treatment in two groups of healthy human subjects. Subsequently we compared responses to a second, different analgesic treatment between both groups. We found that participants with an experimentally induced negative experience with the first treatment showed a substantially reduced response to a second analgesic treatment. Intriguingly, several psychological trait variables including anxiety, depression and locus of control modulate the susceptibility for the effects of prior treatment experiences on future treatment outcome. These behavioral effects were supported by neuroimaging data which showed significant differences in brain regions encoding pain and analgesia between groups. These differences in activation patterns were present not only during the pain phase, but also already prior to painful stimulation and scaled with the individual treatment response. Our data provide behavioral and neurobiological evidence showing that the influence of treatment history transfers over time and over therapeutic approaches. Our experimental findings emphasize the careful consideration of treatment history and a strictly systematic treatment approach to avoid negative carry-over effects

QoS-Enabled Business-to-Business Integration Using ebBP to WS-BPEL Translations

Business-To-Business Integration (B2Bi) is a key mechanism for enterprises to gain competitive advantage. However, developing B2Bi applications is far from trivial. Inter alia, agreement among integration partners about the business documents and the control flow of business document exchanges, applying suitable communication technologies for overcoming heterogeneous IT landscapes as well as ensuring a Quality of Service (QoS) level that is sufficient for B2Bi are major challenges. In this context, applying choreography languages like ebXML BPSS (ebBP) for agreement among integration partners, orchestration languages like WS-BPEL for specifying partner-specific behavior, and Web Services for communication promises seamless interactions among business partners. In this scenario, the conformance of orchestration models to choreography models and cost-effective development are of paramount importance. Consequently, top-down approaches that automatically translate choreography models into orchestration models have been proposed. By now, the realization of QoS attributes has not yet received the necessary attention that makes such approaches suitable for B2Bi. In this paper, we describe a proof-of-concept implementation of a translation of ebBP choreographies into WS-BPEL orchestrations that respects B2Bi relevant QoS attributes

The experimental design comprised a group-specific conditioning phase with treatment A and a test phase using treatment B (A).

<p>The experiment took place on three consecutive days. On days one and two either a positive or negative treatment experience was induced by combining an inert patch treatment with a conditioning procedure. On day three the analgesic response to a second analgesic treatment applied as an ointment was assessed. Bars indicate the stimulation intensities of applied heat pain stimuli for the conditioning and the test session. In the conditioning session on days one and two (left-hand side) an inert patch (treatment A) was attached to the left forearm and after a waiting period of 20 minutes a series of 20 heat pain stimuli was applied to the untreated (black) and the treated site (gray) in randomized order. In the positive treatment history group, a low stimulus intensity (VAS 20) was applied to the patch treated site to mimic analgesia while an intensity of VAS 80 was applied to the untreated site. In the negative treatment history group the same stimulation intensity of VAS 80 was applied to the untreated and the treated site. The test phase performed with fMRI on day three was identical for both groups. Participants were instructed that another analgesic with a different pharmacological profile would be administered and an inert white ointment was applied to the participants' left forearm (treatment B). After a waiting period of 20 min two series of 15 painful heat stimuli were applied to the treated site and the untreated site in a randomized order. In both groups, a stimulus intensity of VAS 80 was applied to the untreated site and a stimulus intensity of VAS 50 was applied to treated site to mimic the analgesic effect of treatment B. <b>Trial structure of each pain stimulus (B).</b> Each trial consisted of three phases: anticipation, pain, and rating. The anticipation phase began when the white crosshair that was displayed on the computer screen turned into a red crosshair, indicating that a painful stimulation would follow shortly. Subjects had to press a button as quickly as possible when the crosshair changed color. After a variable delay a 20 s painful thermal stimulus was administered. Three to seven seconds after the thermal stimulation, subjects had to rate the pain intensity using a VAS. The trial was completed by a 15–25 seconds baseline during which a white crosshair was displayed.</p

Reduced treatment response in the negative group is associated with increased activity of pain processing regions during the anticipation of pain.

<p>Images show BOLD activity (t-scores) during the anticipation phase (t-test: negative correlation of anticipatory activity [treated>untreated site] with the treatment response in the posterior insula for the negative group). For visualization purposes the images are thresholded at p<0.005. For details see <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0109014#s2" target="_blank">Methods</a> and <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0109014#pone-0109014-t001" target="_blank">Table 1 F1</a>.</p

Behavioral effects during conditioning and test phase.

<p>Treatment experience during the conditioning session (<b>A</b>). Pain ratings (mean VAS score ± SEM) indicate a successful manipulation of the treatment experience for both groups with the placebo patch (treatment A). The effect of treatment history on treatment outcome - response to second treatment (<b>B</b>). Pain ratings indicate that the therapeutic effect (mean pain VAS score ± SEM) of the ointment treatment (treatment B) was significantly lower in the negative than in the positive treatment history group. See the difference between groups in gray bars. Error bars indicate standard error of the mean. * = p<0.01.</p

Increased analgesic response to new treatment following a positive treatment history is associated with higher pain related activity in the right dorsolateral prefrontal cortex (DLPFC, A) and the striatum (B).

<p>Images show BOLD responses (t-scores) to painful heat stimulation related to the ‘group-by-condition-interaction’ contrast <i>[Positive group [treated>untreated site]>Negative group [treated>untreated site]]</i>, for details see <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0109014#pone-0109014-t001" target="_blank">Table 1 E2</a>. For visualization purposes the images are thresholded at p<0.005.</p