Automated monitoring of medical protocols: a secure and distributed architecture

The control of the right application of medical protocols is a key issue in hospital environments. For the automated monitoring of medical protocols, we need a domain-independent language for their representation and a fully, or semi, autonomous system that understands the protocols and supervises their application. In this paper we describe a specification language and a multi-agent system architecture for monitoring medical protocols. We model medical services in hospital environments as specialized domain agents and interpret a medical protocol as a negotiation process between agents. A medical service can be involved in multiple medical protocols, and so specialized domain agents are independent of negotiation processes and autonomous system agents perform monitoring tasks. We present the detailed architecture of the system agents and of an important domain agent, the database broker agent, that is responsible of obtaining relevant information about the clinical history of patients. We also describe how we tackle the problems of privacy, integrity and authentication during the process of exchanging information between agents.

[Place of volunteers in home care setting for taking care of individuals with Alzheimer's disease related dementia: Qualitative survey in a specialized unit] Place du bénévolat en EHPAD dans la prise en charge des personnes atteintes de la maladie d'Alzheimer ou démences apparentées : enquête qualitative dans une unité protégée.

Objectifs En EHPAD, selon les recommandations de la Haute Autorité de santé (HAS), la prise en charge non médicamenteuse des troubles psychocomportementaux associés à la maladie d'Alzheimer ou aux syndromes apparentés, implique une réorganisation, une formation spécifique du personnel et du temps. Se pose ici la question du rôle des bénévoles dans cette prise en charge. Matériels et méthodes Enquête descriptive à partir de questionnaires distribués aux différents intervenants (bénévoles, professionnels de santé et aidants familiaux) d'une unité protégée de l'EHPAD de la clinique du Diaconat (Colmar, France) et spécifiquement élaborés pour évaluer leur vécu de l'expérience de bénévolat dans la prise en charge des résidents souffrant d'une maladie d'Alzheimer ou d'un syndrome apparenté. Résultats Sur les 101 questionnaires qui ont été remplis, 85,7 % des aidants, 60 % des bénévoles et 42,1 % des professionnels constataient des bénéfices pour eux-mêmes. Les professionnels et les aidants avaient confiance dans l'intervention des bénévoles. Cependant, les bénévoles semblaient manquer de compétence pour le soutien des aidants et dans les techniques de communication avec les résidents. Les points essentiels pour permettre un fonctionnement harmonieux entre les différents intervenants étaient de bien définir préalablement le rôle de bénévoles et d'en informer les autres intervenants, de former les bénévoles à ce rôle et de favoriser la communication entre les bénévoles et les professionnels. Conclusion Cette enquête montre que les bénévoles ont une place aux côtés des équipes soignantes pour participer à la prise en charge non médicamenteuse des personnes atteintes de maladie d'Alzheimer ou syndromes apparentés. Ils ont une position singulière et jouent un rôle complémentaire de celui des soignants et des aidants. Objectives According to the recommendation of the French High Authority of Health (HAS), the non-pharmaceutical management of psycho-behavioural disorders associated with Alzheimer's disease or related disorders in a nursing home, involves reorganization an specific training for staff members and time. This raises the question of the role of volunteering in this approach. Materials and methods A descriptive survey using questionnaires distributed to various stakeholders (volunteers, healthcare professionals and caregivers) of a protected unit of the nursing home of the Diaconat clinic (Colmar, France) and specifically designed to assess their experience of the volunteering in supporting residents suffering from Alzheimer's diseases or related disorders. Results Of the 101 questionnaires that were filled in, 85.7% of caregivers, 60% of volunteers and 42.1% of professionals recorded benefits for themselves. Professionals and informal carers had confidence in the intervention of volunteers. However, volunteers seemed to lack skills to support informal caregivers and specific knowledge about the technique of communicating with residents. The key points to favor harmonious collaborations between the different stakeholders were: to properly define the role of volunteers and to inform other stakeholders about this role previously, and to specifically educate themselves in this task and to promote communication between volunteers and all other professionals. Conclusion This study shows that volunteers have a place alongside medical teams to participate in the non-pharmaceutical treatment for people with Alzheimer's disease or related syndromes. They have a unique position and play a complementary role to that of carers and informal caregivers.

What interventions facilitate client progress through the assimilation model? A task analysis of interventions in the psychodynamic treatment of depression.

A variation of task analysis was used to build an empirical model of how therapists may facilitate client assimilation process, described in the Assimilation of Problematic Experiences Scale. A rational model was specified and considered in light of an analysis of therapist in-session performances (N = 117) drawn from six inpatient therapies for depression. The therapist interventions were measured by the Comprehensive Psychotherapeutic Interventions Rating Scale. Consistent with the rational model, confronting interventions were particularly useful in helping clients elaborate insight. However, rather than there being a small number of progress-related interventions at lower levels of assimilation, therapists' use of interventions was broader than hypothesized and drew from a wide range of therapeutic approaches. Concerning the higher levels of assimilation, there was insufficient data to allow an analysis of the therapist's progress-related interventions.

Task-induced deactivation from rest extends beyond the default mode brain network

Activity decreases, or deactivations, of midline and parietal cortical brain regions are routinely observed in human functional neuroimaging studies that compare periods of task-based cognitive performance with passive states, such as rest. It is now widely held that such task-induced deactivations index a highly organized"default-mode network" (DMN): a large-scale brain system whose discovery has had broad implications in the study of human brain function and behavior. In this work, we show that common task-induced deactivations from rest also occur outside of the DMN as a function of increased task demand. Fifty healthy adult subjects performed two distinct functional magnetic resonance imaging tasks that were designed to reliably map deactivations from a resting baseline. As primary findings, increases in task demand consistently modulated the regional anatomy of DMN deactivation. At high levels of task demand, robust deactivation was observed in non-DMN regions, most notably, the posterior insular cortex. Deactivation of this region was directly implicated in a performance-based analysis of experienced task difficulty. Together, these findings suggest that task-induced deactivations from rest are not limited to the DMN and extend to brain regions typically associated with integrative sensory and interoceptive processes.

Task complexity, the Cognition Hypothesis and second language learning and performance

In this paper we describe a taxonomy of task demands which distinguishes between Task Complexity, Task Condition and Task Difficulty. We then describe three theoretical claims and predictions of the Cognition Hypothesis (Robinson 2001, 2003b, 2005a) concerning the effects of task complexity on: (a) language production; (b) interaction and uptake of information available in the input to tasks; and (c) individual differences-task interactions. Finally we summarize the findings of the empirical studies in this special issue which all address one or more of these predictions and point to some directions for continuing, future research into the effects of task complexity on learning and performance.

APOE status modulates the changes in network connectivity induced by brain stimulation in non-demented elders.

Behavioral consequences of a brain insult represent an interaction between the injury and the capacity of the rest of the brain to adapt to it. We provide experimental support for the notion that genetic factors play a critical role in such adaptation. We induced a controlled brain disruption using repetitive transcranial magnetic stimulation (rTMS) and show that APOE status determines its impact on distributed brain networks as assessed by functional MRI (fMRI).Twenty non-demented elders exhibiting mild memory dysfunction underwent two fMRI studies during face-name encoding tasks (before and after rTMS). Baseline task performance was associated with activation of a network of brain regions in prefrontal, parietal, medial temporal and visual associative areas. APOE ε4 bearers exhibited this pattern in two separate independent components, whereas ε4-non carriers presented a single partially overlapping network. Following rTMS all subjects showed slight ameliorations in memory performance, regardless of APOE status. However, after rTMS APOE ε4-carriers showed significant changes in brain network activation, expressing strikingly similar spatial configuration as the one observed in the non-carrier group prior to stimulation. Similarly, activity in areas of the default-mode network (DMN) was found in a single component among the ε4-non bearers, whereas among carriers it appeared disaggregated in three distinct spatiotemporal components that changed to an integrated single component after rTMS. Our findings demonstrate that genetic background play a fundamental role in the brain responses to focal insults, conditioning expression of distinct brain networks to sustain similar cognitive performance.

The role of trust and its evolution in distributed teams in a multinational organisation

Tutkimuksen päätavoitteena on ollut selvittää miten kansallinen ja organisaatiokulttuuri, niihin liittyvät normit ja arvot edesauttavat tai vaikeuttavat luottamuksen kehittymistä monikulttuurisissa tiimeissä maailmanlaajuisessa organisaatiossa. Tutkimuksen avulla haluttiin myös selvittää miten luottamus kehittyy hajautetuissa monikansallisissa tiimeissä WorldCom Internationalissa. Empiirinen tutkimusmenetelmä perustuu kvalitatiivisiin teemahaastatteluihin, jotka tehtiin WorldComin työntekijöille. Tutkimuksessa havaittiin, ettei yhteisten sosiaalisten normien merkitys luottamuksen syntymiselle ole niin merkittävä, koska WorldComin yhtenäiset toimintatavat sekä hallitseva amerikkalaisen emoyhtiön "kotikulttuuri" muodostavat yhtenäiset toimintalinjat tiimeissä. Tietokonevälitteisen kommunikoinnin jatkuva käyttö on edesauttanut työntekijöiden ns. sosiaalisen älyn kehittymistä, sillä henkilökohtaisen tapaamisen puuttuminen kehittää vastaavasti taitoja aistia ja tulkita sähköpostien tai puhelinneuvotteluiden aikana välittyviä vastapuolen "näkymättömiä" vihjeitä.

Transferring control demands across incidental learning tasks - Stronger sequence usage in serial reaction task after shortcut option in letter string checking

After incidentally learning about a hidden regularity, participants can either continue to solve the task as instructed or, alternatively, apply a shortcut. Past research suggests that the amount of conflict implied by adopting a shortcut seems to bias the decision for vs. against continuing instruction-coherent task processing. We explored whether this decision might transfer from one incidental learning task to the next. Theories that conceptualize strategy change in incidental learning as a learning-plus-decision phenomenon suggest that high demands to adhere to instruction-coherent task processing in Task 1 will impede shortcut usage in Task 2, whereas low control demands will foster it. We sequentially applied two established incidental learning tasks differing in stimuli, responses and hidden regularity (the alphabet verification task followed by the serial reaction task, SRT). While some participants experienced a complete redundancy in the task material of the alphabet verification task (low demands to adhere to instructions), for others the redundancy was only partial. Thus, shortcut application would have led to errors (high demands to follow instructions). The low control demand condition showed the strongest usage of the fixed and repeating sequence of responses in the SRT. The transfer results are in line with the learning-plus-decision view of strategy change in incidental learning, rather than with resource theories of self-control.

Sähkönjakeluverkon komponenttien pitoajat

Suomessa sähkönjakeluverkkoyhtiöt toimivat verkkovastuualueillaan yksinoikeudella. Verkkovastuualuiden ominaispiirteet voivat olla hyvin erilaiset. Energiamarkkinavirasto valvoo sähkömarkkinalainsäädännön noudattamista jakeluverkkotoiminnassa. Jakeluverkonhaltijat on velvoitettu Energiamarkkinaviraston valvontamallin kautta määrittämään tiettyjen rajoitusten mukaisesti verkkokomponenteillensa sopivimmat teknistaloudelliset pitoajat. Nämä pitoajat vaikuttavat varsinkin verkkoyhtiön tuottomahdollisuuksiin ja asiakkaiden siirtohintoihin. Lisäksi huomioon on otettava jaettavan sähkön laatu, verkon käyttövarmuus sekä vaikutukset ympäristöön ja turvallisuuteen. Pitoaikojen matemaattinen mallintaminen on usein monimutkaista. Teknistaloudellinen pitoaika valitaankin monesti kokemuksen ja harkinnan perusteella. Tärkeimmät reunaehdot jakeluverkkokomponenttien teknistaloudellisten pitoaikojen valinnalle muodostavat verkkovastuualueen sähkönkulutuksen kasvun sekä infrastruktuurin muutoksen nopeudet. Hitaan muutoksen alueilla verkkokomponenttien teknistaloudelliset pitoajat lähenevät teknisiä pitoaikoja, joihin vaikuttavat voimakkaasti verkkovastuualueen maantieteelliset ja ilmastolliset ominaispiirteet. Yhtiöittäin vaihtelevat verkon rakennus- ja ylläpitomenetelmät tulee myös huomioida. Tässä diplomityössä keskitytään pääosin sähkönjakeluverkon komponenttien teknistaloudelliseen pitoaikaan verkon ja verkkovastuualueen ominaispiirteiden kautta. Aluksi määritellään jakeluverkon pitoaika usealla eri tavalla, sekä selvitetään pitoajan merkitystä nykytilanteessa. Lisäksi työn alkuosassa esitellään Energiamarkkinaviraston vuoden 2005 alusta käyttöönotettu jakeluverkkotoiminnan hinnoittelun kohtuullisuuden valvontamalli ja käydään läpi teknistaloudellisen pitoajan merkitys siinä. Sen jälkeen tarkastellaan jakeluverkkokomponenttien ja niiden osien tekniseen pitoaikaan vaikuttavia tekijöitä. Erityisesti puupylväisiin ja niihin liittyviin ajankohtaisiin asioihin kiinnitetään huomiota, koska puupylväät määräävät monesti koko ilmajohtorakenteen uusimisajankohdan. Lisäksi suolakyllästeiselle puupylväälle esitetään yleinen rappeutumismalli ja jakelumuuntajan rappeutumistapahtumaa tutkitaan. Lopuksi tarkastellaan Graninge Kainuu Oy:tä jakeluverkonhaltijana sekä määritetään sen verkkovastuualueelle ominaisia komponenttien teknisiä ja teknistaloudellisia pitoaikoja haastattelujen, tuoreimpien lähteiden, tutkimustulosten, vertailun ja harkinnan avulla.

Web user interface architecture for advanced planning and scheduling systems Case: Nokia Demand / Supply Planning Applications

In modem hitec industry Advanced Planning and Scheduling (APS) systems provide the basis for e-business solutions towards the suppliers and the customers. One objective of this thesis was to clarify the modem supply chain management with the APS systems and especially concentrate on the area of Collaborative Planning. In order Advanced Planning and Scheduling systems to be complete and usable, user interfaces are needed. Current Visual Basic user interfaces have faced many complaints and arguments from the users as well as from the development team. This thesis is trying to analyze the reasons and causes for the encountered problems and also provide ways to overcome them. The decision has been made to build the new user interfaces to be Web-enabled. Therefore another objective of this thesis was to research and find suitable technologies for building the Web-based user interfaces for Advanced Planning and Scheduling Systems in Nokia Demand/Supply Planning business area. Comparison between the most suitable technologies is made. Usability issues of Web-enabled user interfaces are also covered. The empirical part of the thesis includes design and implementation of a Web-based user interface with the chosen technology for a particular APS module that enables Collaborative Planning with suppliers.

Ohjelmistokehitysprosessi hajautetussa ympäristössä

Työn tavoitteena oli selvittää erilaisten ohjelmistokehitysprosessien soveltuvuus maantieteellisesti hajallaan oleville kehitysryhmille. Aluksi selvitettiin yleisemmin käytössä olevat ohjelmistoprosessit ja niiden pääkohdat. Selvittäminen tehtiin kirjallisuuden ja internet-sivustojen perusteella. Saatuja tuloksia verrattiin CASE – yrityksen, Komartek Oyj:n, prosesseihin. Komartek Oyj:n prosessit selvitettiin haastatteluin sekä yrityksen sisäistä dokumentaatiota hyväksikäyttäen. Toisena tehtävänä työssä käytiin läpi hajautetun kehityksen aiheuttamia erityisvaatimuksia ohjelmistoprojekteille. Kirjallisuudesta löydettyjä vaatimuksia verrattiin jälleen Komartekin tämän hetkiseen kehitystyön hajautukseen ja selvitettiin myös lähitulevaisuuden näkymiä yrityksessä.

EAACI IG Biologicals task force paper on the use of biologic agents in allergic disorders.

Biologic agents (also termed biologicals or biologics) are therapeutics that are synthesized by living organisms and directed against a specific determinant, for example, a cytokine or receptor. In inflammatory and autoimmune diseases, biologicals have revolutionized the treatment of several immune-mediated disorders. Biologicals have also been tested in allergic disorders. These include agents targeting IgE; T helper 2 (Th2)-type and Th2-promoting cytokines, including interleukin-4 (IL-4), IL-5, IL-9, IL-13, IL-31, and thymic stromal lymphopoietin (TSLP); pro-inflammatory cytokines, such as IL-1β, IL-12, IL-17A, IL-17F, IL-23, and tumor necrosis factor (TNF); chemokine receptor CCR4; and lymphocyte surface and adhesion molecules, including CD2, CD11a, CD20, CD25, CD52, and OX40 ligand. In this task force paper of the Interest Group on Biologicals of the European Academy of Allergy and Clinical Immunology, we review biologicals that are currently available or tested for the use in various allergic and urticarial pathologies, by providing an overview on their state of development, area of use, adverse events, and future research directions.

How environmental sounds become meaningful

The term "sound object" describes an auditory experience that is associated with an acoustic event produced by a sound source. In natural settings, a sound produced by a living being or an object provides information about the identity and the location of the sound source. Sound's identity is orocessed alono the ventral "What" pathway which consists of regions within the superior and middle temporal cortices as well as the inferior frontal gyrus. This work concerns the creation of individual auditory object representations in narrow semantic categories and their plasticity using electrical imaging. Discrimination of sounds from broad category has been shown to occur along a temporal hierarchy and in different brain regions along the ventral "What" pathway. However, sounds belonging to the same semantic category, such as faces or voices, were shown to be discriminated in specific brain areas and are thought to represent a special class of stimuli. I have investigated how cortical representations of a narrow category, here birdsongs, is modulated by training novices to recognized songs of individual bird species. Dynamic analysis of distributed source estimations revealed differential sound object representations within the auditory ventral "What" pathway as a function of the level of expertise newly acquired. Correct recognition of trained items induces a sharpening within a left-lateralized semantic network starting around 200ms, whereas untrained items' processing occurs later in lower-level and memory-related regions. With another category of sounds belonging to the same category, here heartbeats, I investigated the cortical representations of correct and incorrect recognition of sounds. Source estimations revealed differential representations partially overlapping with regions involved in the semantic network that is activated when participants became experts in the task. Incorrect recognition also induces a higher activation when compared to correct recognition in regions processing lower-level features. The discrimination of heartbeat sounds is a difficult task and requires a continuous listening. I investigated whether the repetition effects are modulated by participants' behavioral performance. Dynamic source estimations revealed repetition suppression in areas located outside of the semantic network. Therefore, individual environmental sounds become meaningful with training. Their representations mainly involve a left-lateralized network of brain regions that are tuned with expertise, as well as other brain areas, not related to semantic processing, and occurring in early stages of semantic processing. -- Le terme objet sonore" décrit une expérience auditive associée à un événement acoustique produit par une source sonore. Dans l'environnement, un son produit par un être vivant ou un objet fournit des informations concernant l'identité et la localisation de la source sonore. Les informations concernant l'identité d'un son sont traitée le long de la voie ventrale di "Quoi". Cette voie est composée de regions situées dans le cortex temporal et frontal. L'objet de ce travail est d'étudier quels sont les neuro-mecanismes impliqués dans la représentation de nouveaux objets sonores appartenant à une meme catégorie sémantique ainsi que les phénomènes de plasticité à l'aide de l'imagerie électrique. Il a été montré que la discrimination de sons appartenant à différentes catégories sémantiques survient dans différentes aires situées le long la voie «Quoi» et suit une hiérarchie temporelle II a également été montré que la discrimination de sons appartenant à la même catégorie sémantique tels que les visages ou les voix, survient dans des aires spécifiques et représenteraient des stimuli particuliers. J'ai étudié comment les représentations corticales de sons appartenant à une même catégorie sémantique, dans ce cas des chants d'oiseaux, sont modifiées suite à un entraînement Pour ce faire, des sujets novices ont été entraînés à reconnaître des chants d'oiseaux spécifiques L'analyse des estimations des sources neuronales au cours du temps a montré que les representations des objets sonores activent de manière différente des régions situées le long de la vo,e ventrale en fonction du niveau d'expertise acquis grâce à l'entraînement. La reconnaissance des chants pour lesquels les sujets ont été entraînés implique un réseau sémantique principalement situé dans l'hémisphère gauche activé autour de 200ms. Au contraire, la reconnaissance des chants pour lesquels les sujets n'ont pas été entraînés survient plus tardivement dans des régions de plus bas niveau. J'ai ensuite étudié les mécanismes impliqués dans la reconnaissance et non reconnaissance de sons appartenant à une autre catégorie, .es battements de coeur. L'analyse des sources neuronales a montre que certaines régions du réseau sémantique lié à l'expertise acquise sont recrutées de maniere différente en fonction de la reconnaissance ou non reconnaissance du son La non reconnaissance des sons recrute des régions de plus bas niveau. La discrimination des bruits cardiaques est une tâche difficile et nécessite une écoute continue du son. J'ai étudié l'influence des réponses comportementales sur les effets de répétitions. L'analyse des sources neuronales a montré que la reconnaissance ou non reconnaissance des sons induisent des effets de repétition différents dans des régions situées en dehors des aires du réseau sémantique. Ainsi, les sons acquièrent un sens grâce à l'entraînement. Leur représentation corticale implique principalement un réseau d'aires cérébrales situé dans l'hémisphère gauche, dont l'activité est optimisée avec l'acquisition d'un certain niveau d'expertise, ainsi que d'autres régions qui ne sont pas liée au traitement de l'information sémantique. L'activité de ce réseau sémantique survient plus rapidemement que la prédiction par le modèle de la hiérarchie temporelle.