117 research outputs found
Coalition unionism : exploring how and when coalitions contribute to union renewal in Sydney, Toronto and Chicago
Item does not contain fulltextWe have previously identified eight novel autoantibody targets in the cerebrospinal fluid of multiple sclerosis (MS) patients, including sperm-associated Ag 16 (SPAG16). In the current study, we further investigated the autoantibody response against SPAG16-a protein with unknown function in the CNS-and its expression in MS pathology. Using isoelectric focusing, we detected SPAG16-specific oligoclonal bands in the cerebrospinal fluid of 5 of 23 MS patients (22%). Analysis of the anti-SPAG16 Ab reactivity in the plasma of a total of 531 donors using ELISA demonstrated significantly elevated anti-SPAG16 Ab levels (p = 0.002) in 32 of 153 MS patients (21%) compared with all other control groups with 95% specificity for the disease. To investigate the pathologic relevance of anti-SPAG16 Abs in vivo, anti-SPAG16 Abs were injected in mice with experimental autoimmune encephalomyelitis, resulting in a significant disease exacerbation. Finally, we demonstrated a consistent upregulation of SPAG16 in MS brain and experimental autoimmune encephalomyelitis spinal cord lesions, more specifically in reactive astrocytes. We conclude that SPAG16 is a novel autoantibody target in a subgroup of MS patients and in combination with other diagnostic criteria, elevated levels of anti-SPAG16 Abs could be used as a biomarker for diagnosis. Furthermore, the pathologic relevance of anti-SPAG16 Abs was shown in vivo
Behavioral challenges in policy analysis with conflicting objectives
Public policy problems are rife with conflicting objectives: efficiency versus fairness,
technical criteria versus political goals, costs versus multiple benefits. Multi-Criteria
Decision Analysis provides robust methodologies to support policy makers in making
tough choices and in designing better policy options when considering these
conflicting objectives. However, important behavioral challenges exist in developing
these models: the use of expert judgments, whenever evidence is not available; the
elicitation of preferences and priorities from policy makers and communities; and the
effective management of group decision processes. The extensive developments in
behavioral decision research, social psychology, facilitated decision modeling, and
incomplete preference models shed light on how decision analysts should address
these issues, so we can provide better decision support and develop high quality
decision models. In this tutorial I discuss the main findings of these extensive, but
rather fragmented, literatures providing a coherent and practical framework for
managing behavioral issues, minimizing behavioral biases, and optimizing the quality
of human judgments in policy analysis models with conflicting objectives. I illustrate
these guidelines with policy analysis interventions that we have conducted over the
last decade for several organizations, such as the World Health Organization (WHO),
the Food and Agriculture Organization of the United Nations (FAO), the UK
Department of Environment Food and Rural Affairs (DEFRA), the Malaria
Consortium/USAID, the UK National Audit Office, among others
Is U.S. health care an appropriate system? A strategic perspective from systems science
<p>Abstract</p> <p>Context</p> <p>Systems science provides organizational principles supported by biologic findings that can be applied to any organization; any incongruence indicates an incomplete or an already failing system. U.S. health care is commonly referred to as a system that consumes an ever- increasing percentage of the gross domestic product and delivers seemingly diminishing value.</p> <p>Objective</p> <p>To perform a comparative study of U.S. health care with the principles of systems science and, if feasible, propose solutions.</p> <p>Design</p> <p>General systems theory provides the theoretical foundation for this observational research.</p> <p>Main Outcome Measures</p> <p>A degree of compliance of U.S. health care with systems principles and its space-time functional location within the dynamic systems model.</p> <p>Results of comparative analysis</p> <p>U.S. health care is an incomplete system further threatened by the fact that it functions in the zone of chaos within the dynamic systems model.</p> <p>Conclusion</p> <p>Complying with systems science principles and the congruence of pertinent cycles, U.S. health care would likely dramatically improve its value creation for all of society as well as its resiliency and long-term sustainability.</p> <p>Immediate corrective steps could be taken: Prioritize and incentivize <it>health </it>over <it>care</it>; restore fiscal soundness by combining health and life insurance for the benefit of the insured and the payer; rebalance horizontal/providers and vertical/government hierarchies.</p
Mapping the multicausality of Alzheimer's disease through group model building
Alzheimer's disease (AD) is a complex, multicausal disorder involving several spatiotemporal scales and scientific domains. While many studies focus on specific parts of this system, the complexity of AD is rarely studied as a whole. In this work, we apply systems thinking to map out known causal mechanisms and risk factors ranging from intracellular to psychosocial scales in sporadic AD. We report on the first systemic causal loop diagram (CLD) for AD, which is the result of an interdisciplinary group model building (GMB) process. The GMB was based on the input of experts from multiple domains and all proposed mechanisms were supported by scientific literature. The CLD elucidates interaction and feedback mechanisms that contribute to cognitive decline from midlife onward as described by the experts. As an immediate outcome, we observed several non-trivial reinforcing feedback loops involving factors at multiple spatial scales, which are rarely considered within the same theoretical framework. We also observed high centrality for modifiable risk factors such as social relationships and physical activity, which suggests they may be promising leverage points for interventions. This illustrates how a CLD from an interdisciplinary GMB process may lead to novel insights into complex disorders. Furthermore, the CLD is the first step in the development of a computational model for simulating the effects of risk factors on AD.Neuro Imaging Researc
Using system dynamics for collaborative design: a case study
<p>Abstract</p> <p>Background</p> <p>In order to facilitate the collaborative design, system dynamics (SD) with a group modelling approach was used in the early stages of planning a new stroke unit. During six workshops a SD model was created in a multiprofessional group.</p> <p>Aim</p> <p>To explore to which extent and how the use of system dynamics contributed to the collaborative design process.</p> <p>Method</p> <p>A case study was conducted using several data sources.</p> <p>Results</p> <p>SD supported a collaborative design, by facilitating an explicit description of stroke care process, a dialogue and a joint understanding. The construction of the model obliged the group to conceptualise the stroke care and experimentation with the model gave the opportunity to reflect on care.</p> <p>Conclusion</p> <p>SD facilitated the collaborative design process and should be integrated in the early stages of the design process as a quality improvement tool.</p
Why so serious? Theorising playful model-driven group decision support with situated affectivity
This is the author accepted manuscript. The final version is available from Springer via the DOI in this record.An integrative approach to theorising behavioural, affective and cognitive processes in modeldriven
group decision support (GDS) interventions is needed to gain insight into the (micro-)processes
by which outcomes are accomplished. This paper proposes that the theoretical lens of situated
affectivity, grounded in recent extensions of scaffolded mind models, is suitable to understand the
performativity of affective micro-processes in model-driven GDS interventions. An illustrative vignette
of a humorous micro-moment in a group decision workshop is presented to reveal the performativity of
extended affective scaffolding processes for group decision development. The lens of situated
affectivity constitutes a novel approach for the study of interventionist practice in the context of group
decision making (and negotiation). An outlook with opportunities for future research is offered to
facilitate an integrated approach to the study of cognitive-affective and behavioural micro-processes in
model-driven GDS interventions.This work was supported in part by the EU FP7-ENERGY- SMARTCITIES-2012
(314277) project STEEP (Systems Thinking for Comprehensive City Efficient Energy Planning
Chronic Stress Induces Sex-Specific Alterations in Methylation and Expression of Corticotropin-Releasing Factor Gene in the Rat
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