Developing a conceptual model for exploring emergence

Emergence is a fundamental property of complex systems and can be thought of as a new property or behaviour which appears due to non-linear interactions within the system; emergence may be considered to be the 'product' or by-product of the system. For example, within social systems, social capital, the World Wide Web, law and indeed civilization in general may be considered emergent, although all within different time scales. As our world becomes increasingly more interconnected, understanding how emergence arises and how to design for and manage specific types of emergence is ever more important. To date, the concept of emergence has been mainly used as an explanatory framework (as used by Johnson 2001), to inform the logic of action research (Mitleton-Kelly 2004) or as a means of exploring the range of emergent potential of simulation of real complex systems (Axelrod 2003). If we are to improve our ability to manage and control emergence, we need first to directly study the phenomenon of emergence, its causes and consequences across real complex systems

A methodology for exploring emergence in learning communities

Learning communities are becoming increasingly complex in nature, often being used to drive multiple agendas. For example, there is an increasing move to develop learning cities which seek to draw on synergies to both improve citizen learning and skills as well as economic regeneration. Such synergy-driven learning communities, of which the learning cities are but one example, seek to utilise interaction to develop 'emergent products', be it at the individual level or the system-wide level, which could not be produced in isolation. Successfully enabling emergence is critical to their success. Designing for specific types of emergence is however difficult given the intrinsic unpredictability of complex systems. Insight into the intrinsic characteristics of these synergy-driven learning communities and how their interaction leads to emergence over time is required. This paper reports on the methodology developed to explore these highly complex learning communities. The approach adopted was to combine exploratory case studies which established the intrinsic characteristics of the learning communities with an exploration of emergence guided by a meta-level conceptual framework of emergence. This was augmented by secondary data to aid triangulation and provide rigour. As well as discussing the rationale for the adopted approach, implementation issues and the rich information set obtained are discussed using specific case examples. Findings from the investigations led to recommendations regarding future development of appropriate methods for seeding and managing such complex learning communities. The meta level framework means the approach may be readily adapted to other complex social system

Community space in complex learning communities : lessons learnt

Highly complex learning communities where diverse participants collaborate to achieve multiple aims through synergy have the potential to be highly creative and productive. However the diversity and multiple aims can also mean the advantages of a community - share understand, trust and direction - are difficult to achieve, resulting in few if any of the aims being realised. We review two case studies, where the learning community is trying to achieve multiple aims, in order to explore how virtual and physical space are employed to support collaborative learning and enhance synergistic potential. The analysis shows that high levels of diversity have influenced these spaces and trends towards differentiation and holistically designed hybrid, virtual and physical, collaboration space. The characteristics of theses cases are sufficiently general to lead us to draw insights for the building of collaborative space in multi-purpose complex learning communities. These are equably applicable to learning communities which share features such as heterogeneity, multiple locations or a mixture of spaces

Which treatment is most effective for patients with Achilles tendinopathy?:A living systematic review with network meta-analysis of 29 randomised controlled trials

Objective: To provide a consistently updated overview of the comparative effectiveness of treatments for Achilles tendinopathy. Design: Living systematic review and network meta-analysis. Data sources: Multiple databases including grey literature sources were searched up to February 2019. Study eligibility criteria: Randomised controlled trials examining the effectiveness of any treatment in patients wit

Which treatment is most effective for adults with Achilles tendinopathy?

__Introduction__ Achilles tendinopathy is a condition that affects both active and sedentary individuals. It is characterized by localized pain in relation to tendon-loading activities. As chronic Achilles tendinopathy results in substantial disease burden, it is vital to treat it effectively. There are many different conservative and surgical treatments available, but the comparative effectiveness of these treatments has never been evalu

Dapagliflozin: a sodium glucose cotransporter 2 inhibitor in development for type 2 diabetes

Type 2 diabetes mellitus (T2DM) is a growing worldwide epidemic. Patients face lifelong therapy to control hyperglycemia and prevent the associated complications. There are many medications, with varying mechanisms, available for the treatment of T2DM, but almost all target the declining insulin sensitivity and secretion that are associated with disease progression. Medications with such insulin-dependent mechanisms of action often lose efficacy over time, and there is increasing interest in the development of new antidiabetes medications that are not dependent upon insulin. One such approach is through the inhibition of renal glucose reuptake. Dapagliflozin, the first of a class of selective sodium glucose cotransporter 2 inhibitors, reduces renal glucose reabsorption and is currently under development for the treatment of T2DM. Here, we review the literature relating to the preclinical and clinical development of dapagliflozin

Genome-wide meta-analysis associates HLA-DQA1/DRB1 and LPA and lifestyle factors with human longevity

Genomic analysis of longevity offers the potential to illuminate the biology of human aging. Here, using genome-wide association meta-analysis of 606,059 parents' survival, we discover two regions associated with longevity (HLA-DQA1/DRB1 and LPA). We also validate previous suggestions that APOE, CHRNA3/5, CDKN2A/B, SH2B3 and FOXO3A influence longevity. Next we show that giving up smoking, educational attainment, openness to new experience and high-density lipoprotein (HDL) cholesterol levels are most positively genetically correlated with lifespan while susceptibility to coronary artery disease (CAD), cigarettes smoked per day, lung cancer, insulin resistance and body fat are most negatively correlated. We suggest that the effect of education on lifespan is principally mediated through smoking while the effect of obesity appears to act via CAD. Using instrumental variables, we suggest that an increase of one body mass index unit reduces lifespan by 7 months while 1 year of education adds 11 months to expected lifespan

Global surveillance of cancer survival 1995-2009: analysis of individual data for 25,676,887 patients from 279 population-based registries in 67 countries (CONCORD-2)

BACKGROUND: Worldwide data for cancer survival are scarce. We aimed to initiate worldwide surveillance of cancer survival by central analysis of population-based registry data, as a metric of the effectiveness of health systems, and to inform global policy on cancer control. METHODS: Individual tumour records were submitted by 279 population-based cancer registries in 67 countries for 25·7 million adults (age 15-99 years) and 75,000 children (age 0-14 years) diagnosed with cancer during 1995-2009 and followed up to Dec 31, 2009, or later. We looked at cancers of the stomach, colon, rectum, liver, lung, breast (women), cervix, ovary, and prostate in adults, and adult and childhood leukaemia. Standardised quality control procedures were applied; errors were corrected by the registry concerned. We estimated 5-year net survival, adjusted for background mortality in every country or region by age (single year), sex, and calendar year, and by race or ethnic origin in some countries. Estimates were age-standardised with the International Cancer Survival Standard weights. FINDINGS: 5-year survival from colon, rectal, and breast cancers has increased steadily in most developed countries. For patients diagnosed during 2005-09, survival for colon and rectal cancer reached 60% or more in 22 countries around the world; for breast cancer, 5-year survival rose to 85% or higher in 17 countries worldwide. Liver and lung cancer remain lethal in all nations: for both cancers, 5-year survival is below 20% everywhere in Europe, in the range 15-19% in North America, and as low as 7-9% in Mongolia and Thailand. Striking rises in 5-year survival from prostate cancer have occurred in many countries: survival rose by 10-20% between 1995-99 and 2005-09 in 22 countries in South America, Asia, and Europe, but survival still varies widely around the world, from less than 60% in Bulgaria and Thailand to 95% or more in Brazil, Puerto Rico, and the USA. For cervical cancer, national estimates of 5-year survival range from less than 50% to more than 70%; regional variations are much wider, and improvements between 1995-99 and 2005-09 have generally been slight. For women diagnosed with ovarian cancer in 2005-09, 5-year survival was 40% or higher only in Ecuador, the USA, and 17 countries in Asia and Europe. 5-year survival for stomach cancer in 2005-09 was high (54-58%) in Japan and South Korea, compared with less than 40% in other countries. By contrast, 5-year survival from adult leukaemia in Japan and South Korea (18-23%) is lower than in most other countries. 5-year survival from childhood acute lymphoblastic leukaemia is less than 60% in several countries, but as high as 90% in Canada and four European countries, which suggests major deficiencies in the management of a largely curable disease. INTERPRETATION: International comparison of survival trends reveals very wide differences that are likely to be attributable to differences in access to early diagnosis and optimum treatment. Continuous worldwide surveillance of cancer survival should become an indispensable source of information for cancer patients and researchers and a stimulus for politicians to improve health policy and health-care systems

Track E Implementation Science, Health Systems and Economics

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/138412/1/jia218443.pd