Do healthcare services behave as complex systems? Analysis of patterns of attendance and implications for service delivery

Background: The science of complex systems has been proposed as a way of understanding health services and the demand for them, but there is little quantitative evidence to support this. We analysed patterns of healthcare use in different urgent care settings to see if they showed two characteristic statistical features of complex systems: heavy-tailed distributions (including the inverse power law) and generative burst patterns. Methods: We conducted three linked studies. In study 1 we analysed the distribution of number of contacts per patient with an urgent care service in two settings: emergency department (ED) and primary care out-of-hours (PCOOH) services. We hypothesised that these distributions should be heavy-tailed (inverse power law or log-normal) in keeping with typical complex systems. In study 2 we analysed the distribution of bursts of contact with urgent care services by individuals: correlated bursts of activity occur in complex systems and represent a mechanism by which overall heavy-tailed distributions arise. In study 3 we replicated the approach of study 1 using data systematically identified from published sources. Results: Study 1 involved data from a PCOOH service in Scotland (725,000) adults, 1.1 million contacts) and an ED in New Zealand (60,000 adults, 98,000 contacts). The total number of contacts per individual in each dataset was statistically indistinguishable from an inverse power law (p &gt; 0.05) above 4 contacts for the PCOOH data and 3 contacts for the ED data. Study 2 found the distribution of contact bursts closely followed a heavy-tailed distribution (p &lt; 0.008), indicating the presence of correlated bursts. Study 3 identified data from 17 studies across 8 countries and found distributions similar to study 1 in all of them. Conclusions: Urgent healthcare use displays characteristic statistical features of large complex systems. These studies provide strong quantitative evidence that healthcare services behave as complex systems and have important implications for urgent care. Interventions to manage demand must address drivers for consultation across the whole system: focusing on only the highest users (in the tail of the distribution) will have limited impact on efficiency. Bursts of attendance - and ways to shorten them - represent promising targets for managing demand.</p

A problem structuring method for ecosystem-based management : the DPSIR modelling process

The purpose of this paper is to learn from Complex Adaptive Systems (CAS) theory to inform the development of Problem Structuring Methods (PSMs) both in general and in the specific context of marine management. The focus on marine management is important because it is concerned with a CAS (formed through the interconnection between natural systems, designed systems and social systems) which exemplifies their particularly ‘wicked' nature. Recognition of this compels us to take seriously the need to develop tools for knowledge elicitation and structuring which meet the demands of CAS. In marine management, chief among those tools is the DPSIR (Drivers - Pressures - State Changes - Impacts - Responses) model and, although widely applied, the extent to which it is appropriate for dealing with the demands of a CAS is questionable. Such questioning is particularly pertinent in the context of the marine environment where there is a need to not only recognise a broad range of stakeholders (a question of boundary critique) but also to manage competing knowledge (economic, local and scientific) and value claims. Hence this paper emphasises how a CAS perspective might add impetus to the development of a critical perspective on DPSIR and PSM theory and practice to promote a more systemic view of decision-making and policy development

Management of the marine environment: Integrating ecosystem services and societal benefits with the DPSIR framework in a systems approach

Ever increasing and diverse use of the marine environment is leading to human-induced changes in marine life, habitats and landscapes, making necessary the development of marine policy that considers all members of the user community and addresses current, multiple, interacting uses. Taking a systems approach incorporating an understanding of The Ecosystem Approach, we integrate the DPSIR framework with ecosystem services and societal benefits, and the focus this gives allows us to create a specific framework for supporting decision making in the marine environment. Based on a linking of these three concepts, we present a set of basic postulates for the management of the marine environment and emphasise that these postulates should hold for marine management to be achieved. We illustrate these concepts using two case studies: the management of marine aggregates extraction in UK waters and the management of marine biodiversity at Flamborough Head, UK. (C) 2010 Elsevier Ltd. All rights reserved

A comparative study of factors affecting product quality and customer needs compliance in the new product development process

To succeed and survive in competitive markets, products need to be of the desired quality. Quality is how well the product, in its entirety, satisfies the needs of the intended customers. With products in industrial markets, there are many different types of customers to satisfy. Research has been published that is of general use to help define the New Product Development (NPD) process and the management of its activities and this was useful as a basis for this research study. However, little previous work is available that details the specific aspect of designing for customer needs compliance. An exploratory investigation, using analysis of selected cases and experience surveys, was undertaken to help direct conceptual work. A conceptual model was developed to help describe the NPD process and customer needs compliance. The hypotheses that guided the main study sought to understand the perceptions which the design team has of the product in terms of different customer needs. They also aimed to determine how information management during NPD may affect the final design and, consequently, the quality of the product. With the objective of drawing conclusions across the four companies involved in the main study, collection methods and data analysis provided quantitative results on what is essentially qualitative types of information. The findings conclude that each of the companies do perceive a difference in the needs of the customers between different product types. However, they also imply that specific types of customers have similar needs, no matter what types of products are involved. With a small set of respondents in each company, no evidence was found to suggest that the different perceptions the people involved in the design and development of the product had could be attributed to the functional, managerial or customer involvement groupings under investigation. However, there was some evidence that customer needs compliance may be affected by the way the company handled its information management during the NPD process

Activation of PKR by Bunyamwera virus is independent of the viral interferon antagonist NSs

Double-stranded RNA (dsRNA) is a by-product of viral RNA polymerase activity, and its recognition is one mechanism by which the innate immune system is activated. Cellular responses to dsRNA include induction of alpha/beta interferon (IFN) synthesis and activation of the enzyme PKR, which exerts its antiviral effect by phosphorylating the eukaryotic initiation factor eIF-2 alpha, thereby inhibiting translation. We have recently identified the nonstructural protein NSs of Bunyamwera virus (BUNV), the prototype of the family Bunyaviridae, as a virulence factor that blocks the induction of IFN by dsRNA. Here, we investigated the potential of NSs to inhibit PKR. We show that wild-type (wt) BUNV that expresses NSs triggered PKR-dependent phosphorylation of eIF-2 alpha to levels similar to those of a recombinant virus that does not express NSs (BUNdelNSs virus). Furthermore, the sensitivity of viruses in cell culture to IFN was independent of PKR and was not determined by NSs. PKR knockout mice, however, succumbed to infection approximately 1 day earlier than wt mice or mice deficient in expression of RNase L, another dsRNA-activated antiviral enzyme. Our data indicate that (i) bunyaviruses activate PKR, but are only marginally sensitive to its antiviral effect, and (ii) NSs is different from other IFN antagonists, since it inhibits dsRNA-dependent IFN induction but has no effect on the dsRNA-activated PKR and RNase L systems

An Administrative Approach for Special Educator Retention

Special education teacher attrition is an ongoing area of concern across the US. One factor that influences special educator attrition and retention is administrative support. Unfortunately, administrators often enter school leadership positions with little or no background in special education, thus making it difficult to provide the much-needed support. This practitioner piece provides information and resources for school-based administrators to use to support special education teachers and students within their schools

An Analysis of Perceptions of the Relationship Between the Athletic Director and Athletics’ Direct Reports in NCAA Division II

The roles and responsibilities of the individual designated as the athletics’ direct report (ADR) on NCAA Division II member institution campuses are not clearly defined. The absence of clear guidelines creates the opportunity for differences in the relationships between the athletic director (AD) and the designated ADR between peer institutions. The purpose of this study was to explore the current relationship between ADs and ADRs and analyze current practices. Results indicated positive relations between ADs and ADRs on campus and that communication is key to a successful relationship. Recommendations for practitioners are discussed

Barriers to access: Investigation of plus-size women consumer experiences at fashion events

Finkel, Rebecca - ORCID 0000-0003-2120-6211 https://orcid.org/0000-0003-2120-6211Recent cross-disciplinary literature in the social sciences has shown that fat women experience weight bias and marginalisation in nearly all aspects of life, including within the fashion industry. This stigmatisation results in exclusion from brand and designer collections, runway shows, and other fashion events. As research in this area and in particular within an event context is very scarce, this chapter draws upon accessibility research, fat studies, and critical events studies to investigate the physical and psychological barriers to access for plus-size women at fashion events along with consumer attitudes with regard to fashion events. Research methods adopt quantitative approaches and include a survey of plus-size women who have attended a fashion event in 2017, which allowed for analysis of their experiences with regard to accessibility obstacles as well as their attitudes regarding fashion events and fashion event managers. Findings reveal plus-size consumers are more likely to attend fashion events if they see their body types represented in promotional event materials. They are also more likely to attend if they believe their needs will be met by the event facilities. Consumer attitudes toward fashion events and fashion event managers were generally negative, but provided several opportunities for growth and improvement.https://www.routledge.com/Marginalisation-and-Events-1st-Edition/Walters-Jepson/p/book/9780429506697pubpu

Pharmacist-led management of chronic pain in primary care:results from a randomised controlled exploratory trial

To compare the effectiveness of pharmacist medication review, with or without pharmacist prescribing, with standard care, for patients with chronic pain

Decision making in conceptual engineering design: an empirical investigation

This paper describes the aims, methodology and results of an empirical research project. The aim was to gather new insight about how collaborative decision-making processes in the conceptual engineering design phase of the product development process takes place. The insight contributes to bridging the gap between the theoretical development of new decision-making methods in academia and the needs of practitioners. The researchers observed, recorded and transcribed three workshops involving groups that were engaged in the collaborative decision-making processes. Through analysing the transcripts, a set of decision-making related activities was identified. Each activity's time consumption was quantified, and a number of decision-making process models at different levels of detail were developed. During this analysis, various observations on particular process characteristics were made. It was observed that generating formal structures and documentation was beneficial to the decision-making process. This was particularly true with respect to developing problem understanding and consistency. The outcomes should be valuable for the design and development of improved decision-support systems