Adaptive Workflow Design Based on Blockchain

Increasingly, organizational processes have become more complex. There is a need for the design of workflows to focus on how organizations adapt to emergent processes while balancing the need for decentralization and centralization goal. The advancement in new technologies especially blockchain provides organizations with the opportunity to achieve the goal. Using blockchain technology (i.e. smart contract and blocks of specified consensus for deferred action), we leverage the theory of deferred action and a coordination framework to conceptually design a workflow management system that addresses organizational emergence (e-WfMS). Our artifact helps managers to predict and store the impact of deferred actions. We evaluated the effectiveness of our system against a complex adaptive system for utility assessment

Baseline natural killer and T cell populations correlation with virologic outcome after regimen simplification to atazanavir/ritonavir alone (ACTG 5201)

Objectives: Simplified maintenance therapy with ritonavir-boosted atazanavir (ATV/r) provides an alternative treatment option for HIV-1 infection that spares nucleoside analogs (NRTI) for future use and decreased toxicity. We hypothesized that the level of immune activation (IA) and recovery of lymphocyte populations could influence virologic outcomes after regimen simplification. Methods: Thirty-four participants with virologic suppression ≥48 weeks on antiretroviral therapy (2 NRTI plus protease inhibitor) were switched to ATV/r alone in the context of the ACTG 5201 clinical trial. Flow cytometric analyses were performed on PBMC isolated from 25 patients with available samples, of which 24 had lymphocyte recovery sufficient for this study. Assessments included enumeration of T-cells (CD4/CD8), natural killer (NK) (CD3+CD56 +CD16+) cells and cell-associated markers (HLA-DR, CD's 38/69/94/95/158/279). Results: Eight of the 24 patients had at least one plasma HIV-1 RNA level (VL) <50 copies/mL during the study. NK cell levels below the group median of 7.1% at study entry were associated with development of VL <50 copies/mL following simplification by regression and survival analyses (p = 0.043 and 0.023), with an odds ratio of 10.3 (95% CI: 1.92-55.3). Simplification was associated with transient increases in naïve and CD25+ CD4+ T-cells, and had no impact on IA levels. Conclusions: Lower NK cell levels prior to regimen simplification were predictive of virologic rebound after discontinuation of nucleoside analogs. Regimen simplification did not have a sustained impact on markers of IA or T lymphocyte populations in 48 weeks of clinical monitoring. Trial Registration: ClinicalTrials.gov NCT00084019

The Risk of Virologic Failure Decreases with Duration of HIV Suppression, at Greater than 50% Adherence to Antiretroviral Therapy

Background: We hypothesized that the percent adherence to antiretroviral therapy necessary to maintain HIV suppression would decrease with longer duration of viral suppression. Methodology: Eligible participants were identified from the REACH cohort of marginally housed HIV infected adults in San Francisco. Adherence to antiretroviral therapy was measured through pill counts obtained at unannounced visits by research staff to each participant's usual place of residence. Marginal structural models and targeted maximum likelihood estimation methodologies were used to determine the effect of adherence to antiretroviral therapy on the probability of virologic failure during early and late viral suppression. Principal Findings: A total of 221 subjects were studied (median age 44.1 years; median CD4+ T cell nadir 206 cells/mm3). Most subjects were taking the following types of antiretroviral regimens: non-nucleoside reverse transcriptase inhibitor based (37%), ritonavir boosted protease inhibitor based (28%), or unboosted protease inhibitor based (25%). Comparing the probability of failure just after achieving suppression vs. after 12 consecutive months of suppression, there was a statistically significant decrease in the probability of virologic failure for each range of adherence proportions we considered, as long as adherence was greater than 50%. The estimated risk difference, comparing the probability of virologic failure after 1 month vs. after 12 months of continuous viral suppression was 0.47 (95% CI 0.23–0.63) at 50–74% adherence, 0.29 (CI 0.03–0.50) at 75–89% adherence, and 0.36 (CI 0.23–0.48) at 90–100% adherence. Conclusions: The risk of virologic failure for adherence greater than 50% declines with longer duration of continuous suppression. While high adherence is required to maximize the probability of durable viral suppression, the range of adherence capable of sustaining viral suppression is wider after prolonged periods of viral suppression

Modelling imperfect adherence to HIV induction therapy

Abstract Background Induction-maintenance therapy is a treatment regime where patients are prescribed an intense course of treatment for a short period of time (the induction phase), followed by a simplified long-term regimen (maintenance). Since induction therapy has a significantly higher chance of pill fatigue than maintenance therapy, patients might take drug holidays during this period. Without guidance, patients who choose to stop therapy will each be making individual decisions, with no scientific basis. Methods We use mathematical modelling to investigate the effect of imperfect adherence during the inductive phase. We address the following research questions: 1. Can we theoretically determine the maximal length of a possible drug holiday and the minimal number of doses that must subsequently be taken while still avoiding resistance? 2. How many drug holidays can be taken during the induction phase? Results For a 180 day therapeutic program, a patient can take several drug holidays, but then has to follow each drug holiday with a strict, but fairly straightforward, drug-taking regimen. Since the results are dependent upon the drug regimen, we calculated the length and number of drug holidays for all fifteen protease-sparing triple-drug cocktails that have been approved by the US Food and Drug Administration. Conclusions Induction therapy with partial adherence is tolerable, but the outcome depends on the drug cocktail. Our theoretical predictions are in line with recent results from pilot studies of short-cycle treatment interruption strategies and may be useful in guiding the design of future clinical trials

A Project Portfolio Management Approach to Tacklingthe Exploration/Exploitation Trade-off

Organizational ambidexterity (OA) is an essen-tial capability for surviving in dynamic business environ-ments that advocates the simultaneous engagement inexploration and exploitation. Over the last decades,knowledge on OA has substantially matured, coveringinsights into antecedents, outcomes, and moderators of OA.However, there is little prescriptive knowledge that offersguidance on how to put OA into practice and to tackle thetrade-off between exploration and exploitation. To addressthis gap, the authors adopt the design science researchparadigm and propose an economic decision model asartifact. The decision model assists organizations inselecting and scheduling exploration and exploitation pro-jects to become ambidextrous in an economically reason-able manner. As for justificatory knowledge, the decisionmodel draws from prescriptive knowledge on projectportfolio management and value-based management, andfrom descriptive knowledge related to OA to structure thefield of action. To evaluate the decision model, its designspecification is discussed against theory-backed designobjectives and with industry experts. The paper alsoinstantiates the decision model as a software prototype andapplies the prototype to a case based on real-world data

Business process redesign at a mental healthcare institute: a coulored petri net approach

Business Process Redesign aims to radically improve the performance of business processes. One of the approaches to derive such an improved process design is an evolutionary approach, making use of redesign heuristics (Reijers, 2003). Simulation of the redesigned business process comes into play if one has to decide whether the redesign is better than the previous process design, or if one needs to compare alternative redesigns. Usually, the characteristics of the process are such that a purely analytical performance evaluation is not feasible. This paper shows the applicability of coloured Petri nets, especially CPN Tools, in such a redesign approach. The starting point of the paper is a case study in a mental healthcare institute, which focussed on improvement of the intake process: reduction of flow time and service time. We show the initial CPN model and an alternative redesigned CPN model for the intake process and evaluate the impact on flow time and service time. In line with previous research, we conclude that coloured Petri nets are well suited to model and simulate business processes. Applying Monitors in addition to the regular CPN Tools package helped us to carry out the simulations in such a way that we were able to carry out statistical analysis, enabling us to compare the performance of different models. An important drawback of our approach is that modelling resources in a business process is quite laborious and results in complex constructions, which are hard to communicate with people who should be able to evaluate the effect of a particular redesign

Workflow management systems + swarm intelligence = dynamic task assignment for emergency management applications

The assignment of tasks to human performers is a critical component in people-centric business process management systems. Workflow management systems typically assign work items using strategies that only consider qualified resources. There are, however, situations, where this approach falls short. For instance, in emergency response situations, tasks need to be carried out by resources that are available immediately, even if they do not match all skill requirements. This paper compares the performance of a set of six task assignment mechanisms for workflow applications using a scenario from the emergency management domain. In particular, we develop and simulate assignment strategies inspired by stimulus/response models derived from swarm intelligence, and benchmark these strategies against conventional task assignment strategies. Our findings show that swarm intelligence-based approaches outperform the traditional assignment of tasks in ad-hoc organizations, and that workflow-based emergency management systems could benefit significantly from these novel task assignment strategies

Integrated process and decision modeling for data-driven processes

\u3cp\u3eWhile business process models have been proven to represent useful artifacts for organizations, they are not suitable to represent the detailed decision logic underlying processes. Ignoring this limitation often results in complex, spaghetti-like process models for workflows driven by data-based decisions. To avoid this, decision logic should be isolated from process logic, following a separation of concerns paradigm. To support this practice, we present an approach that automatically derives process models for which this paradigm applies. It takes as input structural dataflow relations underlying a workflow and produces a process model that emphasizes the most important decisions in a process, while detailed decision logic is outsourced to dedicated decision models.\u3c/p\u3