MET-4

In healthcare organizations, clinical workflows are executed by interdisciplinary healthcare teams (IHTs) that operate in ways that are difficult to manage. Responding to a need to support such teams, we designed and developed the MET4 multi-agent system that allows IHTs to manage patients according to presentation-specific clinical workflows. In this paper, we describe a significant extension of the MET4 system that allows for supporting rich team dynamics (understood as team formation, management and task-practitioner allocation), including selection and maintenance of the most responsible physician and more complex rules of selecting practitioners for the workflow tasks. In order to develop this extension, we introduced three semantic components: (1) a revised ontology describing concepts and relations pertinent to IHTs, workflows, and managed patients, (2) a set of behavioral rules describing the team dynamics, and (3) an instance base that stores facts corresponding to instances of concepts from the ontology and to relations between these instances. The semantic components are represented in first-order logic and they can be automatically processed using theorem proving and model finding techniques. We employ these techniques to find models that correspond to specific decisions controlling the dynamics of IHT. In the paper, we present the design of extended MET4 with a special focus on the new semantic components. We then describe its proof-of-concept implementation using the WADE multi-agent platform and the Z3 solver (theorem prover/model finder). We illustrate the main ideas discussed in the paper with a clinical scenario of an IHT managing a patient with chronic kidney disease.

The objective of the present study was to investigate the effects of methionine (Met) supplementation on growth performance of cubs, nutrient digestibility, nitrogen metabolism and serum biochemical parameters of female blue foxes. One hundred primiparous female blue foxes that were similar in breeding date, pedigree, age, and weight were selected for the trial. The foxes were randomly assigned to four groups (n = 25 each group) and fed diets supplemented with Met at 2 (Met2), 4 (Met4), 6 (Met6) and 8 g/kg (Met8), respectively, for 40 days. Our data showed that body weights at 20 and 40 d were significantly higher in the Met4 group than in the Met2 group (P < 0.05). The Met4 group also had the highest apparent digestibility of dry matter and crude protein compared with either the Met2, Met6, or Met8 group (P < 0.05). The serum Met and isoleucine (Ile) concentrations were significantly higher in the Met4 group than in the Met6 or Met8 group (P < 0.05). In summary, these data indicate that supplementary Met improves growth performance of cubs likely due to increased crude protein and dry matter and increased nitrogen retention of female blue foxes. The optimal amount of Met supplementation is 10 g/kg basal diet.