The assessment of pain.

Objective To investigate the efficacy and safety of transcutaneous electrical nerve stimulation (TENS) for relief of pain in adults. Design Systematic review and meta-analysis. Data sources Medline, Cochrane Central, Embase (and others) from inception to July 2019 and updated on 17 May 2020. Eligibility criteria for study selection Randomised controlled trials (RCTs) comparing strong non-painful TENS at or close to the site of pain versus placebo or other treatments in adults with pain, irrespective of diagnosis. Data extraction and synthesis Reviewers independently screened, extracted data and assessed risk of bias (RoB, Cochrane tool) and certainty of evidence (Grading and Recommendations, Assessment, Development and Evaluation). Mean pain intensity and proportions of participants achieving reductions of pain intensity (≥30% or >50%) during or immediately after TENS. Random effect models were used to calculate standardised mean differences (SMD) and risk ratios. Subgroup analyses were related to trial methodology and characteristics of pain. Results The review included 381 RCTs (24 532 participants). Pain intensity was lower during or immediately after TENS compared with placebo (91 RCTs, 92 samples, n=4841, SMD=−0·96 (95% CI −1·14 to –0·78), moderate-certainty evidence). Methodological (eg, RoB, sample size) and pain characteristics (eg, acute vs chronic, diagnosis) did not modify the effect. Pain intensity was lower during or immediately after TENS compared with pharmacological and non-pharmacological treatments used as part of standard of care (61 RCTs, 61 samples, n=3155, SMD = −0·72 (95% CI −0·95 to –0·50], low-certainty evidence). Levels of evidence were downgraded because of small-sized trials contributing to imprecision in magnitude estimates. Data were limited for other outcomes including adverse events which were poorly reported, generally mild and not different to comparators. Conclusion There was moderate-certainty evidence that pain intensity is lower during or immediately after TENS compared with placebo and without serious adverse events. PROSPERO registration number CRD42019125054.

/pdf/efficacy-and-safety-of-transcutaneous-electrical-nerve-2qeyp6ni.pdf

Efficacy and safety of transcutaneous electrical nerve stimulation (TENS) for acute and chronic pain in adults: a systematic review and meta-analysis of 381 studies (the meta-TENS study)

For many years, research in AI has been mostly oriented towards a single agent approach. In this approach, an agent evolves in a static environment and its main activities are: gathering information, planning, and executing her plan to achieve some goal. This approach has been proven insufficient due to the inevitable presence of a number of agents in the real world. In this world, each agent should plan her activities while keeping in mind the other agents' activities that can either help or hinder her. Hence, the scientific community is interested in analyzing and developing intelligent \"communities\" which comprise collections of interacting, coordinated knowledge-based processes. The body of research that deals with this problem has come to be known as a distributed artificial intelligence (DAI). DAI, a relatively new but growing body of research in AI, is based on a different model than traditional artificial intelligence. Indeed, the latter stipulates that an intelligent system simulates a certain form of human reasoning, knowledge, and expertise for a given task, whereas distributed AI systems were conceived as a group of intelligent entities, called agents, that interact by cooperation, by coexistence, or by competition. More precisely, DAI is concerned with how a decentralized intelligent agents should coordinate their activities to achieve their goals. When pursuing common or overlapping goals, they should act synergistically so as to accomplish more as a group than individually; wlaen pursuing conflicting goals, they should compete intelligently. There are many reasons for wanting to cope with multi-agent systems. The first reason is related to the necessity to treat distributed knowledge and/or distributed activity in some domains. Notice that the distribution can arise because of geographicdistribution coupled with processing or data bandwidth limitations (e.g. air traffic control, robotic systems, office information systems, etc.), because of the natural functional distribution in a problem (e.g. medical diagnosis, speech understanding system, etc.), because of a desire to distribute control (e.g. needs for increased reliability, efficiency or speed), or for a modular construction ofmultiknowledge-based processes. Integration of AI systems is a second reason for studying DAI systems. Indeed, now there is interest in integrating existing AI systems to gain power and to improve capability. Third, a system may be so complicated and contain so much knowledge that is better to break it down into different cooperative entities. Finally, research in DAI promises to have wide-ranging impacts in basic AI research (knowledge representations, epistemology, reasoning about others, etc.), cognitive science (mental states, cognitive cognition), distributed systems (architectures and languages for DAI), AI applications (distributed expert systems, real-time expert systems, cooperating robots, collaborative design problem solvers, etc.), and manmachine cooperation (intelligent interfaces, mental states, speech acts, etc.). This paper presents a structured annotated bibliography concerning major DAI approaches. This bibliography is organized at the highest level into seven sections that correspond to the types of research activities related to distributed artificial intelligence:

Distributed artificial intelligence: an annotated bibliography

In today's environment of global competition/cooperation, distributed organizations often form alliances to improve their ability to accomplish their customers' requests. The paper concerns such alliances alliances with loose relations between peer autonomous organizations that allow them to negotiate services, especially with a view to outsourcing work that they cannot perform alone. We are working on a platform that aims at providing support for the design of such alliances, letting their members flexibly negotiate services, make informed decisions and consistently enact contracts. The platform is built according to a multitier approach, where the lowest layers are concerned with pure communication issues between abstract entities (agents, objects, components) and the highest layers are concerned with the actual entities that form the application (i.e. the alliance). In this paper we focus on an intermediate layer, the "middleware" layer which aims at addressing general, domain-independent requirements on the interaction infrastructure to support negotiation. In particular, we describe here the lowest part of the middleware, namely a communication protocol to be used in the implementation of multiparty, multi-attribute negotiation. We illustrate this protocol through an example in the domain of negotiations of print jobs across distributed printshops.

Towards a flexible middleware negotiation facility for distributed components

We explore issues in providing support for information sharing, negotiations and decision-making to distributed autonomous organizations, grouped in alliances to improve their own ability to accomplish customers' requests. In particular, we consider the case of an alliance of printshops offering similar and/or complementary print competencies and capabilities, competing but also collaborating with each other to perform print jobs.

We present a typical scenario of the activities within such an alliance, where the main task of the printshop managers is to schedule their portfolio of jobs. We then introduce a multi-agent architecture, called AllianceNet, allowing a manager to flexibly negotiate with the allied print-shops some jobs that s/he cannot or does not wish to perform locally. The purpose of the agents in AllianceNet is not to replace the printshop managers, but rather to assist them in the decision process by making available the information needed in the negotiations and by automating the tasks implementing the committed decisions. In particular, we discuss the kind of information used and shared among printshops, the support offered to printshop managers to make informed decisions and to consistently enact and monitor their execution.

/pdf/alliancenet-information-sharing-negotiation-and-decision-21aewogx1n.pdf

AllianceNet: Information Sharing, Negotiation and Decision-Making for Distributed Organizations

In an office environment where agents cooperate to accomplish a certain tasks, the agents perform their tasks based on certain plans To ensure the integrity of their teamwork, agents communicate with one another to coordinate their plans Meanwhile, tasks are distributed to other agents via this communication process This report describes a commitment-based communication model for autonomous agents to synchronize and track their activities in office environments The communication model includes a communication process, a set of protocols to bind commitments, a set of communication operators and a set of commitment tracking operators

A commitment-based communication model for distributed office environments

As chronic pain affects 115 million people and costs $600B annually in the US alone, effective noninvasive nonpharmacological remedies are desirable. The purpose of this study was to determine the efficacy and the generalisability of Noxipoint therapy (NT), a novel electrotherapy characterised by site-specific stimulation, intensity-and-submodality-specific settings and a immobilization period, for chronic neck and shoulder pain. Ninety-seven heavily pretreated severe chronic neck/shoulder pain patients were recruited; 34 and 44 patients were randomly allocated to different treatment arms in two patient-and-assessor-blinded, randomised controlled studies. The participants received NT or conventional physical therapy including transcutaneous electrical nerve stimulation (PT-TENS) for three to six 90-minute sessions. In Study One, NT improved chronic pain (−89.6%, Brief Pain Inventory, p < 0.0001, 95% confidence interval), function (+77.4%, range of motion) and quality of life (+88.1%) at follow-up (from 4 weeks to 5 months), whereas PT-TENS resulted in no significant changes in these parameters. Study Two demonstrated similar advantages of NT over PT-TENS and the generalisability of NT. NT-like treatments in a randomised rat study showed a similar reduction in chronic hypersensitivity (−81%, p < 0.01) compared with sham treatments. NT substantially reduces chronic neck and shoulder pain, restores function and improves quality of life in a sustained manner.

/pdf/novel-noxipoint-therapy-versus-conventional-physical-therapy-4ze1o0662d.pdf

Novel Noxipoint Therapy versus Conventional Physical Therapy for Chronic Neck and Shoulder Pain: Multicentre Randomised Controlled Trials

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A commitment-based communication model for distributed office environments

Novel Noxipoint Therapy versus Conventional Physical Therapy for Chronic Neck and Shoulder Pain: Multicentre Randomised Controlled Trials