51
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Crielaard L, Dutta P, Quax R, Nicolaou M, Merabet N, Stronks K, Sloot PMA. Social norms and obesity prevalence: From cohort to system dynamics models. Obes Rev 2020; 21:e13044. [PMID: 32400030 PMCID: PMC7507199 DOI: 10.1111/obr.13044] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Revised: 04/14/2020] [Accepted: 04/15/2020] [Indexed: 11/29/2022]
Abstract
Group-level obesity can be seen as an emergent property of a complex system, consisting of feedback loops between individual body weight perception, individual weight-related behaviour and group-level social norms (a product of group-level 'normal' body mass index (BMI) and sociocultural 'ideal' BMI). As overweight becomes normal, the norm might be counteracting health awareness in shaping individual weight-related behaviour. System dynamics modelling facilitates understanding and simulating this system's emergent behaviour. We constructed six system dynamics models (SDMs) based on an expert-informed causal loop diagram and data from six sociocultural groups (Dutch, Moroccan and South-Asian Surinamese men and women). The SDMs served to explore the effect of three scenarios on group-level BMI: 'what if' weight-related behaviour were driven by (1) health awareness, (2) norms or (3) a combination of the two. Median BMI decreased approximately 50% and 30% less in scenarios 2 and 3, respectively, than in 1. In men, the drop in BMI was approximately two times larger in scenario 1 versus 3, whereas in women, the drop was approximately equal in these scenarios. This study indicates that the overweight norm in men holds group-level BMI close to overweight despite health awareness. Since norms are counteracting health awareness less strongly in women, other drivers of obesity must be more relevant.
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Affiliation(s)
- Loes Crielaard
- Department of Public Health, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands.,Institute for Advanced Study, University of Amsterdam, Amsterdam, The Netherlands
| | - Pritha Dutta
- Complexity Institute, Nanyang Technological University, Singapore.,Interdisciplinary Graduate Programme, Nanyang Technological University, Singapore
| | - Rick Quax
- Institute for Advanced Study, University of Amsterdam, Amsterdam, The Netherlands.,Computational Science Lab, University of Amsterdam, Amsterdam, The Netherlands
| | - Mary Nicolaou
- Department of Public Health, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands.,Institute for Advanced Study, University of Amsterdam, Amsterdam, The Netherlands
| | - Nadège Merabet
- Department of Public Health, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands.,Institute for Advanced Study, University of Amsterdam, Amsterdam, The Netherlands
| | - Karien Stronks
- Department of Public Health, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands.,Institute for Advanced Study, University of Amsterdam, Amsterdam, The Netherlands
| | - Peter M A Sloot
- Institute for Advanced Study, University of Amsterdam, Amsterdam, The Netherlands.,Complexity Institute, Nanyang Technological University, Singapore.,Computational Science Lab, University of Amsterdam, Amsterdam, The Netherlands
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Abstract
PURPOSE Improving early diagnosis of cancer through system change initiatives is endemic in England's NHS cancer services. These initiatives, however, often fail to gain traction due to the complexities of health system structures. The purpose of this paper is to explore whether using a change framework grounded in systems thinking could be of help to system leaders. DESIGN/METHODOLOGY/APPROACH A portfolio of geographically independent projects, all implementing cancer service changes as part of the Accelerate, Coordinate, Evaluate Programme, was used for the study. Eight projects were purposively selected to give a varied case-mix. Two semi-structured interviews were conducted with each project. Analysis of interviews was carried out using the Framework Method. FINDINGS Processes working for (growth processes) and against (limiting processes) change were evident in and common across all eight projects. Projects commonly encountered challenges of relevance, time and bounded thinking. Having a network of committed people was vital for both initiating and sustaining change. Furthermore, understanding stakeholders' emotional responses to change helped mitigate emergent challenges. PRACTICAL IMPLICATIONS Leaders should pay constant attention to the dynamics of change, taking time to anticipate and diffuse challenges whilst simultaneously working to create the conditions that help change flourish. A change framework rooted in complex systems theory can help leaders understand the contradictory and non-linear processes inherent in transformational change. ORIGINALITY/VALUE Few studies seek to understand change dynamics by comparing the experiences of separate change initiatives implemented contemporaneously. The findings offer leaders practical insights on how to implement transformation.
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Affiliation(s)
| | - Louise Biddle
- Cancer Research UK, London, UK
- Heidelberg University Hospital, Heidelberg, Germany
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Towards a de facto Nonlinear Periodization: Extending Nonlinearity from Programming to Periodizing. Sports (Basel) 2020; 8:sports8080110. [PMID: 32784454 PMCID: PMC7466683 DOI: 10.3390/sports8080110] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 07/22/2020] [Accepted: 08/03/2020] [Indexed: 01/05/2023] Open
Abstract
Planning is paramount in sport. Among different philosophical approaches to planning, periodization is a highly popular concept that refers to structured training periods with ensuing programs encompassing moments of progressively-loaded training, followed by recovery; it is normally deemed paramount to optimize adaptations and performance. While planning provides generic guidelines, periodization refers to the sequencing/ordering of training periods to enforce a given plan, therefore referring to longer temporal scales, and programming refers to more micro-scale aspects. In fact, similar periodization schemes may implement distinct programming strategies. Literature on the topic has used the linear and nonlinear terms to describe the content of periodized programs. However, these concepts have not been clearly defined in the literature, which may lead to inaccurate and misleading interpretations. Moreover, nonlinear periodization is usually using nonlinear programming, but with pre-stipulated sequencing of the training periods. Finally, it can be argued that nonlinearity has been an integral part of periodization since its inception, at least theoretically. In this essay, the literature was critically reviewed to better understand the validity of the linearity and nonlinearity concepts as applied in currently proposed periodization models. In addition, a novel approach for a de facto nonlinear periodization is presented.
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Held F, Hawe P, Roberts N, Conte K, Riley T. Core and peripheral organisations in prevention: Insights from social network analysis. Health Promot J Austr 2020; 32:492-502. [PMID: 32589299 DOI: 10.1002/hpja.374] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Accepted: 06/05/2020] [Indexed: 12/15/2022] Open
Abstract
ISSUE Formal (eg funded) community-level organisational collaborations are becoming more common in prevention. Rapid methods to assess organisational relationships could allow us to consider the significance of any pre-existing relationship patterns in communities that might impact on collaboration effectiveness. Insights may identify new options for practice. METHODS We used social network analysis to study organisations engaged in prevention but not (yet) part of a formal purposive collaboration. Within a single community, we identified organisations providing programs in chronic disease prevention. We used whole network analysis methods to describe the extent to which organisations were aware, had contact, coordinated activity and/or collaborated more intensively. We also identified the contribution made to prevention locally. Results were compared with key informant interviews. RESULTS There was an identifiable network structure, with more relationships across the network than one would expect by chance. The network had a core-periphery structure, meaning that, in terms of the relationships we measured, there were highly connected organisations who were strongly interlinked with each other (the core), alongside less connected organisations that were linked to the core but not to each other (the periphery). Core organisations were significantly more likely to have expertise in prevention and to have prevention staff. CONCLUSIONS To our knowledge, it is new to identify inherent or "pre-existing" core-periphery structures in interorganisational health promotion. Yet, core-periphery structures are common in many social settings. They advantage entities in the core and are prone to further entrenchment. SO WHAT?: Our results map and quantify intuitive understandings about organisational "key players", thus enabling practitioners/organisations to critically reflect on what their role should be when it comes to activating communities ie to embed, or attempt to counterbalance, pre-existing power structures.
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Affiliation(s)
- Fabian Held
- Charles Perkins Centre, D17, University of Sydney, Sydney, NSW, Australia
| | - Penelope Hawe
- Menzies Centre for Health Policy and Australian Prevention Partnership Centre, Charles Perkins Centre, D17, University of Sydney, Sydney, NSW, Australia
| | - Nick Roberts
- New South Wales Ministry of Health, North Sydney, NSW, Australia
| | - Kathleen Conte
- Menzies Centre for Health Policy and Australian Prevention Partnership Centre, Charles Perkins Centre, D17, University of Sydney, Sydney, NSW, Australia
| | - Therese Riley
- Formerly, Australian Prevention Partnership Centre, Sax Institute, Ultimo, NSW, Australia.,Therese Riley Consulting, Melbourne, Australia
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55
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Coughlan JJ, Mullins CF, Kiernan TJ. Diagnosing, fast and slow. Postgrad Med J 2020; 97:103-109. [PMID: 32595113 DOI: 10.1136/postgradmedj-2019-137412] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2019] [Revised: 02/10/2020] [Accepted: 06/01/2020] [Indexed: 11/04/2022]
Abstract
Diagnostic error is increasingly recognised as a source of significant morbidity and mortality in medicine. In this article, we will attempt to address several questions relating to clinical decision making; How do we decide on a diagnosis? Why do we so often get it wrong? Can we improve our critical faculties?We begin by describing a clinical vignette in which a medical error occurred and resulted in an adverse outcome for a patient. This case leads us to the concepts of heuristic thinking and cognitive bias. We then discuss how this is relevant to our current clinical paradigm, examples of heuristic thinking and potential mechanisms to mitigate bias.The aim of this article is to increase awareness of the role that cognitive bias and heuristic thinking play in medical decision making. We hope to motivate clinicians to reflect on their own patterns of thinking with an overall aim of improving patient care.
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Affiliation(s)
- J J Coughlan
- Cardiology, Saint James's Hospital, Dublin, Ireland
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Matheson A. Health Inequality as a Large-Scale Outcome of Complex Social Systems: Lessons for Action on the Sustainable Development Goals. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E2684. [PMID: 32295177 PMCID: PMC7215954 DOI: 10.3390/ijerph17082684] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Revised: 03/30/2020] [Accepted: 04/09/2020] [Indexed: 11/26/2022]
Abstract
Action on the Sustainable Development Goals (SDGs) needs to become real and impactful, taking a "whole systems" perspective on levers for systems change. This article reviews what we have learned over the past century about the large-scale outcome of health inequality, and what we know about the behaviour of complex social systems. This combined knowledge provides lessons on the nature of inequality and what effective action on our big goals, like the SDGs, might look like. It argues that economic theories and positivist social theories which have dominated the last 150 years have largely excluded the nature of human connections to each other, and the environment. This exclusion of intimacy has legitimatised arguments that only value-free economic processes matter for macro human systems, and only abstract measurement constitutes valuable social science. Theories of complex systems provide an alternative perspective. One where health inequality is viewed as emergent, and causes are systemic and compounding. Action therefore needs to be intensely local, with power relationships key to transformation. This requires conscious and difficult intervention on the intolerable accumulation of resources; improved reciprocity between social groups; and reversal of system flows, which at present ebb away from the local and those already disadvantaged.
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Affiliation(s)
- Anna Matheson
- School of Health, Te Herenga Waka, Victoria University of Wellington, Wellington 6140, New Zealand;
- Te Pūnaha Matatini, Centre for Complex Systems, Auckland 1142, New Zealand
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Olsson A, Thunborg C, Björkman A, Blom A, Sjöberg F, Salzmann-Erikson M. A scoping review of complexity science in nursing. J Adv Nurs 2020. [PMID: 32281684 DOI: 10.1111/jan.14382] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Revised: 03/03/2020] [Accepted: 03/25/2020] [Indexed: 11/26/2022]
Abstract
AIM To describe how complexity science has been integrated into nursing. DESIGN A scoping review. DATA SOURCE/REVIEW METHOD Academic Search Elite, Scopus, PsycINFO, Cumulative Index to Nursing and Allied Health Literature, PubMed and Web of Science were searched November 2016, updated in October 2017 and January 2020. The working process included: problem identification, literature search, data evaluation, synthesizing and presentation. RESULTS Four categories were found in the included 89 articles: (a) how complexity science is integrated into the nursing literature in relation to nursing education and teaching; (b) patients' symptoms, illness outcome and safety as characteristics of complexity science in nursing; (c) that leaders and managers should see organizations as complex and adaptive systems, rather than as linear machines; and (d) the need for a novel approach to studying complex phenomena such as healthcare organizations. Lastly, the literature explains how complexity science has been incorporated into the discourse in nursing and its development. CONCLUSION The review provided strong support for use in complexity science in the contemporary nursing literature. Complexity science is also highly applicable and relevant to clinical nursing practice and nursing management from an organizational perspective. The application of complexity science as a tool in the analysis of complex nursing systems could improve our understanding of effective interactions among patients, families, physicians and hospital and skilled nursing facility staff as well as of education. IMPACT Understanding complexity science in relation to the key role of nurses in the healthcare environment can improve nursing work and nursing theory development. The use of complexity science provides nurses with a language that liberates them from the reductionist view on nursing education, practice and management.
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Affiliation(s)
- Annakarin Olsson
- Faculty of Health and Occupational Studies, Department of Caring Science, University of Gävle, Gävle, Sweden
| | - Charlotta Thunborg
- Department of Neurobiology, Care Sciences and Society, Division of Clinical geriatrics, Karolinska Institutet, Stockholm, Sweden.,School of Health, Care and Social Welfare, Mälardalen University, Västerås, Sweden
| | - Annica Björkman
- Faculty of Health and Occupational Studies, Department of Caring Science, University of Gävle, Gävle, Sweden.,Health Services Research, Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Anneli Blom
- Centre for Clinical Research, Västmanland County Hospital, Västerås, Sweden
| | - Fredric Sjöberg
- Unit of Anaesthesiology and Intensive Care, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
| | - Martin Salzmann-Erikson
- Faculty of Health and Occupational Studies, Department of Caring Science, University of Gävle, Gävle, Sweden
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58
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Are Synapse-Like Structures a Possible Way for Crosstalk of Cancer with Its Microenvironment? Cancers (Basel) 2020; 12:cancers12040806. [PMID: 32230806 PMCID: PMC7226151 DOI: 10.3390/cancers12040806] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Revised: 03/23/2020] [Accepted: 03/25/2020] [Indexed: 01/03/2023] Open
Abstract
The failure of therapies directed at targets within cancer cells highlight the necessity for a paradigm change in cancer therapy. The attention of researchers has shifted towards the disruption of cancer cell interactions with the tumor microenvironment. A typical example of such a disruption is the immune checkpoint cancer therapy that disrupts interactions between the immune and the cancer cells. The interaction of cancer antigens with T cells occurs in the immunological synapses. This is characterized by several special features, i.e., the proximity of the immune cells and their target cells, strong intercellular adhesion, and secretion of signaling cytokines into the intercellular cleft. Earlier, we hypothesized that the cancer-associated fibroblasts interacting with cancer cells through a synapse-like adhesion might play an important role in cancer tumors. Studies of the interactions between cancer cells and cancer-associated fibroblasts showed that their clusterization on the membrane surface determined their strength and specificity. The hundreds of interacting pairs are involved in the binding that may indicate the formation of synapse-like structures. These interactions may be responsible for successful metastasis of cancer cells, and their identification and disruption may open new therapeutic possibilities.
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59
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Hitch D, Pepin G. Doing, being, becoming and belonging at the heart of occupational therapy: An analysis of theoretical ways of knowing. Scand J Occup Ther 2020; 28:13-25. [PMID: 32091297 DOI: 10.1080/11038128.2020.1726454] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Background: Theoretical ways of knowing in occupational therapy include paradigms, conceptual practice models and related knowledge. Despite the diversity of models available to guide practice, there are few examples of analyses which compare and contrast their respective core concepts.Aims: The aims of this paper are to describe how the dimensions of occupation described in the Pan Occupational Paradigm pervade conceptual practice models, and are embedded within case reports of occupational therapy.Materials and Methods: A framework analysis was undertaken, using the dimensions of occupation - doing, being, becoming and belonging - as core concepts. The alignment of concepts from four widely utilised occupational therapy conceptual practice models with these dimensions were investigated and described. Four case reports developed in reference to these specific conceptual practice models were also analysed, and their expression of the core concepts and dimensions discussed.Results: The dimensions of occupation were embedded in all reviewed conceptual practice models and case reports. The dimensions are explained in discrete, relational and embedded forms, with each conceptual practice model adopting a specific terminology and structure to describe them.Conclusions and Significance: The presence of all four dimensions of occupation, regardless of form, terminology or structural arrangement, is proposed as a hallmark of an occupational therapy conceptual practice model.
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Affiliation(s)
- Danielle Hitch
- Department of Occupational Therapy, Deakin University, Geelong, Australia
| | - Genevieve Pepin
- Department of Occupational Therapy, Deakin University, Geelong, Australia
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Ioannidis K, Askelund AD, Kievit RA, van Harmelen AL. The complex neurobiology of resilient functioning after childhood maltreatment. BMC Med 2020; 18:32. [PMID: 32050974 PMCID: PMC7017563 DOI: 10.1186/s12916-020-1490-7] [Citation(s) in RCA: 58] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2019] [Accepted: 01/07/2020] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Childhood maltreatment has been associated with significant impairment in social, emotional and behavioural functioning later in life. Nevertheless, some individuals who have experienced childhood maltreatment function better than expected given their circumstances. MAIN BODY Here, we provide an integrated understanding of the complex, interrelated mechanisms that facilitate such individual resilient functioning after childhood maltreatment. We aim to show that resilient functioning is not facilitated by any single 'resilience biomarker'. Rather, resilient functioning after childhood maltreatment is a product of complex processes and influences across multiple levels, ranging from 'bottom-up' polygenetic influences, to 'top-down' supportive social influences. We highlight the complex nature of resilient functioning and suggest how future studies could embrace a complexity theory approach and investigate multiple levels of biological organisation and their temporal dynamics in a longitudinal or prospective manner. This would involve using methods and tools that allow the characterisation of resilient functioning trajectories, attractor states and multidimensional/multilevel assessments of functioning. Such an approach necessitates large, longitudinal studies on the neurobiological mechanisms of resilient functioning after childhood maltreatment that cut across and integrate multiple levels of explanation (i.e. genetics, endocrine and immune systems, brain structure and function, cognition and environmental factors) and their temporal interconnections. CONCLUSION We conclude that a turn towards complexity is likely to foster collaboration and integration across fields. It is a promising avenue which may guide future studies aimed to promote resilience in those who have experienced childhood maltreatment.
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Affiliation(s)
- Konstantinos Ioannidis
- University of Cambridge, Department of Psychiatry, 18b Trumpington Rd, Cambridge, CB2 8AH, UK.
- Cambridgeshire and Peterborough NHS Foundation Trust/S3 Eating Disorder Service, Addenbrookes Hospital, Hills Rd Cambridge, CB2 0QQ, PO Box 175, Cambridge, UK.
| | - Adrian Dahl Askelund
- University of Cambridge, Department of Psychiatry, 18b Trumpington Rd, Cambridge, CB2 8AH, UK
| | - Rogier A Kievit
- MRC Cognition And Brain Sciences Unit, 15 Chaucer Road, University of Cambridge, Cambridge, UK
| | - Anne-Laura van Harmelen
- University of Cambridge, Department of Psychiatry, 18b Trumpington Rd, Cambridge, CB2 8AH, UK.
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61
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The compendium of self-enactable techniques to change and self-manage motivation and behaviour v.1.0. Nat Hum Behav 2020; 4:215-223. [DOI: 10.1038/s41562-019-0798-9] [Citation(s) in RCA: 89] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Accepted: 11/22/2019] [Indexed: 11/08/2022]
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Abstract
We can think of forests as multiscale multispecies networks, constantly evolving toward a climax or potential natural community—the successional process-pattern of natural regeneration that exhibits sensitivity to initial conditions. This is why I look into forest succession in light of the Red Queen hypothesis and focus on the key aspects of ecological self-organisation: dynamical criticality, evolvability and intransitivity. The idea of the review is that forest climax should be associated with habitat dynamics driven by a large continuum of ecologically equivalent time scales, so that the same ecological conclusions could be drawn statistically from any scale. A synthesis of the literature is undertaken in order to (1) present the framework for assessing habitat dynamics and (2) present the types of successional trajectories based on tree regeneration mode in forest gaps. In general, there are four types of successional trajectories within the process-pattern of forest regeneration that exhibits sensitivity to initial conditions: advance reproduction specialists, advance reproduction generalists, early reproduction generalists and early reproduction specialists. A successional trajectory is an expression of a fractal connectivity among certain patterns of natural regeneration in the multiscale multispecies networks of landscape habitats. Theoretically, the organically derived measures of pattern diversity, integrity and complexity, determined by the rates of recruitment, growth and mortality of forest tree species, are the means to test the efficacy of specific interventions to avert the disturbance-related decline in forest regeneration. That is of relevance to the emerging field of biocomplexity research.
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63
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Shi B, Wang L, Yan C, Chen D, Liu M, Li P. Nonlinear heart rate variability biomarkers for gastric cancer severity: A pilot study. Sci Rep 2019; 9:13833. [PMID: 31554856 PMCID: PMC6761171 DOI: 10.1038/s41598-019-50358-y] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Accepted: 09/11/2019] [Indexed: 12/24/2022] Open
Abstract
Identifying prognostic factors by affordable tools is crucial for guiding gastric cancer (GC) treatments especially at earlier stages for timing interventions. The autonomic function that is clinically assessed by heart rate variability (HRV) is involved in tumorigenesis. This pilot study was aimed to examine whether nonlinear indices of HRV can be biomarkers of GC severity. Sixty-one newly-diagnosed GC patients were enrolled. Presurgical serum fibrinogen (FIB), carcinoembryonic antigen (CEA), and carbohydrate antigen 19-9 (CA199) were examined. Resting electrocardiogram (ECG) of 5-min was collected prior to surgical treatments to enable the HRV analysis. Twelve nonlinear HRV indices covering the irregularity, complexity, asymmetry, and temporal correlation of heartbeat fluctuations were obtained. Increased short-range temporal correlations, decreased asymmetry, and increased irregularity of heartbeat fluctuations were associated with higher FIB level. Increased irregularity and decreased complexity were also associated with higher CEA level. These associations were independent of age, sex, BMI, alcohol consumption, history of diabetes, left ventricular ejection fraction, and anemia. The results support the hypothesis that perturbations in nonlinear dynamical patterns of HRV predict increased GC severity. Replication in larger samples as well as the examination of longitudinal associations of HRV nonlinear features with cancer prognosis/survival are warranted.
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Affiliation(s)
- Bo Shi
- School of Medical Imaging, Bengbu Medical College, Bengbu, Anhui, 233030, China
| | - Lili Wang
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Bengbu Medical College, Bengbu, Anhui, 233004, China
| | - Chang Yan
- School of Control Science and Engineering, Shandong University, Jinan, Shandong, 250061, China
| | - Deli Chen
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Bengbu Medical College, Bengbu, Anhui, 233004, China
| | - Mulin Liu
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Bengbu Medical College, Bengbu, Anhui, 233004, China
| | - Peng Li
- School of Control Science and Engineering, Shandong University, Jinan, Shandong, 250061, China.
- Division of Sleep and Circadian Disorders, Brigham & Women's Hospital, Harvard Medical School, Boston, 02115, MA, USA.
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64
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Tobin R, Hallett J, Lobo R, Maycock BR. Taking a systems approach to explore the impacts and outcomes of a research and evaluation capacity building partnership: a protocol. BMJ Open 2019; 9:e026706. [PMID: 31542735 PMCID: PMC6756426 DOI: 10.1136/bmjopen-2018-026706] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2018] [Revised: 07/31/2019] [Accepted: 08/30/2019] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION Partnership models that bring researchers, policymakers and service providers closer together are gaining traction as a strategy to improve public health practice. Yet, there is little evidence of how these models work, or indeed if they do work. The Sexual Health and Blood-borne Virus Applied Research and Evaluation Network (SiREN) is one such model. SiREN is a partnership between researchers, policymakers and service providers that aims to develop the research and evaluation capacity and evidence-informed decision making capability of professionals working to address sexual health and bloodborne virus issues in Western Australia. This study will use a systems approach to identify the mechanisms of action, impacts and outcomes of SiREN and inform the development of evaluation tools. METHODS AND ANALYSIS Data will be collected from organisational documents, surveys, in-depth interviews and a workshop. It will be analysed using a complex adaptive systems lens and findings will be used to inform the development of a type of qualitative systems model called a causal loop diagram. The causal loop diagram will illustrate the: contextual factors influencing engagement; mechanisms of action; and impacts and outcomes of SiREN. Evaluation tools will then be developed that can be used to assess the indicators identified in the causal loop diagram. ETHICS AND DISSEMINATION Ethics approval was obtained from the Curtin University Human Research Ethics Committee (approval number: HRE2017-0090). Participants will be free to withdraw from the study at any point and confidentiality will be maintained by de-identifying participant responses in any published or shared data. The findings from this study will be shared in conference presentations, reports, peer-reviewed journals and online through websites and social media.
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Affiliation(s)
- Rochelle Tobin
- School of Public Health, Curtin University, Perth, Western Australia, Australia
| | - Jonathan Hallett
- School of Public Health, Curtin University, Perth, Western Australia, Australia
| | - Roanna Lobo
- School of Public Health, Curtin University, Perth, Western Australia, Australia
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Tallon E, Dreisbach C. Using Data Science to Understand Complexity and Quantify Heterogeneity in the Onset and Progression of Chronic Disease. Biol Res Nurs 2019; 21:449-457. [PMID: 31345047 DOI: 10.1177/1099800419863161] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Novel discoveries in genomics and other omics sciences are rapidly redefining our understanding of health and disease as well as advancing the development of targeted therapeutics for improving health outcomes. The scale of these findings, fueled by vast increases in computing power and new techniques in data analytics, easily supersedes that of phenomena observed using more traditional research approaches. Until recently, the classification and diagnosis of disease has involved rather subjective processes, whereby signs and late symptom patterns are linked with clinical outcomes. However, symptom patterns, disease trajectories, and health outcomes are complex entities characterized by a wide range of clinical manifestations and progression patterns. The burgeoning fields of data science and bioinformatics are opening opportunities for nurse scientists to quantify disease heterogeneity by defining and categorizing disease phenotypes and endotypes. Nurse scientists and clinicians can play a critical role in engaging patients and the larger scientific community in these efforts. The purpose of this article is to provide an introduction to concepts critical to understanding and quantifying heterogeneity in the onset and progression of chronic disease. To present and exemplify key concepts, we (1) discuss evidence for heterogeneity in the onset and progression of Type 1 diabetes, (2) link emerging research approaches in data science with principles in network science and systems biology to lay the groundwork for stratifying subclinical and advanced chronic disease, thus expanding the purview of symptom science, and (3) describe the computational skills needed to engage in these analyses.
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Affiliation(s)
- Erin Tallon
- 1 MU Sinclair School of Nursing, University of Missouri, Columbia, MO, USA.,2 University of Missouri Informatics Institute, University of Missouri, Columbia, MO, USA
| | - Caitlin Dreisbach
- 3 School of Nursing, University of Virginia, Charlottesville, VA, USA
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Abstract
This commentary argues that health psychology, as a scientific discipline, needs to address the negative consequences of Anthropocene by helping individuals, communities and health systems to produce proactive efforts and prepare effective responses strategies for climate change consequences. The commentary addresses the following questions: How to demarcate health psychology at Anthropocene age? What are the best mitigation and adaptation behaviors for health and environment? How to help the environmental migrants and future climate refugees? How to develop a more resilient and adapted health care systems? Should we be in and out of health psychology? In conclusion, health psychologists and academics have to move forward helping individuals, communities and health systems to radically develop lower-carbon lifestyles in a sustainable society.
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Affiliation(s)
- P Bernard
- Department of Physical Activity Sciences, Université du Québec à Montréal, Montreal, Canada.,Research Center, University Institute of Mental Health at Montreal, Montreal, Canada
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67
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Castillo EA, Trinh MP. Catalyzing capacity: absorptive, adaptive, and generative leadership. JOURNAL OF ORGANIZATIONAL CHANGE MANAGEMENT 2019. [DOI: 10.1108/jocm-04-2017-0100] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Purpose
Organizations increasingly operate under volatile, uncertain, complex and ambiguous (VUCA) conditions. Traditional command-and-control leadership can be ineffective in such chaotic environments. The purpose of this paper is to outline an alternative model to help leaders and organizations navigate effectively through VUCA environments. By developing three fundamental capacities (absorptive, adaptive and generative), leaders can cultivate organizations capable of continuous synchronization with their fitness landscapes. Central tenets of the framework include diversity, slack, learning, humility, reflection in action and abductive logic.
Design/methodology/approach
This framework is designed based on literature insights, conceptual analysis and experts’ judgment. The paper integrates knowledge from a variety of disciplines and interprets them through the lens of complex adaptive systems.
Findings
This paper argues for a process centered, contemplative approach to organizational leadership and development. By providing the underlying rationale for the proposed interventions (e.g. Ashby’s law of requisite variety), the paper also reorients busy leaders’ mental models to show why these time investments are worth implementing.
Practical implications
This actionable framework can help leaders and organizations be more effective operating in a VUCA context.
Originality/value
This paper provides a historic context as to why prediction and certainty are favored leadership strategies, why these approaches are no longer suitable and specific steps leaders can take to develop absorptive, adaptive and generative capacities to transform their organizations. Its scholarly contribution is the synthesis of disparate bodies of literature, weaving those multiple academic perspectives into a practical roadmap to enhance organizational leadership.
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68
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Kerr DJR, Deane FP, Crowe TP. Narrative Identity Reconstruction as Adaptive Growth During Mental Health Recovery: A Narrative Coaching Boardgame Approach. Front Psychol 2019; 10:994. [PMID: 31133932 PMCID: PMC6517514 DOI: 10.3389/fpsyg.2019.00994] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Accepted: 04/15/2019] [Indexed: 12/14/2022] Open
Abstract
Objective The purpose of this paper is to construct a conceptual framework for investigating the reconstruction of narrative identity in mental health recovery from a complexity perspective. This conceptual framework provides the foundation for developing a health boardgame to facilitate narrative identity reconstruction. Methods A selective integrative review of the theoretical and empirical literature relevant to narrative identity reconstruction in recovery was conducted. Sources included books, dissertations, internet resources, and professional journals. Findings The reviewed material provides a conceptual framework that offers an enriched understanding of narrative identity reconstruction in recovery as a process of adaptive growth. It identifies the Hero's Journey, the life story model of identity (LSMI), and intentional change theory (ITC) as particularly relevant in informing strategies for narrative identity reconstruction. The conceptual framework can be operationalized in a narrative coaching treatment approach using a boardgame. Conclusion and Implications for Practice In practice, mental health professionals could use the narrative coaching boardgame to facilitate people's adaptive change with a focus on building skills to reconstruct their preferred narrative identity and foster hope. Future research should explore what aspects of narrative identity and non-linear dynamic processes of change are most important in people's recovery narratives and in particular these processes can be assessed in response to the use of the boardgame.
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Affiliation(s)
- Douglas J R Kerr
- School of Psychology, University of Wollongong, Wollongong, NSW, Australia
| | - Frank P Deane
- School of Psychology, University of Wollongong, Wollongong, NSW, Australia
| | - Trevor P Crowe
- School of Psychology, University of Wollongong, Wollongong, NSW, Australia
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69
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Seeking a Chaotic Order in the Cryptocurrency Market. MATHEMATICAL AND COMPUTATIONAL APPLICATIONS 2019. [DOI: 10.3390/mca24020036] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
In this study, we investigate the existence of chaos in the global cryptocurrency market. Specifically, we analyze parameters of chaotic order, nonlinearity, sensitivity to the initial conditions, monofractality, and multifractality. For this purpose, we conduct a comprehensive series of tests, including Brock–Dechert–Scheinkman (BDS) test, largest Lyapunov exponent, box-counting, and monogram analysis for fractal dimension, and multiple tests for long-range dependence (Aggregated Variances, Peng, Higuchi, R/S Analysis, and Multifractal Detrended Fluctuation Analysis (MFDFA)). All tests are performed over a variety of major cryptocurrencies: Bitcoin, Litecoin, Ethereum, and Ripple. The empirical results support the existence of chaos in the cryptocurrency market. Accordingly, cryptocurrency returns are not random and follow a chaotic order. Therefore, long term predictions are not possible, contrary to most of the discussions ongoing in the media and the public.
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Petticrew M, Knai C, Thomas J, Rehfuess EA, Noyes J, Gerhardus A, Grimshaw JM, Rutter H, McGill E. Implications of a complexity perspective for systematic reviews and guideline development in health decision making. BMJ Glob Health 2019; 4:e000899. [PMID: 30775017 PMCID: PMC6350708 DOI: 10.1136/bmjgh-2018-000899] [Citation(s) in RCA: 79] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Revised: 08/02/2018] [Accepted: 08/26/2018] [Indexed: 01/03/2023] Open
Abstract
There is growing interest in the potential for complex systems perspectives in evaluation. This reflects a move away from interest in linear chains of cause-and-effect, towards considering health as an outcome of interlinked elements within a connected whole. Although systems-based approaches have a long history, their concrete implications for health decisions are still being assessed. Similarly, the implications of systems perspectives for the conduct of systematic reviews require further consideration. Such reviews underpin decisions about the implementation of effective interventions, and are a crucial part of the development of guidelines. Although they are tried and tested as a means of synthesising evidence on the effectiveness of interventions, their applicability to the synthesis of evidence about complex interventions and complex systems requires further investigation. This paper, one of a series of papers commissioned by the WHO, sets out the concrete methodological implications of a complexity perspective for the conduct of systematic reviews. It focuses on how review questions can be framed within a complexity perspective, and on the implications for the evidence that is reviewed. It proposes criteria which can be used to determine whether or not a complexity perspective will add value to a review or an evidence-based guideline, and describes how to operationalise key aspects of complexity as concrete research questions. Finally, it shows how these questions map onto specific types of evidence, with a focus on the role of qualitative and quantitative evidence, and other types of information.
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Affiliation(s)
- Mark Petticrew
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Cécile Knai
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - James Thomas
- EPPI-Centre, SSRU, Department of Social Science, UCL Institute of Education, University College London, London, UK
| | - Eva Annette Rehfuess
- Institute for Medical Information Processing, Biometry and Epidemiology, Pettenkofer School of Public Health, LMU Munich, Munich, Germany
| | - Jane Noyes
- School of Social Sciences, Bangor University, Bangor, UK
| | - Ansgar Gerhardus
- Institut für Public Health und Pflegeforschung, Universität Bremen, Bremen, Germany,Department of Health Services Research, Institute for Public Health and Nursing Research, University of Bremen, Bremen, Germany
| | - Jeremy M Grimshaw
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada,Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Harry Rutter
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK,Department of Social and Policy Sciences, University of Bath, Claverton Down, Bath, UK
| | - Elizabeth McGill
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
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71
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Alibrahim A, Wu S. Modelling competition in health care markets as a complex adaptive system: an agent-based framework. Health Syst (Basingstoke) 2019; 9:212-225. [PMID: 32939260 DOI: 10.1080/20476965.2019.1569480] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
Health market reforms necessitate continuous re-evaluation of initiatives, competitive regulations, and antitrust policies. Synergistic implications, evolution, and behaviour changes associated with the market competition are often overlooked due to methodological limitations. To rectify these limitations, parallels between defining features of health care markets (HCM) and complex adaptive systems (CAS) are drawn. The science of CAS develops complex system-level models of dynamic interactions to allow insights for heterogeneous agents and emergent behaviours. Agent-based modelling (ABM) is a computational tool of CAS science suitable for investigating competition in HCM. The proposed agent-based framework conceptualises agents, environment, and interactions, and formalises agent-specific attributes and modules that achieve agent roles to recreate HCM dynamics. The framework conceptualises competition in HCM into an implementable ABM for a CAS assessment, identifies data sources, and develops face-validity procedures. Developments in data, computational power, and decisions theory compel CAS approach to complement studies on pressing HCM issues.
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Affiliation(s)
- Abdullah Alibrahim
- Industrial & Management Systems Engineering College of Engineering & Petroleum Kuwait University
| | - Shinyi Wu
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, CA, USA.,Daniel J. Epstein Department of Industrial & Systems Engineering, University of Southern California, Los Angeles, CA, USA.,Edward R. Roybal Institute on Aging, University of Southern California, Los Angeles, CA.,Leonard D. Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles, CA, USA
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72
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Moore GF, Evans RE, Hawkins J, Littlecott H, Melendez-Torres G, Bonell C, Murphy S. From complex social interventions to interventions in complex social systems: Future directions and unresolved questions for intervention development and evaluation. EVALUATION (LONDON, ENGLAND : 1995) 2019; 25:23-45. [PMID: 30705608 PMCID: PMC6330692 DOI: 10.1177/1356389018803219] [Citation(s) in RCA: 182] [Impact Index Per Article: 36.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
Complex systems approaches to social intervention research are increasingly advocated. However, there have been few attempts to consider how models of intervention science, such as the UK's Medical Research Council complex interventions framework, might be reframed through a complex systems lens. This article identifies some key areas in which this framework might be reconceptualized, and a number of priority areas where further development is needed if alignment with a systems perspective is to be achieved. We argue that a complex systems perspective broadens the parameters of 'relevant' evidence and theory for intervention development, before discussing challenges in defining feasibility in dynamic terms. We argue that whole systems evaluations may be neither attainable, nor necessary; acknowledgment of complexity does not mean that evaluations must be complex, or investigate all facets of complexity. However, a systems lens may add value to evaluation design through guiding identification of key uncertainties, and informing decisions such as timings of follow-up assessments.
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Affiliation(s)
| | | | | | | | | | - Chris Bonell
- London School of Hygiene & Tropical Medicine, UK
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73
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Baugh Littlejohns L, Baum F, Lawless A, Freeman T. The value of a causal loop diagram in exploring the complex interplay of factors that influence health promotion in a multisectoral health system in Australia. Health Res Policy Syst 2018; 16:126. [PMID: 30594203 PMCID: PMC6310960 DOI: 10.1186/s12961-018-0394-x] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2018] [Accepted: 11/20/2018] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Despite calls for the application of complex systems science in empirical studies of health promotion, there are very few examples. The aim of this paper was to use a complex systems approach to examine the key factors that influenced health promotion (HP) policy and practice in a multisectoral health system in Australia. METHODS Within a qualitative case study, a schema was developed that incorporated HP goals, actions and strategies with WHO building blocks (leadership and governance, financing, workforce, services and information). The case was a multisectoral health system bounded in terms of geographical and governance structures and a history of support for HP. A detailed analysis of 20 state government strategic documents and interviews with 53 stakeholders from multiple sectors were completed. Based upon key findings and dominants themes, causal pathways and feedback loops were established. Finally, a causal loop diagram was created to visualise the complex array of feedback loops in the multisectoral health system that influenced HP policy and practice. RESULTS The complexity of the multisectoral health system was clearly illustrated by the numerous feedback mechanisms that influenced HP policy and practice. The majority of feedback mechanisms in the causal loop diagram were vicious cycles that inhibited HP policy and practice, which need to be disrupted or changed for HP to thrive. There were some virtuous cycles that facilitated HP, which could be amplified to strengthen HP policy and practice. Leadership and governance at federal-state-local government levels figured prominently and this building block was interdependently linked to all others. CONCLUSION Creating a causal loop diagram enabled visualisation of the emergent properties of the case health system. It also highlighted specific leverage points at which HP policy and practice can be improved. This paper demonstrates the critical importance of leveraging leadership and governance for HP and adds urgency to the need for increased and strong advocacy efforts targeting all levels of government in multisectoral health systems.
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Affiliation(s)
- Lori Baugh Littlejohns
- Menzies Centre for Health Policy, The Australian Prevention Partnership Centre, D17 Charles Perkins Centre, University of Sydney, Sydney, NSW 2006 Australia
- Research Affiliate, University of Sydney, Sydney, Australia
| | - Fran Baum
- Southgate Institute for Health, Society and Equity, Flinders University, South Australia Bedford Park, Australia
| | - Angela Lawless
- Discipline of Speech Pathology, Flinders University, South Australia Bedford Park, Australia
| | - Toby Freeman
- Southgate Institute for Health, Society and Equity, Flinders University, South Australia Bedford Park, Australia
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74
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Heino MTJ, Knittle K, Haukkala A, Vasankari T, Hankonen N. Simple and rationale-providing SMS reminders to promote accelerometer use: a within-trial randomised trial comparing persuasive messages. BMC Public Health 2018; 18:1352. [PMID: 30526616 PMCID: PMC6286544 DOI: 10.1186/s12889-018-6121-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Accepted: 10/15/2018] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Literature on persuasion suggests compliance increases when requests are accompanied with a reason (i.e. the "because-heuristic"). The reliability of outcomes in physical activity research is dependent on sufficient accelerometer wear-time. This study tested whether SMS reminders-especially those that provided a rationale-are associated with increased accelerometer wear-time. METHODS We conducted a within-trial partially randomised controlled trial during baseline data collection in a school-based physical activity intervention trial. Of 375 participants (mean age = 18.1), 280 (75%) opted to receive daily SMS reminders to wear their accelerometers. These 280 participants were then randomised to receive either succinct reminders or reminders including a rationale. Data was analyzed across groups using both frequentist and Bayesian methods. RESULTS No differences in total accelerometer wear minutes were detected between the succinct reminder group (Mdn = 4909, IQR = 3429-5857) and the rationale group (Mdn = 4808, IQR = 3571-5743); W = 8860, p = 0.65, CI95 = - 280.90-447.20. Similarly, we found no differences in wear time between participants receiving SMS reminders (Mdn = 4859, IQR = 3527-5808) and those not receiving them (Mdn = 5067, IQR = 3201-5885); W = 10,642.5, p = 0.77, CI95 = - 424.20-305.30. Bayesian ANOVA favored a model of equal weartime means, over one of unequal means, by a Bayes Factor of 12.05. Accumulated days of valid accelerometer wear data did not differ either. Equivalence testing indicated rejection of effects more extreme than a Cohen's d (standardised mean difference) of ±~0.3. CONCLUSIONS This study casts doubt on the effectiveness of using the because-heuristic via SMS messaging, to promote accelerometer wear time among youth. The because-heuristic might be limited to face-to-face communication and situations where no intention for or commitment to the behavior has yet been made. Other explanations for null effects include non-reading of messages, and reminder messages undermining the self-reminding strategies which would occur naturally in the absence of reminders. TRIAL REGISTRATION DRKS DRKS00007721 . Registered 14.04.2015. Retrospectively registered.
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Affiliation(s)
- Matti T. J. Heino
- Faculty of Social Sciences, University of Helsinki, Helsinki, Finland
- Faculty of Social Sciences, University of Tampere, Tampere, Finland
| | - Keegan Knittle
- Faculty of Social Sciences, University of Helsinki, Helsinki, Finland
| | - Ari Haukkala
- Faculty of Social Sciences, University of Helsinki, Helsinki, Finland
| | - Tommi Vasankari
- UKK Institute for Health Promotion Research, Tampere, Finland
| | - Nelli Hankonen
- Faculty of Social Sciences, University of Helsinki, Helsinki, Finland
- Faculty of Social Sciences, University of Tampere, Tampere, Finland
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75
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Aranda-Anzaldo A, Dent MA. Landscaping the epigenetic landscape of cancer. PROGRESS IN BIOPHYSICS AND MOLECULAR BIOLOGY 2018; 140:155-174. [DOI: 10.1016/j.pbiomolbio.2018.06.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Revised: 05/16/2018] [Accepted: 06/07/2018] [Indexed: 02/07/2023]
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76
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Burton CR, Rycroft-Malone J, Williams L, Davies S, McBride A, Hall B, Rowlands AM, Jones A, Fisher D, Jones M, Caulfield M. NHS managers’ use of nursing workforce planning and deployment technologies: a realist synthesis. HEALTH SERVICES AND DELIVERY RESEARCH 2018. [DOI: 10.3310/hsdr06360] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BackgroundPolicy and reviews of health-care safety and quality emphasise the role of NHS managers in ensuring safe, good-quality patient care through effective staffing. Guidance requires that NHS managers combine professional judgement with evidence-based workforce planning and deployment tools and technologies (WPTs). Evidence has focused on the effectiveness of WPTs, but little is known about supporting their implementation, or the impact of using WPTs across settings.ObjectivesThe review answered the following question: ‘NHS managers’ use of workforce planning and deployment technologies and their impacts on nursing staffing and patient care: what works, for whom, how and in what circumstances?’.DesignA realist synthesis was conducted. A programme theory was formulated and expressed as hypotheses in the form of context, mechanisms and outcomes; this considered how, through using WPTs, particular conditions produced responses to generate outcomes. There were four phases: (1) development of a theoretical territory to understand nurse workforce planning and deployment complexity, resulting in an initial programme theory; (2) retrieval, review and synthesis of evidence, guided by the programme theory; (3) testing and refinement of the programme theory for practical application; and (4) actionable recommendations to support NHS managers in the implementation of WPTs for safe staffing.ParticipantsNHS managers, patient and public representatives and policy experts informed the programme theory in phase 1, which was validated in interviews with 10 NHS managers. In phase 3, 11 NHS managers were interviewed to refine the programme theory.ResultsWorkforce planning and deployment tools and technologies can be characterised functionally by their ability to summarise and aggregate staffing information, communicate about staffing, allocate staff and facilitate compliance with standards and quality assurance. NHS managers need to combine local knowledge and professional judgement with data from WPTs for effective staffing decisions. WPTs are used in a complex workforce system in which proximal factors (e.g. the workforce satisfaction with staffing) can influence distal factors (e.g. organisational reputation and potential staff recruitment). The system comprises multiple organisational strategies (e.g. professional and financial), which may (or may not) align around effective staffing. The positive impact of WPTs can include ensuring that staff are allocated effectively, promoting the patient safety agenda within an organisation, learning through comparison about ‘what works’ in effective staffing and having greater influence in staffing work. WPTs appear to have a positive impact when they visibly integrate data on needs and resources and when there is technical and leadership support. A collaborative process appears to be best for developing and implementing WPTs, so that they are fit for purpose.LimitationsThe evidence, predominantly from acute care, often lacked detail on how managers applied professional judgement to WPTs for staffing decisions. The evidence lacked specificity about how managers develop skills on communicating staffing decisions to patients and the public.Conclusions and recommendationsThe synthesis produced initial explanations of the use and impact of WPTs for decision-making and what works to support NHS managers to use these effectively. It is suggested that future research should further evaluate the programme theory.Study registrationThis study is registered as PROSPERO CRD42016038132.FundingThe National Institute for Health Research Health Services and Delivery Research programme.
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Affiliation(s)
- Christopher R Burton
- School of Healthcare Sciences, College of Health and Behavioural Sciences, Bangor University, Bangor, UK
| | - Jo Rycroft-Malone
- School of Healthcare Sciences, College of Health and Behavioural Sciences, Bangor University, Bangor, UK
| | - Lynne Williams
- School of Healthcare Sciences, College of Health and Behavioural Sciences, Bangor University, Bangor, UK
| | - Siân Davies
- School of Healthcare Sciences, College of Health and Behavioural Sciences, Bangor University, Bangor, UK
| | - Anne McBride
- Alliance Manchester Business School, University of Manchester, Manchester, UK
| | - Beth Hall
- School of Healthcare Sciences, College of Health and Behavioural Sciences, Bangor University, Bangor, UK
| | | | - Adrian Jones
- Betsi Cadwaladr University Health Board, Bangor, UK
| | - Denise Fisher
- School of Healthcare Sciences, College of Health and Behavioural Sciences, Bangor University, Bangor, UK
| | - Margaret Jones
- School of Healthcare Sciences, College of Health and Behavioural Sciences, Bangor University, Bangor, UK
| | - Maria Caulfield
- School of Healthcare Sciences, College of Health and Behavioural Sciences, Bangor University, Bangor, UK
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Nonlinear Dynamic Measures for Evaluating Postural Control in Individuals With and Without Chronic Ankle Instability. Motor Control 2018; 23:243-261. [PMID: 30318988 DOI: 10.1123/mc.2017-0001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
This study aimed to compare time-to-boundary and sample entropy during a single-leg balance task between individuals with chronic ankle instability (CAI), lateral ankle sprain copers, and healthy controls. Twenty-two participants with CAI, 20 lateral ankle sprain copers, and 24 healthy controls performed a single-leg balance task during an eyes-closed condition. Participants with CAI exhibited lower time-to-boundary values compared with lateral ankle sprain copers and healthy controls. However, we did not find differences in sample entropy variables between cohorts. A decrease in time-to-boundary values in participants with CAI indicated that CAI may constrain the ability of the sensorimotor system to maintain the center of pressure within the boundaries of the base of support. However, the regularity of the center of pressure velocity time series appears not to be altered in the CAI cohort in this study.
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78
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Matheson A. Reducing social inequalities in obesity: complexity and power relationships. J Public Health (Oxf) 2018; 38:826-829. [PMID: 28158692 DOI: 10.1093/pubmed/fdv197] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
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Burman CJ. Re-Contextualizing Medical Pluralism in South Africa: a Research Schema for Indigenous Decision Making. SYSTEMIC PRACTICE AND ACTION RESEARCH 2018. [DOI: 10.1007/s11213-018-9460-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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80
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Deghedi GA. Understanding Games Through Complexity Thinking Approach. INTERNATIONAL JOURNAL OF GAMING AND COMPUTER-MEDIATED SIMULATIONS 2018. [DOI: 10.4018/ijgcms.2018070103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The complexity theory and the concept of emergence is a theoretical framework that offers a vocabulary and tool for analyzing games as systems. Rather than dealing with a game as one complex adaptive system, this article uses the complexity thinking approach to study a game as a complex system composed of different levels of subsystems. Each level can be considered a complex system in itself; moreover, the interaction between a game's subsystems creates complex, dynamic, and often unpredictable behavior. For a detailed understanding of a game system and how complex it is, this article focuses on the concepts of complexity and emergence at three levels of a game system: the design level, play level and metagame level. This explanation is meant to guide game designers in incorporating the various emergent consequences of game play from the beginning of the design process.
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Affiliation(s)
- Ghada Ahmed Deghedi
- Socio-Computing Department, Faculty of Economics and Political Science, Cairo University, Cairo, Egypt
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81
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Sverdlov ED. Unsolvable Problems of Biology: It Is Impossible to Create Two Identical Organisms, to Defeat Cancer, or to Map Organisms onto Their Genomes. BIOCHEMISTRY (MOSCOW) 2018; 83:370-380. [PMID: 29626924 DOI: 10.1134/s0006297918040089] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
The review is devoted to unsolvable problems of biology. 1) Problems unsolvable due to stochastic mutations occurring during DNA replication that make it impossible to create two identical organisms or even two identical complex cells (Sverdlov, E. D. (2009) Biochemistry (Moscow), 74, 939-944) and to "defeat" cancer. 2) Problems unsolvable due to multiple interactions in complex systems leading to the appearance of unpredictable emergent properties that prevent establishment of unambiguous relationships between the genetic architecture and phenotypic manifestation of the genome and make impossible to predict with certainty responses of the organism, its parts, or pathological processes to external factors. 3) Problems unsolvable because of the uncertainty principle and observer effect in biology, due to which it is impossible to obtain adequate information about cells in their tissue microenvironment by isolating and analyzing individual cells. In particular, we cannot draw conclusions on the properties of stem cells in their niches based on the properties of stem cell cultures. A strategy is proposed for constructing the pattern most closely approximated to the relationship of genotypes with their phenotypes by designing networks of intermediate phenotypes (endophenotypes).
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Affiliation(s)
- E D Sverdlov
- Shemyakin-Ovchinnikov Institute of Bioorganic Chemistry, Russian Academy of Sciences, Moscow, 117997, Russia.
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Akaishi T, Takahashi T, Nakashima I. Chaos theory for clinical manifestations in multiple sclerosis. Med Hypotheses 2018; 115:87-93. [DOI: 10.1016/j.mehy.2018.04.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Revised: 04/09/2018] [Accepted: 04/10/2018] [Indexed: 01/19/2023]
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83
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Abstract
Complexity science offers ways to change our collective mindset about healthcare systems, enabling us to improve performance that is otherwise stagnant, argues Jeffrey Braithwaite
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Affiliation(s)
- Jeffrey Braithwaite
- Macquarie University, Australian Institute of Health Innovation, Level 6, 75 Talavera Road North Ryde, NSW 2109, Australia
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84
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Parrott JS, Henry B, Thompson KL, Ziegler J, Handu D. Managing Complexity in Evidence Analysis: A Worked Example in Pediatric Weight Management. J Acad Nutr Diet 2018; 118:1526-1542.e3. [PMID: 29728327 DOI: 10.1016/j.jand.2018.01.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Indexed: 10/17/2022]
Abstract
Nutrition interventions are often complex and multicomponent. Typical approaches to meta-analyses that focus on individual causal relationships to provide guideline recommendations are not sufficient to capture this complexity. The objective of this study is to describe the method of meta-analysis used for the Pediatric Weight Management (PWM) Guidelines update and provide a worked example that can be applied in other areas of dietetics practice. The effects of PWM interventions were examined for body mass index (BMI), body mass index z-score (BMIZ), and waist circumference at four different time periods. For intervention-level effects, intervention types were identified empirically using multiple correspondence analysis paired with cluster analysis. Pooled effects of identified types were examined using random effects meta-analysis models. Differences in effects among types were examined using meta-regression. Context-level effects are examined using qualitative comparative analysis. Three distinct types (or families) of PWM interventions were identified: medical nutrition, behavioral, and missing components. Medical nutrition and behavioral types showed statistically significant improvements in BMIZ across all time points. Results were less consistent for BMI and waist circumference, although four distinct patterns of weight status change were identified. These varied by intervention type as well as outcome measure. Meta-regression indicated statistically significant differences between the medical nutrition and behavioral types vs the missing component type for both BMIZ and BMI, although the pattern varied by time period and intervention type. Qualitative comparative analysis identified distinct configurations of context characteristics at each time point that were consistent with positive outcomes among the intervention types. Although analysis of individual causal relationships is invaluable, this approach is inadequate to capture the complexity of dietetics practice. An alternative approach that integrates intervention-level with context-level meta-analyses may provide deeper understanding in the development of practice guidelines.
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Koivu-Jolma M, Annila A. Epidemic as a natural process. Math Biosci 2018; 299:97-102. [PMID: 29534891 PMCID: PMC7094378 DOI: 10.1016/j.mbs.2018.03.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Revised: 03/07/2018] [Accepted: 03/09/2018] [Indexed: 12/17/2022]
Abstract
Mathematical epidemiology is a well-recognized discipline to model infectious diseases. It also provides guidance for public health officials to limit outbreaks. Nevertheless, epidemics take societies by surprise every now and then, for example, when the Ebola virus epidemic raged seemingly unrestrained in Western Africa. We provide insight to this capricious character of nature by describing the epidemic as a natural process, i.e., a phenomenon governed by thermodynamics. Our account, based on statistical mechanics of open systems, clarifies that it is impossible to predict accurately epidemic courses because everything depends on everything else. Nonetheless, the thermodynamic theory yields a comprehensive and analytical view of the epidemic. The tenet subsumes various processes in a scale-free manner from the molecular to the societal levels. The holistic view accentuates overarching procedures in arresting and eradicating epidemics.
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Affiliation(s)
- Mikko Koivu-Jolma
- Department of Physics, University of Helsinki, Helsinki, FI-00014, Finland
| | - Arto Annila
- Department of Physics, University of Helsinki, Helsinki, FI-00014, Finland; Department of Biosciences, University of Helsinki, Helsinki, FI-00014, Finland.
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86
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Bhat R, Pally D. Complexity: the organizing principle at the interface of biological (dis)order. J Genet 2018; 96:431-444. [PMID: 28761007 DOI: 10.1007/s12041-017-0793-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The term complexity means several things to biologists.When qualifying morphological phenotype, on the one hand, it is used to signify the sheer complicatedness of living systems, especially as a result of the multicomponent aspect of biological form. On the other hand, it has been used to represent the intricate nature of the connections between constituents that make up form: a more process-based explanation. In the context of evolutionary arguments, complexity has been defined, in a quantifiable fashion, as the amount of information, an informatic template such as a sequence of nucleotides or amino acids stores about its environment. In this perspective, we begin with a brief review of the history of complexity theory. We then introduce a developmental and an evolutionary understanding of what it means for biological systems to be complex.We propose that the complexity of living systems can be understood through two interdependent structural properties: multiscalarity of interconstituent mechanisms and excitability of the biological materials. The answer to whether a system becomes more or less complex over time depends on the potential for its constituents to interact in novel ways and combinations to give rise to new structures and functions, as well as on the evolution of excitable properties that would facilitate the exploration of interconstituent organization in the context of their microenvironments and macroenvironments.
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Affiliation(s)
- Ramray Bhat
- Department of Molecular Reproduction Development and Genetics, Indian Institute of Science, Bengaluru 560 012, India.
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87
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In search of missing time: A review of the study of time in leadership research. LEADERSHIP QUARTERLY 2018. [DOI: 10.1016/j.leaqua.2017.12.001] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Dischiavi S, Wright A, Hegedus E, Bleakley C. Biotensegrity and myofascial chains: A global approach to an integrated kinetic chain. Med Hypotheses 2018; 110:90-96. [DOI: 10.1016/j.mehy.2017.11.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Revised: 10/20/2017] [Accepted: 11/16/2017] [Indexed: 01/13/2023]
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Kirchhoff M, Parr T, Palacios E, Friston K, Kiverstein J. The Markov blankets of life: autonomy, active inference and the free energy principle. J R Soc Interface 2018; 15:20170792. [PMID: 29343629 PMCID: PMC5805980 DOI: 10.1098/rsif.2017.0792] [Citation(s) in RCA: 148] [Impact Index Per Article: 24.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2017] [Accepted: 12/14/2017] [Indexed: 11/12/2022] Open
Abstract
This work addresses the autonomous organization of biological systems. It does so by considering the boundaries of biological systems, from individual cells to Home sapiens, in terms of the presence of Markov blankets under the active inference scheme-a corollary of the free energy principle. A Markov blanket defines the boundaries of a system in a statistical sense. Here we consider how a collective of Markov blankets can self-assemble into a global system that itself has a Markov blanket; thereby providing an illustration of how autonomous systems can be understood as having layers of nested and self-sustaining boundaries. This allows us to show that: (i) any living system is a Markov blanketed system and (ii) the boundaries of such systems need not be co-extensive with the biophysical boundaries of a living organism. In other words, autonomous systems are hierarchically composed of Markov blankets of Markov blankets-all the way down to individual cells, all the way up to you and me, and all the way out to include elements of the local environment.
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Affiliation(s)
- Michael Kirchhoff
- Department of Philosophy, University of Wollongong Faculty of Law Humanities and the Arts, Wollongong, New South Wales, Australia
| | - Thomas Parr
- Wellcome Trust Centre for Neuroimaging, London, UK
| | | | - Karl Friston
- Wellcome Trust Centre for Neuroimaging, Institute of Neurology UCL, London, UK
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Chaos. Br J Gen Pract 2018; 68:36. [DOI: 10.3399/bjgp17x694313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
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Dona O, Hall GB, Noseworthy MD. Temporal fractal analysis of the rs-BOLD signal identifies brain abnormalities in autism spectrum disorder. PLoS One 2017; 12:e0190081. [PMID: 29272297 PMCID: PMC5741226 DOI: 10.1371/journal.pone.0190081] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2017] [Accepted: 12/07/2017] [Indexed: 12/28/2022] Open
Abstract
Background Brain connectivity in autism spectrum disorders (ASD) has proven difficult to characterize due to the heterogeneous nature of the spectrum. Connectivity in the brain occurs in a complex, multilevel and multi-temporal manner, driving the fluctuations observed in local oxygen demand. These fluctuations can be characterized as fractals, as they auto-correlate at different time scales. In this study, we propose a model-free complexity analysis based on the fractal dimension of the rs-BOLD signal, acquired with magnetic resonance imaging. The fractal dimension can be interpreted as measure of signal complexity and connectivity. Previous studies have suggested that reduction in signal complexity can be associated with disease. Therefore, we hypothesized that a detectable difference in rs-BOLD signal complexity could be observed between ASD patients and Controls. Methods and findings Anatomical and functional data from fifty-five subjects with ASD (12.7 ± 2.4 y/o) and 55 age-matched (14.1 ± 3.1 y/o) healthy controls were accessed through the NITRC database and the ABIDE project. Subjects were scanned using a 3T GE Signa MRI and a 32-channel RF-coil. Axial FSPGR-3D images were used to prescribe rs-BOLD (TE/TR = 30/2000ms) where 300 time points were acquired. Motion correction was performed on the functional data and anatomical and functional images were aligned and spatially warped to the N27 standard brain atlas. Fractal analysis, performed on a grey matter mask, was done by estimating the Hurst exponent in the frequency domain using a power spectral density approach and refining the estimation in the time domain with de-trended fluctuation analysis and signal summation conversion methods. Voxel-wise fractal dimension (FD) was calculated for every subject in the control group and in the ASD group to create ROI-based Z-scores for the ASD patients. Voxel-wise validation of FD normality across controls was confirmed, and non-Gaussian voxels were eliminated from subsequent analysis. To maintain a 95% confidence level, only regions where Z-score values were at least 2 standard deviations away from the mean (i.e. where |Z| > 2.0) were included in the analysis. We found that the main regions, where signal complexity significantly decreased among ASD patients, were the amygdala (p = 0.001), the vermis (p = 0.02), the basal ganglia (p = 0.01) and the hippocampus (p = 0.02). No regions reported significant increase in signal complexity in this study. Our findings were correlated with ADIR and ADOS assessment tools, reporting the highest correlation with the ADOS metrics. Conclusions Brain connectivity is best modeled as a complex system. Therefore, a measure of complexity as the fractal dimension of fluctuations in brain oxygen demand and utilization could provide important information about connectivity issues in ASD. Moreover, this technique can be used in the characterization of a single subject, with respect to controls, without the need for group analysis. Our novel approach provides an ideal avenue for personalized diagnostics, thus providing unique patient specific assessment that could help in individualizing treatments.
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Affiliation(s)
- Olga Dona
- McMaster School of Biomedical Engineering, McMaster University, Hamilton, Ontario, Canada
- Imaging Research Centre, St. Joseph’s Healthcare, Hamilton, Ontario, Canada
| | - Geoffrey B. Hall
- Imaging Research Centre, St. Joseph’s Healthcare, Hamilton, Ontario, Canada
- Department of Psychology, Neuroscience & Behaviour, McMaster University, Hamilton, Ontario, Canada
| | - Michael D. Noseworthy
- McMaster School of Biomedical Engineering, McMaster University, Hamilton, Ontario, Canada
- Imaging Research Centre, St. Joseph’s Healthcare, Hamilton, Ontario, Canada
- Department of Electrical and Computer Engineering, McMaster University, Hamilton, Ontario, Canada
- Department of Radiology, McMaster University, Hamilton, Ontario, Canada
- * E-mail:
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Friel S, Pescud M, Malbon E, Lee A, Carter R, Greenfield J, Cobcroft M, Potter J, Rychetnik L, Meertens B. Using systems science to understand the determinants of inequities in healthy eating. PLoS One 2017; 12:e0188872. [PMID: 29190662 PMCID: PMC5708780 DOI: 10.1371/journal.pone.0188872] [Citation(s) in RCA: 60] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Accepted: 11/14/2017] [Indexed: 12/21/2022] Open
Abstract
INTRODUCTION Systems thinking has emerged in recent years as a promising approach to understanding and acting on the prevention and amelioration of non-communicable disease. However, the evidence on inequities in non-communicable diseases and their risks factors, particularly diet, has not been examined from a systems perspective. We report on an approach to developing a system oriented policy actor perspective on the multiple causes of inequities in healthy eating. METHODS Collaborative conceptual modelling workshops were held in 2015 with an expert group of representatives from government, non-government health organisations and academia in Australia. The expert group built a systems model using a system dynamics theoretical perspective. The model developed from individual mind maps to pair blended maps, before being finalised as a causal loop diagram. RESULTS The work of the expert stakeholders generated a comprehensive causal loop diagram of the determinants of inequity in healthy eating (the HE2 Diagram). This complex dynamic system has seven sub-systems: (1) food supply and environment; (2) transport; (3) housing and the built environment; (4) employment; (5) social protection; (6) health literacy; and (7) food preferences. DISCUSSION The HE2 causal loop diagram illustrates the complexity of determinants of inequities in healthy eating. This approach, both the process of construction and the final visualisation, can provide the basis for planning the prevention and amelioration of inequities in healthy eating that engages with multiple levels of causes and existing policies and programs.
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Affiliation(s)
- Sharon Friel
- School of Regulation and Global Governance (RegNet), Australian National University, Canberra, Australia
| | - Melanie Pescud
- School of Regulation and Global Governance (RegNet), Australian National University, Canberra, Australia
| | - Eleanor Malbon
- School of Regulation and Global Governance (RegNet), Australian National University, Canberra, Australia
| | | | | | | | | | - Jane Potter
- National Heart Foundation, Melbourne, Australia
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Gray K, Evans SC, Griffiths A, Schneider J. Critical reflections on methodological challenge in arts and dementia evaluation and research. DEMENTIA 2017; 17:775-784. [PMID: 28980477 DOI: 10.1177/1471301217734478] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Methodological rigour, or its absence, is often a focus of concern for the emerging field of evaluation and research around arts and dementia. However, this paper suggests that critical attention should also be paid to the way in which individual perceptions, hidden assumptions and underlying social and political structures influence methodological work in the field. Such attention will be particularly important for addressing methodological challenges relating to contextual variability, ethics, value judgement and signification identified through a literature review on this topic. Understanding how, where and when evaluators and researchers experience such challenges may help to identify fruitful approaches for future evaluation.
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Affiliation(s)
- Karen Gray
- Association for Dementia Studies, University of Worcester, UK
| | | | - Amanda Griffiths
- Division of Psychiatry and Applied Psychology, School of Medicine, University of Nottingham, UK
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Kibirango MM, Munene JC, Balunywa WJ, Obbo JK. Mediation effect of novelty ecosystems on intrapreneurial behaviour process within an organisational dynamic environment among Kenyan universities. JOURNAL OF ORGANIZATIONAL CHANGE MANAGEMENT 2017. [DOI: 10.1108/jocm-08-2016-0157] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
The purpose of this paper is to examine, explain, predict and guide the processes, mechanisms and outcomes of intrapreneurial behaviour to provide evidence that novelty ecosystems mediate the relationships between generative influence, positive deviance and intrapreneurial behaviour. It also enlightens the capacity of replicating the intrapreneurial best practices.
Design/methodology/approach
The study uses an integrated approach of entrepreneurship and complexity theories. Its subjects were full-time designated university employees in the Republic of Kenya. A total number of 244 employees were selected using snowball sampling technique from ten public and private universities in the Kenya. A self-administered questionnaire was used to collect data.
Findings
The structural equation modelling path analysis and the bootstrapping results confirmed full mediation of novelty ecosystems in the relationship between generative influence and intrapreneurial behaviour. The findings, further, verified that novelty ecosystems partially mediate the relationship between positive deviance and intrapreneurial behaviour.
Research limitations/implications
Subjective appraisals were used, despite the fact that studied variables are ultimately based on what employees perceive. Future research should generate and include more objective measures.
Practical implications
Intrapreneurial behaviour can only be explained and predicted through novelty ecosystems. University leaders need to fully understand and facilitate novelty ecosystems.
Social implications
A deeper understanding of the power of generative influence, positive deviance and novelty ecosystems will not be fully realized until researchers devote as much energy and attention to facilitation as has been devoted to conflict.
Originality/value
This study extends existing intrapreneurial research into complexity approach.
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Repression of Salmonella Host Cell Invasion by Aromatic Small Molecules from the Human Fecal Metabolome. Appl Environ Microbiol 2017; 83:AEM.01148-17. [PMID: 28754707 DOI: 10.1128/aem.01148-17] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Accepted: 07/18/2017] [Indexed: 02/07/2023] Open
Abstract
The human microbiome is a collection of microorganisms that inhabit every surface of the body that is exposed to the environment, generally coexisting peacefully with their host. These microbes have important functions, such as producing vitamins, aiding in maturation of the immune system, and protecting against pathogens. We have previously shown that a small-molecule extract from the human fecal microbiome has a strong repressive effect on Salmonella enterica serovar Typhimurium host cell invasion by modulating the expression of genes involved in this process. Here, we describe the characterization of this biological activity. Using a series of purification methods, we obtained fractions with biological activity and characterized them by mass spectrometry. These experiments revealed an abundance of aromatic compounds in the bioactive fraction. Selected compounds were obtained from commercial sources and tested with respect to their ability to repress the expression of hilA, the gene encoding the master regulator of invasion genes in Salmonella We found that the aromatic compound 3,4-dimethylbenzoic acid acts as a strong inhibitor of hilA expression and of invasion of cultured host cells by Salmonella Future studies should reveal the molecular details of this phenomenon, such as the signaling cascades involved in sensing this bioactive molecule.IMPORTANCE Microbes constantly sense and adapt to their environment. Often, this is achieved through the production and sensing of small extracellular molecules. The human body is colonized by complex communities of microbes, and, given their biological and chemical diversity, these ecosystems represent a platform where the production and sensing of molecules occur. In previous work, we showed that small molecules produced by microbes from the human gut can significantly impair the virulence of the enteric pathogen Salmonella enterica Here, we describe a specific compound from the human gut that produces this same effect. The results from this work not only shed light on an important biological phenomenon occurring in our bodies but also may represent an opportunity to develop drugs that can target these small-molecule interactions to protect us from enteric infections and other diseases.
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A SYSTEMATIC APPROACH FOR ASSESSING, IN THE ABSENCE OF FULL EVIDENCE, WHETHER MULTICOMPONENT INTERVENTIONS CAN BE MORE COST-EFFECTIVE THAN SINGLE COMPONENT INTERVENTIONS. Int J Technol Assess Health Care 2017; 33:444-453. [PMID: 28889817 DOI: 10.1017/s0266462317000721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVES Multicomponent interventions (MCIs), consisting of at least two interventions, are common in rehabilitation and other healthcare fields. When the effectiveness of the MCI versus that of its single interventions is comparable or unknown, evidence of their expected incremental cost-effectiveness can be helpful in deciding which intervention to recommend. As such evidence often is unavailable this study proposes an approach to estimate what is more cost-effective; the MCI or the single intervention(s). METHODS We reviewed the literature for potential methods. Of those identified, headroom analysis was selected as the most suitable basis for developing the approach, based on the criteria of being able to estimate the cost-effectiveness of the single interventions versus that of the MCI (a) within a limited time frame, (b) in the absence of full data, and (c) taking into account carry-over and interaction effects. We illustrated the approach with an MCI for cancer survivors. RESULTS The approach starts with analyzing the costs of the MCI. Given a specific willingness-to-pay-value, it is analyzed how much effectiveness the MCI would need to generate to be considered cost-effective, and if this is likely to be attained. Finally, the cost-effectiveness of the single interventions relative to the potential of the MCI for being cost-effective can be compared. CONCLUSIONS A systematic approach using headroom analysis was developed for estimating whether an MCI is likely to be more cost effective than one (or more) of its single interventions.
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Matheson A, Walton M, Gray R, Lindberg K, Shanthakumar M, Fyfe C, Wehipeihana N, Borman B. Evaluating a community-based public health intervention using a complex systems approach. J Public Health (Oxf) 2017; 40:606-613. [DOI: 10.1093/pubmed/fdx117] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Indexed: 11/14/2022] Open
Affiliation(s)
- Anna Matheson
- School of Public Health, Massey University, Wallace Street, Mt Cook, Wellington, New Zealand
| | - Mat Walton
- School of Public Health, Massey University, Wallace Street, Mt Cook, Wellington, New Zealand
| | - Rebecca Gray
- School of Public Health, Massey University, Wallace Street, Mt Cook, Wellington, New Zealand
| | - Kirstin Lindberg
- Environmental Health Indicators Programme, Centre for Public Health Research, Massey University, Wallace Street, Mt Cook, Wellington, New Zealand
| | - Mathu Shanthakumar
- Environmental Health Indicators Programme, Centre for Public Health Research, Massey University, Wallace Street, Mt Cook, Wellington, New Zealand
| | - Caroline Fyfe
- Environmental Health Indicators Programme, Centre for Public Health Research, Massey University, Wallace Street, Mt Cook, Wellington, New Zealand
| | | | - Barry Borman
- Environmental Health Indicators Programme, Centre for Public Health Research, Massey University, Wallace Street, Mt Cook, Wellington, New Zealand
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