Primary health care case management through the lens of complexity: an exploratory study of naturopathic practice using complexity science principles.

BACKGROUND: Advances in systems science creates an opportunity to bring a complexity perspective to health care practices and research. While medical knowledge has greatly progressed using a reductionist and mechanistic philosophy, this approach may be limited in its capacity to manage chronic and complex illness. With its holistic foundation, naturopathy is a primary health profession with a purported alignment with a complexity perspective. As such this pilot study aimed to investigate the application of complexity science principles, strategies, and tools to primary health care using naturopathy as a case study. METHODS: A network mapping and analysis of the naturopathic case management process was conducted. Mind maps were created by naturopathic practitioners to reflect their clinical conceptualisation of a common paper clinical case. These mind maps were inputed into Gephi, a network mapping, exploration, and analysis software. Various layouts of the data were produced, and these were analysed using exploratory data analysis and computational network analysis. RESULTS: Seven naturopathic practitioners participated in the study. In the combined network mapping, 133 unique elements and 399 links were identified. Obesity, the presenting issue in the case, was centrally located. Along with obesity, other keystone elements included: systemic inflammation, dysbiosis, diet, the liver, and mood. Each element was connected on average to 3.05 other elements, with a degree variation between one and 36. Six communities within the dataset were identified, comprising: the nervous system and mood, gastroinstetinal and dietary factors, systemic inflammation and obesity, the endocrine system and metabolism. CONCLUSIONS: This pilot study demonstrates that it is feasible to apply a complexity science perspective to investigating primary health care case management. This supports a shift to viewing the human organism as a complex adaptive system within primary health care settings, with implications for health care practices that are more cognisant with the treatment of chronic and complex conditions and research opportunities to capture the complex clinical reasoning processes of practitioners

The converging paradigms of holism and complexity: An exploration of naturopathic clinical case management using complexity science principles.

RATIONALE: Traditional whole systems of medicine, such as naturopathy, are founded upon holism; a philosophical paradigm consistent with contemporary complexity science. Naturopathic case management is predicated upon the understanding of an intimately interconnected internal physiological and external context of the human organism-potentially indicating a worldview aligned with a complexity perspective. In this study we investigate naturopathic clinical reasoning using a complexity lens with the aim of ascertaining the extent of correspondence between the two. METHOD: Mind maps depicting case presentations were sought from Australian degree qualified naturopaths. A network mapping was undertaken, which was then analysed in accordance with a complexity science framework using exploratory data analysis and network analysis processes and tools. RESULTS: Naturopathic case schematics, in the form of mind maps (n = 70), were collected, network mapped, and analysed. A total of 739 unique elements and 2724 links were identified across the network. Integral elements across the network were: stress, fatigue, general anxiety, systemic inflammation, gut dysbiosis, and diet. A modularity algorithm detected 11 communities, the primary ones of these representing the nervous system and mood; the gastrointestinal tract, liver, and nutrition; immune function and the immune system; and diet and nutrients. CONCLUSIONS: Naturopathic case management is holistic and based on a perspective of an integrated physiology and external context of the human organism. The traditional concept of holism, when subjected to a complexity lens, leads to the emergence of a contemporary holistic paradigm cognisant of the human organism being a complex system. The application of complexity science to investigate naturopathic case management as employed in this study, demonstrates that it is possible to investigate traditional philosophies and principles in a scientific and critical manner. A complexity science research approach may offer a suitable scientific paradigm to develop our understanding of traditional whole systems of medicine

Cladding mode coupling in highly localized fiber Bragg gratings: modal properties and transmission spectra

The spectral characteristics of a fiber Bragg grating (FBG) with a transversely inhomogeneous refractive index profile, differs con- siderably from that of a transversely uniform one. Transmission spectra of inhomogeneous and asymmetric FBGs that have been inscribed with focused ultrashort pulses with the so-called point-by-point technique are investigated. The cladding mode resonances of such FBGs can span a full octave in the spectrum and are very pronounced (deeper than 20dB). Using a coupled-mode approach, we compute the strength of resonant coupling and find that coupling into cladding modes of higher azimuthal order is very sensitive to the position of the modification in the core. Exploiting these properties allows precise control of such reflections and may lead to many new sensing applications.Comment: Submission to OE, 16 pages, 6 figure

Point-by-point inscription of apodized fiber Bragg gratings

We demonstrate apodized fiber Bragg gratings inscribed with a point-by-point technique. We tailor the grating phase and coupling amplitude through precise control over the longitudinal and transverse position of each laser-inscribed modification. This method of apodization is facilitated by the highly-localized, high-contrast modifications generated by focussed IR femtosecond laser inscription. Our technique provides a simple method for the design and implementation of point-by-point fiber Bragg gratings with complex apodization profiles.Comment: 6 pages, 4 figures, article in revie

Quantum field effects in coupled atomic and molecular Bose-Einstein condensates

This paper examines the parameter regimes in which coupled atomic and molecular Bose-Einstein condensates do not obey the Gross-Pitaevskii equation. Stochastic field equations for coupled atomic and molecular condensates are derived using the functional positive-P representation. These equations describe the full quantum state of the coupled condensates and include the commonly used Gross-Pitaevskii equation as the noiseless limit. The model includes all interactions between the particles, background gas losses, two-body losses and the numerical simulations are performed in three dimensions. It is found that it is possible to differentiate the quantum and semiclassical behaviour when the particle density is sufficiently low and the coupling is sufficiently strong.Comment: 4 postscript figure

Dynamical quantum noise in Bose-Einstein condensates

We introduce the study of dynamical quantum noise in Bose-Einstein condensates through numerical simulation of stochastic partial differential equations obtained using phase space representations. We derive evolution equations for a single trapped condensate in both the positive-$P$ and Wigner representations, and perform simulations to compare the predictions of the two methods. The positive-$P$ approach is found to be highly susceptible to the stability problems that have been observed in other strongly nonlinear, weakly damped systems. Using the Wigner representation, we examine the evolution of several quantities of interest using from a variety of choices of initial state for the condensate, and compare results to those for single-mode models.Comment: 8 figures, submitted to Phys. Rev.

A modified agar pad method for mycobacterial live-cell imaging

<p>Abstract</p> <p>Background</p> <p>Two general approaches to prokaryotic live-cell imaging have been employed to date, growing bacteria on thin agar pads or growing bacteria in micro-channels. The methods using agar pads 'sandwich' the cells between the agar pad on the bottom and a glass cover slip on top, before sealing the cover slip. The advantages of this technique are that it is simple and relatively inexpensive to set up. However, once the cover slip is sealed, the environmental conditions cannot be manipulated. Furthermore, desiccation of the agar pad, and the growth of cells in a sealed environment where the oxygen concentration will be in gradual decline, may not permit longer term studies such as those required for the slower growing mycobacteria.</p> <p>Findings</p> <p>We report here a modified agar pad method where the cells are sandwiched between a cover slip on the bottom and an agar pad on top of the cover slip (rather than the reverse) and the cells viewed from below using an inverted microscope. This critical modification overcomes some of the current limitations with agar pad methods and was used to produce time-lapse images and movies of cell growth for <it>Mycobacterium smegmatis </it>and <it>Mycobacterium bovis </it>BCG.</p> <p>Conclusions</p> <p>This method offers improvement on the current agar pad methods in that long term live cell imaging studies can be performed and modification of the media during the experiment is permitted.</p