Model Checking Logics of Social Commitments for Agent Communication

This thesis is about specifying and verifying communications among autonomous and possibly heterogeneous agents, which are the key principle for constructing effective open multi-agent systems (MASs). Effective systems are those that successfully achieve applicability, feasibility, error-freeness and balance between expressiveness and verification efficiency aspects. Over the last two decades, the MAS community has advocated social commitments, which successfully provide a powerful representation for modeling communications in the figure of business contracts from one agent to another. While modeling communications using commitments provides a fundamental basis for capturing flexible communications and helps address the challenge of ensuring compliance with specifications, the designers and business process modelers of the system as a whole cannot guarantee that an agent complies with its commitments as supposed to or at least not wantonly violate or cancel them. They may still wish to first formulate the notion of commitment-based protocols that regulate communications among agents and then establish formal verification (e.g., model checking) by which compliance verification in those protocols is possible. In this thesis, we address the aforementioned challenges by firstly developing a new branching-time temporal logic---called ACTL*c---that extends CTL* with modal operators for representing and reasoning about commitments and all associated actions. The proposed semantics for ACL (agent communication language) messages in terms of commitments and their actions is formal, declarative, meaningful, verifiable and semi-computationally grounded. We use ACTL*c to derive a new specification language of commitment-based protocols, which is expressive and suitable for model checking. We introduce a reduction method to formally transform the problem of model checking ACTL*c to the problem of model checking GCTL* so that the use of the CWB-NC model checker is possible. We prove the soundness of our reduction method and implement it on top of CWB-NC. To check the effectiveness of our reduction method, we report the verification results of the NetBill protocol and Contract Net protocol against some properties. In addition to the reduction method, we develop a new symbolic algorithm to perform model checking ACTL*c. To balance between expressiveness and verification efficiency, we secondly adopt a refined fragment of ACTL*c, called CTLC, an extension of CTL with modalities for commitments and their fulfillment. We extend the formalism of interpreted systems introduced to develop MASs with shared and unshared variables and considered agents' local states in the definition of a full-computationally grounded semantics for ACL messages using commitments. We present reasonable axioms of commitment and fulfillment modalities. In our verification technique, the problem of model checking CTLC is reduced into the problems of model checking ARCTL and GCTL* so that respectively extended NuSMV and CWB-NC (as a benchmark) are usable. We prove the soundness of our reduction methods and then implement them on top of the extended NuSMV and CWB-NC model checkers. To evaluate the effectiveness of our reduction methods, we verified the correctness of two business case studies. We finally proceed to develop a new symbolic model checking algorithm to directly verify commitments and their fulfillment and commitment-based protocols. We analyze the time complexity of CTLC model checking for explicit models and its space complexity for concurrent programs that provide compact representations. We prove that although CTLC extends CTL, their model checking algorithms still have the same time complexity for explicit models, and the same space complexity for concurrent programs. We fully implement the proposed algorithm on top of MCMAS, a model checker for the verification of MASs, and then check its efficiency and scalability using an industrial case study

Model Checking Real-Time Conditional Commitment Logic using Transformation

A new logical language for real-time conditional commitments called RTCTLcc has been developed by extending the CTL logic with interval bounded until modalities, conditional commitment modalities, and fulfillment modalities. RTCTLcc allows us to express qualitative and quantitative commitment requirements in a convenient way. These requirements can be used to model multi-agent systems (MASs) employed in environments that react properly and timely to events occurring at time instants or within time intervals. However, the timing requirements and behaviors of MASs need an appropriate way to scale and bundle and should be carefully analyzed to ensure their correctness, especially when agents are autonomous. In this paper, we develop transformation algorithms that are fully implemented in a new Java toolkit for automatically transforming the problem of model checking RTCTLcc into the problem of model checking RTCTL (real-time CTL). The toolkit engine is built on top of the NuSMV tool, effectively used to automatically verify and analyze the correctness of real-time distributed systems. We analyzed the time and space computational complexity of the RTCTLcc model checking problem. We proved the soundness and completeness of the transformation technique and experimentally evaluated the validity of the toolkit using a set of business scenarios. Moreover, we added a capability in the toolkit to automatically scale MASs and to bundle requirements in a parametric form. We experimentally evaluated the scalability aspect of our approach using the standard ordering protocol. We further validated the approach using an industrial case study

Reducing model checking commitments for agent communication to model checking ARCTL and GCTL*

Social commitments have been extensively and effectively used to represent and model business contracts among autonomous agents having competing objectives in a variety of areas (e.g., modeling business processes and commitment-based protocols). However, the formal verification of social commitments and their fulfillment is still an active research topic. This paper presents CTLC+ that modifies CTLC, a temporal logic of commitments for agent communication that extends computation tree logic (CTL) logic to allow reasoning about communicating commitments and their fulfillment. The verification technique is based on reducing the problem of model checking CTLC+ into the problem of model checking ARCTL (the combination of CTL with action formulae) and the problem of model checking GCTL* (a generalized version of CTL* with action formulae) in order to respectively use the extended NuSMV symbolic model checker and the CWB-NC automata-based model checker as a benchmark. We also prove that the reduction techniques are sound and the complexity of model checking CTLC+ for concurrent programs with respect to the size of the components of these programs and the length of the formula is PSPACE-complete. This matches the complexity of model checking CTL for concurrent programs as shown by Kupferman et al. We finally provide two case studies taken from business domain along with their respective implementations and experimental results to illustrate the effectiveness and efficiency of the proposed technique. The first one is about the NetBill protocol and the second one considers the Contract Net protocol

Assessment of patient safety culture perception among healthcare workers in intensive care units of Alexandria Main University Hospital, Egypt

Background: Patient safety culture (PSC) is a vital feature to assess the ability of any healthcare setting in addressing and reducing patients harm. This study attempted to assess the PSC in Intensive Care Units (ICUs) at Alexandria Main University Hospital (AMUH) from the point of view of physicians and nurses. Methods: A cross-sectional study was implemented in two ICUs at AMUH over period of six months. Seventy-two participants were interviewed using the Hospital Patient Safety Scale, customized by the Agency for Healthcare Research and Quality (AHRQ). Results: The average positive response to individual items in the patient safety scale ranged from 2.7% to 79.2%. The “Teamwork within Units” dimension had the utmost average percentage positive score (63.5%) amongst all participants, on the other hand, the “Non-Punitive Response to Errors” dimension had the lowest one (12.0%). Less than half (45.8%) of the interviewed participants rated patient’s safety at the hospital as accepted. Conclusions: PSC is friable in targeted ICUs, much of work is needed to raise the responsiveness of health care givers regarding this issue. Executives and supervisors need to encourage the practices of PS through a blame free culture

Laparoscopy in management of appendicitis in high-, middle-, and low-income countries: a multicenter, prospective, cohort study.

BACKGROUND: Appendicitis is the most common abdominal surgical emergency worldwide. Differences between high- and low-income settings in the availability of laparoscopic appendectomy, alternative management choices, and outcomes are poorly described. The aim was to identify variation in surgical management and outcomes of appendicitis within low-, middle-, and high-Human Development Index (HDI) countries worldwide. METHODS: This is a multicenter, international prospective cohort study. Consecutive sampling of patients undergoing emergency appendectomy over 6 months was conducted. Follow-up lasted 30 days. RESULTS: 4546 patients from 52 countries underwent appendectomy (2499 high-, 1540 middle-, and 507 low-HDI groups). Surgical site infection (SSI) rates were higher in low-HDI (OR 2.57, 95% CI 1.33-4.99, p = 0.005) but not middle-HDI countries (OR 1.38, 95% CI 0.76-2.52, p = 0.291), compared with high-HDI countries after adjustment. A laparoscopic approach was common in high-HDI countries (1693/2499, 67.7%), but infrequent in low-HDI (41/507, 8.1%) and middle-HDI (132/1540, 8.6%) groups. After accounting for case-mix, laparoscopy was still associated with fewer overall complications (OR 0.55, 95% CI 0.42-0.71, p < 0.001) and SSIs (OR 0.22, 95% CI 0.14-0.33, p < 0.001). In propensity-score matched groups within low-/middle-HDI countries, laparoscopy was still associated with fewer overall complications (OR 0.23 95% CI 0.11-0.44) and SSI (OR 0.21 95% CI 0.09-0.45). CONCLUSION: A laparoscopic approach is associated with better outcomes and availability appears to differ by country HDI. Despite the profound clinical, operational, and financial barriers to its widespread introduction, laparoscopy could significantly improve outcomes for patients in low-resource environments. TRIAL REGISTRATION: NCT02179112

Global economic burden of unmet surgical need for appendicitis

Background: There is a substantial gap in provision of adequate surgical care in many low-and middle-income countries. This study aimed to identify the economic burden of unmet surgical need for the common condition of appendicitis. Methods: Data on the incidence of appendicitis from 170 countries and two different approaches were used to estimate numbers of patients who do not receive surgery: as a fixed proportion of the total unmet surgical need per country (approach 1); and based on country income status (approach 2). Indirect costs with current levels of access and local quality, and those if quality were at the standards of high-income countries, were estimated. A human capital approach was applied, focusing on the economic burden resulting from premature death and absenteeism. Results: Excess mortality was 4185 per 100 000 cases of appendicitis using approach 1 and 3448 per 100 000 using approach 2. The economic burden of continuing current levels of access and local quality was US $92 492 million using approach 1 and$73 141 million using approach 2. The economic burden of not providing surgical care to the standards of high-income countries was $95 004 million using approach 1 and$75 666 million using approach 2. The largest share of these costs resulted from premature death (97.7 per cent) and lack of access (97.0 per cent) in contrast to lack of quality. Conclusion: For a comparatively non-complex emergency condition such as appendicitis, increasing access to care should be prioritized. Although improving quality of care should not be neglected, increasing provision of care at current standards could reduce societal costs substantially

Pooled analysis of WHO Surgical Safety Checklist use and mortality after emergency laparotomy

Background The World Health Organization (WHO) Surgical Safety Checklist has fostered safe practice for 10 years, yet its place in emergency surgery has not been assessed on a global scale. The aim of this study was to evaluate reported checklist use in emergency settings and examine the relationship with perioperative mortality in patients who had emergency laparotomy. Methods In two multinational cohort studies, adults undergoing emergency laparotomy were compared with those having elective gastrointestinal surgery. Relationships between reported checklist use and mortality were determined using multivariable logistic regression and bootstrapped simulation. Results Of 12 296 patients included from 76 countries, 4843 underwent emergency laparotomy. After adjusting for patient and disease factors, checklist use before emergency laparotomy was more common in countries with a high Human Development Index (HDI) (2455 of 2741, 89.6 per cent) compared with that in countries with a middle (753 of 1242, 60.6 per cent; odds ratio (OR) 0.17, 95 per cent c.i. 0.14 to 0.21, P <0001) or low (363 of 860, 422 per cent; OR 008, 007 to 010, P <0.001) HDI. Checklist use was less common in elective surgery than for emergency laparotomy in high-HDI countries (risk difference -94 (95 per cent c.i. -11.9 to -6.9) per cent; P <0001), but the relationship was reversed in low-HDI countries (+121 (+7.0 to +173) per cent; P <0001). In multivariable models, checklist use was associated with a lower 30-day perioperative mortality (OR 0.60, 0.50 to 073; P <0.001). The greatest absolute benefit was seen for emergency surgery in low- and middle-HDI countries. Conclusion Checklist use in emergency laparotomy was associated with a significantly lower perioperative mortality rate. Checklist use in low-HDI countries was half that in high-HDI countries.Peer reviewe

Outcomes from elective colorectal cancer surgery during the SARS-CoV-2 pandemic

This study aimed to describe the change in surgical practice and the impact of SARS-CoV-2 on mortality after surgical resection of colorectal cancer during the initial phases of the SARS-CoV-2 pandemic

Mortality of emergency abdominal surgery in high-, middle- and low-income countries

Background: Surgical mortality data are collected routinely in high-income countries, yet virtually no low- or middle-income countries have outcome surveillance in place. The aim was prospectively to collect worldwide mortality data following emergency abdominal surgery, comparing findings across countries with a low, middle or high Human Development Index (HDI). Methods: This was a prospective, multicentre, cohort study. Self-selected hospitals performing emergency surgery submitted prespecified data for consecutive patients from at least one 2-week interval during July to December 2014. Postoperative mortality was analysed by hierarchical multivariable logistic regression. Results: Data were obtained for 10 745 patients from 357 centres in 58 countries; 6538 were from high-, 2889 from middle- and 1318 from low-HDI settings. The overall mortality rate was 1⋅6 per cent at 24 h (high 1⋅1 per cent, middle 1⋅9 per cent, low 3⋅4 per cent; P < 0⋅001), increasing to 5⋅4 per cent by 30 days (high 4⋅5 per cent, middle 6⋅0 per cent, low 8⋅6 per cent; P < 0⋅001). Of the 578 patients who died, 404 (69⋅9 per cent) did so between 24 h and 30 days following surgery (high 74⋅2 per cent, middle 68⋅8 per cent, low 60⋅5 per cent). After adjustment, 30-day mortality remained higher in middle-income (odds ratio (OR) 2⋅78, 95 per cent c.i. 1⋅84 to 4⋅20) and low-income (OR 2⋅97, 1⋅84 to 4⋅81) countries. Surgical safety checklist use was less frequent in low- and middle-income countries, but when used was associated with reduced mortality at 30 days. Conclusion: Mortality is three times higher in low- compared with high-HDI countries even when adjusted for prognostic factors. Patient safety factors may have an important role. Registration number: NCT02179112 (http://www.clinicaltrials.gov)

Global variation in anastomosis and end colostomy formation following left-sided colorectal resection

Background End colostomy rates following colorectal resection vary across institutions in high-income settings, being influenced by patient, disease, surgeon and system factors. This study aimed to assess global variation in end colostomy rates after left-sided colorectal resection. Methods This study comprised an analysis of GlobalSurg-1 and -2 international, prospective, observational cohort studies (2014, 2016), including consecutive adult patients undergoing elective or emergency left-sided colorectal resection within discrete 2-week windows. Countries were grouped into high-, middle- and low-income tertiles according to the United Nations Human Development Index (HDI). Factors associated with colostomy formation versus primary anastomosis were explored using a multilevel, multivariable logistic regression model. Results In total, 1635 patients from 242 hospitals in 57 countries undergoing left-sided colorectal resection were included: 113 (6·9 per cent) from low-HDI, 254 (15·5 per cent) from middle-HDI and 1268 (77·6 per cent) from high-HDI countries. There was a higher proportion of patients with perforated disease (57·5, 40·9 and 35·4 per cent; P < 0·001) and subsequent use of end colostomy (52·2, 24·8 and 18·9 per cent; P < 0·001) in low- compared with middle- and high-HDI settings. The association with colostomy use in low-HDI settings persisted (odds ratio (OR) 3·20, 95 per cent c.i. 1·35 to 7·57; P = 0·008) after risk adjustment for malignant disease (OR 2·34, 1·65 to 3·32; P < 0·001), emergency surgery (OR 4·08, 2·73 to 6·10; P < 0·001), time to operation at least 48 h (OR 1·99, 1·28 to 3·09; P = 0·002) and disease perforation (OR 4·00, 2·81 to 5·69; P < 0·001). Conclusion Global differences existed in the proportion of patients receiving end stomas after left-sided colorectal resection based on income, which went beyond case mix alone