Diffusion and social networks: revisiting medical innovation with agents

the classic study on diffusion of Tetracycline by Coleman, Katz and Menzel (1966). Medical Innovation articulates how different patterns of interpersonal communications can influence the diffusion process at different stages of adoption. In their pioneering study, individual network (discussion, friendship or advice) was perceived as a set of disjointed pairs, and the extent of influences were therefore, evaluated for pairs of individuals. Given the existence of overlapping networks and consequent influences on doctors’ adoption decisions, the complexity of actual events was not captured by pair analysis. Subsequent reanalyses (Burt 1987, Strang and Tuma 1993, Valente 1995, Van den Bulte and Lilien 2001) failed to capture the complexity involved in the diffusion process and had a static exposure of the network structure. In this paper, for the first time, we address these limitations by combining Agent-Based Modeling (ABM) and network analysis. Based on the findings of Coleman et. al. (1966) study, we develop a diffusion model, Gammanym. Using SMALLTALK programming language, Gammanym is developed with CORMAS platform under Visual Works environment. The medical community is portrayed in an 8 X 8 spatial grid. The unit cell captures three different locations for professional interactions: practices, hospitals, and conference centers, randomly located over the spatial grid. Two social agents- Doctor and Laboratory are depicted in the model. Doctors are the principal agents in the diffusion process and are initially located at their respective practices. A doctor’s adoption decision is influenced by a random friendship network, and a professional network created through discussions with office colleagues, or hospital visits or conference attendance. A communicating agent, Laboratory, on the other hand, influences doctors’ adoption decisions by sending information through multiple channels: medical representatives or detailman visiting practices, journals sent to doctors’ practices and commercial flyers available during conferences. Doctors’ decisions to adopt a new drug involve interdependent local interactions among different entities in Gammanym. The cumulative adoption curves (Figure 1) are derived for three sets of initial conditions, based on which network topology and evolution of uptake are analyzed. The three scenarios are specified to evaluate the degree of influences by different factors in the diffusion process: baseline scenario with one seed (initial adopter), one detailman and one journal; heavy media scenario with one seed but increasing degrees of external influence, with five detailman and four journals; and integration scenario with one seed, without any external influence from the laboratory

Diffusion and social networks: revisiting medical innovation with agents

the classic study on diffusion of Tetracycline by Coleman, Katz and Menzel (1966). Medical Innovation articulates how different patterns of interpersonal communications can influence the diffusion process at different stages of adoption. In their pioneering study, individual network (discussion, friendship or advice) was perceived as a set of disjointed pairs, and the extent of influences were therefore, evaluated for pairs of individuals. Given the existence of overlapping networks and consequent influences on doctors’ adoption decisions, the complexity of actual events was not captured by pair analysis. Subsequent reanalyses (Burt 1987, Strang and Tuma 1993, Valente 1995, Van den Bulte and Lilien 2001) failed to capture the complexity involved in the diffusion process and had a static exposure of the network structure. In this paper, for the first time, we address these limitations by combining Agent-Based Modeling (ABM) and network analysis. Based on the findings of Coleman et. al. (1966) study, we develop a diffusion model, Gammanym. Using SMALLTALK programming language, Gammanym is developed with CORMAS platform under Visual Works environment. The medical community is portrayed in an 8 X 8 spatial grid. The unit cell captures three different locations for professional interactions: practices, hospitals, and conference centers, randomly located over the spatial grid. Two social agents- Doctor and Laboratory are depicted in the model. Doctors are the principal agents in the diffusion process and are initially located at their respective practices. A doctor’s adoption decision is influenced by a random friendship network, and a professional network created through discussions with office colleagues, or hospital visits or conference attendance. A communicating agent, Laboratory, on the other hand, influences doctors’ adoption decisions by sending information through multiple channels: medical representatives or detailman visiting practices, journals sent to doctors’ practices and commercial flyers available during conferences. Doctors’ decisions to adopt a new drug involve interdependent local interactions among different entities in Gammanym. The cumulative adoption curves (Figure 1) are derived for three sets of initial conditions, based on which network topology and evolution of uptake are analyzed. The three scenarios are specified to evaluate the degree of influences by different factors in the diffusion process: baseline scenario with one seed (initial adopter), one detailman and one journal; heavy media scenario with one seed but increasing degrees of external influence, with five detailman and four journals; and integration scenario with one seed, without any external influence from the laboratory

A guided tour of asynchronous cellular automata

Research on asynchronous cellular automata has received a great amount of attention these last years and has turned to a thriving field. We survey the recent research that has been carried out on this topic and present a wide state of the art where computing and modelling issues are both represented.Comment: To appear in the Journal of Cellular Automat

Executive Summary:International Clinical Practice Guidelines for Pediatric Ventilator Liberation, A Pediatric Acute Lung Injury and Sepsis Investigators (PALISI) Network Document

Rationale: Pediatric-specific ventilator liberation guidelines are lacking despite the many studies exploring elements of extubation readiness testing. The lack of clinical practice guidelines has led to significant and unnecessary variation in methods used to assess pediatric patients’ readiness for extubation. Methods: Twenty-six international experts comprised a multiprofessional panel to establish pediatrics-specific ventilator liberation clinical practice guidelines, focusing on acutely hospitalized children receiving invasive mechanical ventilation for more than 24 hours. Eleven key questions were identified and first prioritized using the Modified Convergence of Opinion on Recommendations and Evidence. A systematic review was conducted for questions that did not meet an a priori threshold of &gt;80% agreement, with Grading of Recommendations, Assessment, Development, and Evaluation methodologies applied to develop the guidelines. The panel evaluated the evidence and drafted and voted on the recommendations. Measurements and Main Results: Three questions related to systematic screening using an extubation readiness testing bundle and a spontaneous breathing trial as part of the bundle met Modified Convergence of Opinion on Recommendations criteria of &gt;80% agreement. For the remaining eight questions, five systematic reviews yielded 12 recommendations related to the methods and duration of spontaneous breathing trials, measures of respiratory muscle strength, assessment of risk of postextubation upper airway obstruction and its prevention, use of postextubation noninvasive respiratory support, and sedation. Most recommendations were conditional and based on low to very low certainty of evidence. Conclusions: This clinical practice guideline provides a conceptual framework with evidence-based recommendations for best practices related to pediatric ventilator liberation.</p

Child mental health differences amongst ethnic groups in Britain: a systematic review

BACKGROUND: Inter-ethnic differences have been reported for many mental health outcomes in the UK, but no systematic review on child mental health has been published. The aim of this review is to compare the population-based prevalence of child mental disorders between ethnic groups in Britain, and relate these findings to ethnic differences in mental health service use. METHODS: A systematic search of bibliographic databases for population-based and clinic-based studies of children aged 0-19, including all ethnic groups and the main child mental disorders. We synthesised findings by comparing each minority group to the White British study sample. RESULTS: 31 population-based and 18 clinic-based studies met the inclusion criteria. Children in the main minority groups have similar or better mental health than White British children for common disorders, but may have higher rates for some less common conditions. The causes of these differences are unclear. There may be unmet need for services among Pakistani and Bangladeshi children. CONCLUSION: Inter-ethnic differences exist but are largely unexplained. Future studies should address the challenges of cross-cultural psychiatry and investigate reasons for inter-ethnic differences

Therapeutic Hypothermia after In-Hospital Cardiac Arrest in Children

BACKGROUND: Targeted temperature management is recommended for comatose adults and children after out-of-hospital cardiac arrest; however, data on temperature management after in-hospital cardiac arrest are limited. METHODS: In a trial conducted at 37 children’s hospitals, we compared two temperature interventions in children who had had in-hospital cardiac arrest. Within 6 hours after the return of circulation, comatose children older than 48 hours and younger than 18 years of age were randomly assigned to therapeutic hypothermia (target temperature, 33.0°C) or therapeutic normothermia (target temperature, 36.8°C). The primary efficacy outcome, survival at 12 months after cardiac arrest with a score of 70 or higher on the Vineland Adaptive Behavior Scales, second edition (VABS-II, on which scores range from 20 to 160, with higher scores indicating better function), was evaluated among patients who had had a VABS-II score of at least 70 before the cardiac arrest. RESULTS: The trial was terminated because of futility after 329 patients had undergone randomization. Among the 257 patients who had a VABS-II score of at least 70 before cardiac arrest and who could be evaluated, the rate of the primary efficacy outcome did not differ significantly between the hypothermia group and the normothermia group (36% [48 of 133 patients] and 39% [48 of 124 patients], respectively; relative risk, 0.92; 95% confidence interval [CI], 0.67 to 1.27; P = 0.63). Among 317 patients who could be evaluated for change in neurobehavioral function, the change in VABS-II score from baseline to 12 months did not differ significantly between the groups (P = 0.70). Among 327 patients who could be evaluated for 1-year survival, the rate of 1-year survival did not differ significantly between the hypothermia group and the normothermia group (49% [81 of 166 patients] and 46% [74 of 161 patients], respectively; relative risk, 1.07; 95% CI, 0.85 to 1.34; P = 0.56). The incidences of blood-product use, infection, and serious adverse events, as well as 28-day mortality, did not differ significantly between groups. CONCLUSIONS: Among comatose children who survived in-hospital cardiac arrest, therapeutic hypothermia, as compared with therapeutic normothermia, did not confer a significant benefit in survival with a favorable functional outcome at 1 year. (Funded by the National Heart, Lung, and Blood Institute; THAPCA-IH ClinicalTrials.gov number, NCT00880087.

Resource Efficiency: Potential and Economic Implications

Despite enormous progress in the past decades towards improving human prosperity and well-being, this has come at the lasting cost of degradation of the natural environment and depletion of natural resources. Meeting the needs of a growing and increasingly affluent population, will require natural resource extraction to increase from 85 to 186 billion tonnes by 2050. This can cause irreversible environmental damage and endanger the capacity of Earth to continue to provide resources which are essential for human survival and development. Analysis in the report shows that policies and initiatives to improve resource efficiency and tackle climate change can reduce global resource extraction by up to 28 per cent while also boosting the value of world economic activity by 1 per cent in 2050, against the baseline. Such policy actions can also cut global greenhouse gas emissions by around 60 per cent in 2050 relative to 2015 levels. This report has been produced by the UNEP’s International Resource Panel in response to a request by leaders of the G7 nations in the context of efforts to promote resource efficiency as a core element of sustainable development. The report conducts a rigorous survey to assess and articulate the prospects and solutions for resource efficiency. It considers how more efficient use of resources can contribute to economic growth, employment and development, at the same time as reducing the world’s use of materials, energy, biomass and water, and the resulting environmental impacts. The report documents many examples of best practices for increasing the resource efficiency of different sectors from countries around the world. The challenge for policy-makers is to learn from and scale up these good practices, and to conceive and implement a set of transformative policies that will enable countries to reap the associated social, environmental and economic benefits. Ambitious action to use resources in a more efficient and sustainable manner can help place the world on the right track to meet its commitments under the 2030 Agenda on Sustainable Development and the Paris Climate Change Agreement, and thereby to realise a more equitable and sustainable future