Making sense of complexity in context and implementation: the Context and Implementation of Complex Interventions (CICI) framework.

BACKGROUND: The effectiveness of complex interventions, as well as their success in reaching relevant populations, is critically influenced by their implementation in a given context. Current conceptual frameworks often fail to address context and implementation in an integrated way and, where addressed, they tend to focus on organisational context and are mostly concerned with specific health fields. Our objective was to develop a framework to facilitate the structured and comprehensive conceptualisation and assessment of context and implementation of complex interventions. METHODS: The Context and Implementation of Complex Interventions (CICI) framework was developed in an iterative manner and underwent extensive application. An initial framework based on a scoping review was tested in rapid assessments, revealing inconsistencies with respect to the underlying concepts. Thus, pragmatic utility concept analysis was undertaken to advance the concepts of context and implementation. Based on these findings, the framework was revised and applied in several systematic reviews, one health technology assessment (HTA) and one applicability assessment of very different complex interventions. Lessons learnt from these applications and from peer review were incorporated, resulting in the CICI framework. RESULTS: The CICI framework comprises three dimensions-context, implementation and setting-which interact with one another and with the intervention dimension. Context comprises seven domains (i.e., geographical, epidemiological, socio-cultural, socio-economic, ethical, legal, political); implementation consists of five domains (i.e., implementation theory, process, strategies, agents and outcomes); setting refers to the specific physical location, in which the intervention is put into practise. The intervention and the way it is implemented in a given setting and context can occur on a micro, meso and macro level. Tools to operationalise the framework comprise a checklist, data extraction tools for qualitative and quantitative reviews and a consultation guide for applicability assessments. CONCLUSIONS: The CICI framework addresses and graphically presents context, implementation and setting in an integrated way. It aims at simplifying and structuring complexity in order to advance our understanding of whether and how interventions work. The framework can be applied in systematic reviews and HTA as well as primary research and facilitate communication among teams of researchers and with various stakeholders

Leolani: a reference machine with a theory of mind for social communication

Our state of mind is based on experiences and what other people tell us. This may result in conflicting information, uncertainty, and alternative facts. We present a robot that models relativity of knowledge and perception within social interaction following principles of the theory of mind. We utilized vision and speech capabilities on a Pepper robot to build an interaction model that stores the interpretations of perceptions and conversations in combination with provenance on its sources. The robot learns directly from what people tell it, possibly in relation to its perception. We demonstrate how the robot's communication is driven by hunger to acquire more knowledge from and on people and objects, to resolve uncertainties and conflicts, and to share awareness of the per- ceived environment. Likewise, the robot can make reference to the world and its knowledge about the world and the encounters with people that yielded this knowledge.Comment: Invited keynote at 21st International Conference on Text, Speech and Dialogue, https://www.tsdconference.org/tsd2018

Intelligent libraries and apomediators: distinguishing between Library 3.0 and Library 2.0.

Many terms and concepts have appeared in and disappeared from the history of librarianship. Currently, the use of “point oh” naming system to label developments in librarianship is prevalent. Debate on the appropriateness, basis and syntax of this naming system is ongoing. Specifically, the profession has been lately engrossed in discourses in various contexts to unravel the real meaning and potential of Library 2.0. But even before this debate is settled, a new term, Library 3.0, is seeking space in the core librarianship lexicon. This development is causing confusion among librarianship scholars, practitioners and students especially on whether there is any significant difference between the two models. Through documentary analysis, the authors explored the true meanings of these terms and have concluded that Library 2.0 and Library 3.0 are indeed different. The authors have also concluded that whereas Library 2.0 could be seen as attempting to weaken the role of librarians in the emerging information environment, Library 3.0 projects librarians as prominent apomediaries standing by and guiding the library users on how best to locate, access and use credible information in myriad formats from diverse sources, at the point of need. The authors therefore note that the prospect of the Library 3.0 model has revived hope amongst the librarians who were uncomfortable with the crowd intelligence architecture on which the Library 2.0 model was founded. Similarly, the authors have concluded that Library 3.0 provides the tools and framework to organize the infosphere that the Library 2.0 threw into disarray. Thus Library 3.0 is generally understood to be an improvement of Library 2.0 tools and techniques. The authors propose that a 3.0 library be perceived as a personalizable, intelligent, sensitive and living institution created and sustained by a seamless engagement of library users, librarians and subject experts on a federated network of information pathways

Associations between transcranial Doppler vasospasm and clinical outcomes after aneurysmal subarachnoid hemorrhage: A retrospective observational study

OBJECTIVE: The objective is to examine the relationship between transcranial Doppler cerebral vasospasm (TCD-vasospasm), and clinical outcomes in aneurysmal subarachnoid hemorrhage (aSAH). METHODS: In a retrospective cohort study, using univariate and multivariate analysis, we examined the association between TCD-vasospasm (defined as Lindegaard ratio \u3e3) and patient\u27s ability to ambulate without assistance, the need for tracheostomy and gastrostomy tube placement, and the likelihood of being discharged home from the hospital. RESULTS: We studied 346 patients with aSAH; median age 55 years (Interquartile range IQR 46,64), median Hunt and Hess 3 [IQR 1-5]. Overall, 68.6% (n=238) had TCD-vasospasm, and 28% (n=97) had delayed cerebral ischemia. At hospital discharge, 54.3% (n=188) were able to walk without assistance, 5.8% (n=20) had received a tracheostomy, and 12% (n=42) had received a gastrostomy tube. Fifty-three percent (n=183) were discharged directly from the hospital to their home. TCD-vasospasm was not associated with ambulation without assistance at discharge (adjusted odds ratio, aOR 0.54, 95% 0.19,1.45), tracheostomy placement (aOR 2.04, 95% 0.23,18.43), gastrostomy tube placement (aOR 0.95, 95% CI 0.28,3.26), discharge to home (aOR 0.36, 95% CI 0.11,1.23). CONCLUSION: This single-center retrospective study finds that TCD-vasospasm is not associated with clinical outcomes such as ambulation without assistance, discharge to home from the hospital, tracheostomy, and gastrostomy feeding tube placement. Routine screening for cerebral vasospasm and its impact on vasospasm diagnostic and therapeutic interventions and their associations with improved clinical outcomes warrant an evaluation in large, prospective, case-controlled, multi-center studies

Benchmarking hospital practices and policies on intrahospital neurocritical care transport: The Safe-Neuro-Transport study

An electronic survey was administered to multidisciplinary neurocritical care providers at 365 hospitals in 32 countries to describe intrahospital transport (IHT) practices of neurocritically ill patients at their institutions. The reported IHT practices were stratified by World Bank country income level. Variability between high-income (HIC) and low/middle-income (LMIC) groups, as well as variability between hospitals within countries, were expressed as counts/percentages and intracluster correlation coefficients (ICCs) with a 95% confidence interval (CI). A total of 246 hospitals (67% response rate

Stochastic Modelling: From Pattern Classification to Speech Recognition and Language Translation

This paper gives an overview of the stochastic modelling approach to machine translation. Starting with the Bayes decision rule as in pattern classification and speech recognition, we show how the resulting system architecture can be structured into three parts: the language model probability, the string translation model probability and the search procedure that gener-ates the word sequence in the target language. We discuss the properties of the system components and report results on the translation of spoken dialogues in the VERBMOBIL project. The experience obtained in the VERB-MOBIL project, in particular a large-scale end-to-end evaluation, showed that the stochastic modelling approach resulted in significantly lower error rates than three competing translation approaches: the sentence error rate was 29 % in comparison with 52 % to 62% for the other translation approaches.