Why We Belong - Exploring Membership of Healthcare Professionals in an Intensive Care Virtual Community Via Online Focus Groups: Rationale and Protocol

Background: Many current challenges of evidence-based practice are related to ineffective social networks among health care professionals. Opportunities exist for multidisciplinary virtual communities to transcend professional and organizational boundaries and facilitate important knowledge transfer. Although health care professionals have been using the Internet to form virtual communities for many years, little is known regarding “why” they join, as most research has focused on the perspective of “posters,” who form a minority of members. Objective: Our aim was to develop a comprehensive understanding of why health care professionals belong to a virtual community (VC). Methods: A qualitative approach will be used to explore why health care professionals belong to an intensive care practice-based VC, established since 2003. Three asynchronous online focus groups will be convened using a closed secure discussion forum. Participants will be recruited directly by sending emails to the VC and a Google form used to collect consent and participant demographics. Participants will be stratified by their online posting behaviors between September 1, 2012, and August 31, 2014: (1) more than 5 posts, (2) 1-5 posts, or (3) no posts. A question guide will be used to guide participant discussion. A moderation approach based on the principles of focus group method and e-moderation has been developed. The main source of data will be discussion threads, supported by a research diary and field notes. Data analysis will be undertaken using a thematic approach and framed by the Diffusion of Innovation theory. NVivo software will be used to support analyses. Results: At the time of writing, 29 participants agreed to participate (Focus Group 1: n=4; Focus Group 2: n=16; Focus Group 3: n=9) and data collection was complete. Conclusions: This study will contribute to a growing body of research on the use of social media in professional health care settings. Specifically, we hope results will demonstrate an enhancement of health care professionals’ social networks and how VCs may improve knowledge distribution and patient care outcomes. Additionally, the study will contribute to research methods development in this area by detailing approaches to understand the effectiveness of online focus groups as a data collection method for qualitative research methods

How health care professionals use social media to create virtual communities: An integrative review

Background: Prevailing health care structures and cultures restrict intraprofessional communication, inhibiting knowledge dissemination and impacting the translation of research into practice. Virtual communities may facilitate professional networking and knowledge sharing in and between health care disciplines. Objectives: This study aimed to review the literature on the use of social media by health care professionals in developing virtual communities that facilitate professional networking, knowledge sharing, and evidence-informed practice. Methods: An integrative literature review was conducted to identify research published between 1990 and 2015. Search strategies sourced electronic databases (PubMed, CINAHL), snowball references, and tables of contents of 3 journals. Papers that evaluated social media use by health care professionals (unless within an education framework) using any research design (except for research protocols or narrative reviews) were included. Standardized data extraction and quality assessment tools were used. Results: Overall, 72 studies were included: 44 qualitative (including 2 ethnographies, 26 qualitative descriptive, and 1 Q-sort) and 20 mixed-methods studies, and 8 literature reviews. The most common methods of data collection were Web-based observation (n=39), surveys (n=23), interviews (n=11), focus groups (n=2), and diaries (n=1). Study quality was mixed. Social media studied included Listservs (n=22), Twitter (n=18), general social media (n=17), discussion forums (n=7), Web 2.0 (n=3), virtual community of practice (n=3), wiki (n=1), and Facebook (n=1). A range of health care professionals were sampled in the studies, including physicians (n=24), nurses (n=15), allied health professionals (n=14), followed by health care professionals in general (n=8), a multidisciplinary clinical specialty area (n=9), and midwives (n=2). Of 36 virtual communities, 31 were monodiscipline for a discrete clinical specialty. Population uptake by the target group ranged from 1.6% to 29% (n=4). Evaluation using related theories of "planned behavior" and the "technology acceptance model" (n=3) suggests that social media use is mediated by an individual's positive attitude toward and accessibility of the media, which is reinforced by credible peers. The most common reason to establish a virtual community was to create a forum where relevant specialty knowledge could be shared and professional issues discussed (n=17). Most members demonstrated low posting behaviors but more frequent reading or accessing behaviors. The most common Web-based activity was request for and supply of specialty-specific clinical information. This knowledge sharing is facilitated by a Web-based culture of collectivism, reciprocity, and a respectful noncompetitive environment. Findings suggest that health care professionals view virtual communities as valuable knowledge portals for sourcing clinically relevant and quality information that enables them to make more informed practice decisions. Conclusions: There is emerging evidence that health care professionals use social media to develop virtual communities to share domain knowledge. These virtual communities, however, currently reflect tribal behaviors of clinicians that may continue to limit knowledge sharing. Further research is required to evaluate the effects of social media on knowledge distribution in clinical practice and importantly whether patient outcomes are significantly improved

A Moving Bump in a Continuous Manifold: A Comprehensive Study of the Tracking Dynamics of Continuous Attractor Neural Networks

Understanding how the dynamics of a neural network is shaped by the network structure, and consequently how the network structure facilitates the functions implemented by the neural system, is at the core of using mathematical models to elucidate brain functions. This study investigates the tracking dynamics of continuous attractor neural networks (CANNs). Due to the translational invariance of neuronal recurrent interactions, CANNs can hold a continuous family of stationary states. They form a continuous manifold in which the neural system is neutrally stable. We systematically explore how this property facilitates the tracking performance of a CANN, which is believed to have clear correspondence with brain functions. By using the wave functions of the quantum harmonic oscillator as the basis, we demonstrate how the dynamics of a CANN is decomposed into different motion modes, corresponding to distortions in the amplitude, position, width or skewness of the network state. We then develop a perturbative approach that utilizes the dominating movement of the network's stationary states in the state space. This method allows us to approximate the network dynamics up to an arbitrary accuracy depending on the order of perturbation used. We quantify the distortions of a Gaussian bump during tracking, and study their effects on the tracking performance. Results are obtained on the maximum speed for a moving stimulus to be trackable and the reaction time for the network to catch up with an abrupt change in the stimulus.Comment: 43 pages, 10 figure

Wind-tunnel investigation of a large-scale model of a lift-cruise fan V/STOL aircraft with extended lift-cruise nacelles

The aerodynamic characteristics of a large-scale model of a lift/cruise fan V/STOL aircraft were determined. The model was equipped with three fans, one mounted in the forward section of the fuselage in a lift mode, and two mounted on top of the wing adjacent to the fuselage in a lift/cruise mode. The data that were obtained include longitudinal and lateral-directional characteristics of the model, with the horizontal tail on and off, for both the powered-lift and cruise configurations. Lateral-directional characteristics were obtained with the horizontal and vertical tail sections removed. Powered-lift data were obtained at several wind-tunnel velocities and at several lift-cruise fan thrust vector angles by varying the position of the hooded deflectors from 0 deg (the cruise condition) to 90 deg

Wind tunnel investigation of a large-scale model of a lift/cruise fan V/STOL aircraft

An investigation was conducted in the Ames 40- by 80-Foot wind tunnel to determine the aerodynamic characteristics of a large scale model of a lift/cruise fan V/STOL aircraft. The model was equipped with three fans, one mounted in the forward section of the fuselage in a lift mode, and two mounted on top of the wing adjacent to the fuselage in a lift/cruise mode. The data that were obtained include longitudinal and lateral-directional characteristics of the model, with the horizontal tail on and off, for both the Powered lift and cruise configurations. Powered lift data were obtained at several wind tunnel velocities and at several lift/cruise fan thrust vector angles by varying the position of the hooded deflectors from 0 deg. (the cruise condition) to 90 deg

If You Build It They Will Come: Growth of an Online Community for Intensive Care in Australia

Rolls, K., Kowal, D., Hansen, M., Group learning and networking are integral to contemporary views of organisational and knowledge management, and learning. Current healthcare structures however create practice silos that promote professional isolation and limit the flow and uptake of knowledge. Computer mediated communication (CMC) technologies transcend time and geography, enabling clinicians to communicate and interact with a broad range of colleagues continuously. This contrasts with traditional approaches to networking that rely on limited personal contacts and/or professional events. In 2003 the NSW Intensive Care Coordination and Monitoring Unit established ‘ICUConnect’, a listserv to network intensive care (IC) clinicians. Initially 130, predominantly senior nurses (94%), were enrolled, with subsequent members self-nominating. Literature suggests that membership uptake is mediated by a perceived need to network, limited internal resources, value, and intra-personal communication channels. A descriptive study using a de-identified dataset examined how membership profiles changed from 2003 to 2009. Analysis included frequencies and proportions of descriptive variables, and chi-square tests for differences in proportions. Membership totalled 1044 in the end of 2009 with 85% nurses, 7% doctors and 8% other healthcare professionals. There were significant changes over time in proportions for professions [2 11.4 p=0.04], location [2 103.3; p=0.000] and workplace [2 31.2; p=0.000]. Outside NSW smaller units had significantly less members (Level 3-61; level 2-23; level 1-0). The rapid uptake of membership is indicative of IC professionals’ desire and need to network, with self-nomination confirming the listerv’s value. The initial concept of professional isolation is confirmed by lack of members in smaller units outside NSW

Attention-dependent modulation of cortical taste circuits revealed by granger causality with signal-dependent noise

We show, for the first time, that in cortical areas, for example the insular, orbitofrontal, and lateral prefrontal cortex, there is signal-dependent noise in the fMRI blood-oxygen level dependent (BOLD) time series, with the variance of the noise increasing approximately linearly with the square of the signal. Classical Granger causal models are based on autoregressive models with time invariant covariance structure, and thus do not take this signal-dependent noise into account. To address this limitation, here we describe a Granger causal model with signal-dependent noise, and a novel, likelihood ratio test for causal inferences. We apply this approach to the data from an fMRI study to investigate the source of the top-down attentional control of taste intensity and taste pleasantness processing. The Granger causality with signal-dependent noise analysis reveals effects not identified by classical Granger causal analysis. In particular, there is a top-down effect from the posterior lateral prefrontal cortex to the insular taste cortex during attention to intensity but not to pleasantness, and there is a top-down effect from the anterior and posterior lateral prefrontal cortex to the orbitofrontal cortex during attention to pleasantness but not to intensity. In addition, there is stronger forward effective connectivity from the insular taste cortex to the orbitofrontal cortex during attention to pleasantness than during attention to intensity. These findings indicate the importance of explicitly modeling signal-dependent noise in functional neuroimaging, and reveal some of the processes involved in a biased activation theory of selective attention