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complexity, decision making, systems

Matthias Jacob, Daniel Chappell, Bernhard F Becker
Oxygen delivery to cells is the basic prerequisite of life. Within the human body, an ingenious oxygen delivery system, comprising steps of convection and diffusion from the upper airways via the lungs and the cardiovascular system to the microvascular area, bridges the gap between oxygen in the outside airspace and the interstitial space around the cells. However, the complexity of this evolutionary development makes us prone to pathophysiological problems. While those problems related to respiration and macrohemodynamics have already been successfully addressed by modern medicine, the pathophysiology of the microcirculation is still often a closed book in daily practice...
October 21, 2016: Critical Care: the Official Journal of the Critical Care Forum
Sanath Allampati, Kevin D Mullen
Hepatic Encephalopathy (HE) is a complex neuropsychiatric syndrome associated with decompensated liver disease. The spectrum of disease ranges from trivial abnormalities in complex decision making and prolonged reaction time to coma in its most severe form1. The very initial stages, recently termed covert Hepatic Encephalopathy (CHE), can only be diagnosed with the help of neuropsychiatric testing while the later and more severe forms, termed overt Hepatic Encephalopathy (OHE), can be diagnosed clinically. Severity of HE is graded based on West Haven Criteria and please refer to table 1 for more details2...
October 20, 2016: Minerva Gastroenterologica e Dietologica
Gemma L Buckland Merrett, Gerald Bloom, Annie Wilkinson, Hayley MacGregor
The emergence and spread of antibiotic resistant pathogens poses a big challenge to policy-makers, who need to oversee the transformation of health systems that evolved to provide easy access to these drugs into ones that encourage appropriate use of antimicrobials, whilst reducing the risk of resistance. This is a particular challenge for low and middle-income countries with pluralistic health systems where antibiotics are available in a number of different markets. This review paper considers access and use of antibiotics in these countries from a complex adaptive system perspective...
2016: Journal of Pharmaceutical Policy and Practice
Rosemary Fama, Edith V Sullivan, Stephanie A Sassoon, Adolf Pfefferbaum, Natalie M Zahr
BACKGROUND: Executive functioning and episodic memory impairment occur in HIV infection (HIV) and chronic alcoholism (ALC). Comorbidity of these conditions (HIV + ALC) is prevalent and heightens risk of vulnerability to separate and compounded deficits. Age and disease-related variables can also serve as mediators of cognitive impairment and should be considered, given the extended longevity of HIV-infected individuals in this era of improved pharmacological therapy. METHODS: HIV, ALC, HIV + ALC, and normal controls (NC) were administered traditional and computerized tests of executive function and episodic memory...
October 19, 2016: Alcoholism, Clinical and Experimental Research
Michel Debacker, Filip Van Utterbeeck, Christophe Ullrich, Erwin Dhondt, Ives Hubloue
It is recognized that the study of the disaster medical response (DMR) is a relatively new field. To date, there is no evidence-based literature that clearly defines the best medical response principles, concepts, structures and processes in a disaster setting. Much of what is known about the DMR results from descriptive studies and expert opinion. No experimental studies regarding the effects of DMR interventions on the health outcomes of disaster survivors have been carried out. Traditional analytic methods cannot fully capture the flow of disaster victims through a complex disaster medical response system (DMRS)...
December 2016: Journal of Medical Systems
Arash Shaban-Nejad, Maxime Lavigne, Anya Okhmatovskaia, David L Buckeridge
Population health decision makers must consider complex relationships between multiple concepts measured with differential accuracy from heterogeneous data sources. Population health information systems are currently limited in their ability to integrate data and present a coherent portrait of population health. Consequentially, these systems can provide only basic support for decision makers. The Population Health Record (PopHR) is a semantic web application that automates the integration and extraction of massive amounts of heterogeneous data from multiple distributed sources (e...
October 17, 2016: Annals of the New York Academy of Sciences
Jennifer Jao, Rohan Hazra, Claude A Mellins, Robert H Remien, Elaine J Abrams
INTRODUCTION: The tremendous success of antiretroviral therapy has resulted in a diminishing population of perinatally HIV-infected children on the one hand and a mounting number of HIV-exposed uninfected (HEU) children on the other. As the oldest of these HEU children are reaching adolescence, questions have emerged surrounding the implications of HEU status disclosure to these adolescents. This article outlines the arguments for and against disclosure of a child's HEU status. DISCUSSION: Disclosure of a child's HEU status, by definition, requires disclosure of maternal HIV status...
2016: Journal of the International AIDS Society
Thandeka T T Dlamini-Simelane, Eileen Moyer
Through various campaigns and strategies, more women are being tested for HIV in countries with a high prevalence of the virus. Despite the ready availability of treatment at government clinics in sub-Saharan African countries like Swaziland, women consistently report difficulty in maintaining access to treatment. Drawing on two individual case studies selected from a larger study of the so-called leaky cascade in Swaziland, we illustrate the protracted journeys married women undertake to initiate treatment...
October 13, 2016: Health Policy and Planning
Osamu Muramoto
BACKGROUND: This essay provides an ethical and conceptual argument for the use of informed consent prior to the diagnosis of brain death. It is meant to enable the family to make critical end-of-life decisions, particularly withdrawal of life support system and organ donation, before brain death is diagnosed, as opposed to the current practice of making such decisions after the diagnosis of death. The recent tragic case of a 13-year-old brain-dead patient in California who was maintained on a ventilator for over 2 years illustrates how such a consent would have made a crucial difference...
October 13, 2016: Philosophy, Ethics, and Humanities in Medicine: PEHM
Brydie Clarke, Boyd Swinburn, Gary Sacks
BACKGROUND: Theories of the policy process are recommended as tools to help explain both policy stasis and change. METHODS: A systematic review of the application of such theoretical frameworks within the field of obesity prevention policy was conducted. A meta-synthesis was also undertaken to identify the key influences on policy decision-making. RESULTS: The review identified 17 studies of obesity prevention policy underpinned by political science theories...
October 13, 2016: BMC Public Health
Jaclyn Yoong, Aleece MacPhail, Gael Trytel, Prashanti Yalini Rajendram, Margaret Winbolt, Joseph E Ibrahim
Objective Limitation of Medical Treatment (LMT) forms are an essential element of end-of-life care. Decision making around LMT is complex and often involves patients with dementia. Despite the complexity, junior doctors frequently play a central role in completing LMT forms. The present study sought perspectives from a range of stakeholders (hospital clinicians, medical education personnel, legal and advocacy staff) about junior doctors' roles in completing LMT forms in general and for patients with dementia...
October 14, 2016: Australian Health Review: a Publication of the Australian Hospital Association
Song Feng, Meritxell Sáez, Carsten Wiuf, Elisenda Feliu, Orkun S Soyer
Bistability, and more generally multistability, is a key system dynamics feature enabling decision-making and memory in cells. Deciphering the molecular determinants of multistability is thus crucial for a better understanding of cellular pathways and their (re)engineering in synthetic biology. Here, we show that a key motif found predominantly in eukaryotic signalling systems, namely a futile signalling cycle, can display bistability when featuring a two-state kinase. We provide necessary and sufficient mathematical conditions on the kinetic parameters of this motif that guarantee the existence of multiple steady states...
October 2016: Journal of the Royal Society, Interface
Robin S Mickelson, Kim M Unertl, Richard J Holden
BACKGROUND: Older adults with chronic disease struggle to manage complex medication regimens. Health information technology has the potential to improve medication management, but only if it is based on a thorough understanding of the complexity of medication management workflow as it occurs in natural settings. Prior research reveals that patient work related to medication management is complex, cognitive, and collaborative. Macrocognitive processes are theorized as how people individually and collaboratively think in complex, adaptive, and messy nonlaboratory settings supported by artifacts...
October 12, 2016: JMIR Human Factors
Caitlin E Rancher, Jody M Shoemaker, Linda E Petree, Mark Holdsworth, John P Phillips, Deborah L Helitzer
BACKGROUND: Returning neuroimaging incidental findings (IF) may create a challenge to research participants' health literacy skills as they must interpret and make appropriate healthcare decisions based on complex radiology jargon. Disclosing IF can therefore present difficulties for participants, research institutions and the healthcare system. The purpose of this study was to identify the extent of the health literacy challenges encountered when returning neuroimaging IF. We report on findings from a retrospective survey and focus group sessions with major stakeholders involved in disclosing IF...
October 11, 2016: BMC Medical Ethics
Hongliang Bu, Fang Wang, William J McShea, Zhi Lu, Dajun Wang, Sheng Li
Understanding the interactions between species and their coexistence mechanisms will help explain biodiversity maintenance and enable managers to make sound conservation decisions. Mesocarnivores are abundant and diverse mid-sized carnivores and can have profound impacts on the function, structure and dynamics of ecosystem after the extirpation of apex predators in many ecosystems. The moist temperate forests of Southwest China harbor a diverse community of mesocarnivores in the absence of apex predators. Sympatric species tend to partition limited resources along time, diet and space to facilitate coexistence...
2016: PloS One
Craig Stephen
The unprecedented threats to the health and sustainability of wildlife populations are inspiring conversations on the need to change the way knowledge is generated, valued, and used to promote action to protect wildlife health. Wildlife Health 2.0 symbolizes the need to investigate how to improve connections between research expertise and policy or practices to protect wildlife health. Two imperatives drive this evolution: 1) growing frustrations that research is inadequately being used to inform management decisions and 2) the realization that scientific certainty is context specific for complex socioecologic issues, such as wildlife health...
October 10, 2016: Journal of Wildlife Diseases
M Vadiati, A Asghari-Moghaddam, M Nakhaei, J Adamowski, A H Akbarzadeh
Due to inherent uncertainties in measurement and analysis, groundwater quality assessment is a difficult task. Artificial intelligence techniques, specifically fuzzy inference systems, have proven useful in evaluating groundwater quality in uncertain and complex hydrogeological systems. In the present study, a Mamdani fuzzy-logic-based decision-making approach was developed to assess groundwater quality based on relevant indices. In an effort to develop a set of new hybrid fuzzy indices for groundwater quality assessment, a Mamdani fuzzy inference model was developed with widely-accepted groundwater quality indices: the Groundwater Quality Index (GQI), the Water Quality Index (WQI), and the Ground Water Quality Index (GWQI)...
October 6, 2016: Journal of Environmental Management
Aizhan Tursunbayeva, Raluca Bunduchi, Massimo Franco, Claudia Pagliari
OBJECTIVE: This systematic review aimed to: (1) determine the prevalence and scope of existing research on human resource information systems (HRIS) in health organizations; (2) analyze, classify, and synthesize evidence on the processes and impacts of HRIS development, implementation, and adoption; and (3) generate recommendations for HRIS research, practice, and policy, with reference to the needs of different stakeholders. METHODS: A structured search strategy was used to interrogate 10 electronic databases indexing research from the health, social, management, technology, and interdisciplinary sciences, alongside gray literature sources and reference lists of qualifying studies...
October 5, 2016: Journal of the American Medical Informatics Association: JAMIA
Luisa Baker, Bernard Lanz, Fausto Andreola, Javier Ampuero, Anisha Wijeyesekera, Elaine Holmes, Nicolaas Deutz
Hepatic encephalopathy (HE) is a neuropsychiatric syndrome which frequently accompanies acute or chronic liver disease. It is characterized by a variety of symptoms of different severity such as cognitive deficits and impaired motor functions. Currently, HE is seen as a consequence of a low grade cerebral oedema associated with the formation of cerebral oxidative stress and deranged cerebral oscillatory networks. However, the pathogenesis of HE is still incompletely understood as liver dysfunction triggers exceptionally complex metabolic derangements in the body which need to be investigated by appropriate technologies...
September 30, 2016: Metabolic Brain Disease
Rana Pishva
: The premise of parent-centred programmes for parents of anxious children is to educate and train caregivers in the sustainable implementation of cognitive behaviour therapy (CBT) in the home. The existing operationalization of parent involvement, however, does not address the systemic, parent or child factors that could influence this process. The qualitative approach of grounded theory was employed to examine patterns of action and interaction involved in the complex process of carrying out CBT with one's child in one's home...
September 29, 2016: Clinical Psychology & Psychotherapy
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