840 resultados para Medication complexity


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This research has explored the relationship between system test complexity and tacit knowledge. It is proposed as part of this thesis, that the process of system testing (comprising of test planning, test development, test execution, test fault analysis, test measurement, and case management), is directly affected by both complexity associated with the system under test, and also by other sources of complexity, independent of the system under test, but related to the wider process of system testing. While a certain amount of knowledge related to the system under test is inherent, tacit in nature, and therefore difficult to make explicit, it has been found that a significant amount of knowledge relating to these other sources of complexity, can indeed be made explicit. While the importance of explicit knowledge has been reinforced by this research, there has been a lack of evidence to suggest that the availability of tacit knowledge to a test team is of any less importance to the process of system testing, when operating in a traditional software development environment. The sentiment was commonly expressed by participants, that even though a considerable amount of explicit knowledge relating to the system is freely available, that a good deal of knowledge relating to the system under test, which is demanded for effective system testing, is actually tacit in nature (approximately 60% of participants operating in a traditional development environment, and 60% of participants operating in an agile development environment, expressed similar sentiments). To cater for the availability of tacit knowledge relating to the system under test, and indeed, both explicit and tacit knowledge required by system testing in general, an appropriate knowledge management structure needs to be in place. This would appear to be required, irrespective of the employed development methodology.

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The lived environment is the arena where our cognitive skills, preferences, and attitudes come together to determine our ability to interact with the world. The mechanisms through which lived environments can benefit cognitive health in older age are yet to be fully understood. The existing literature suggests that environments which are perceived as stimulating, usable and aesthetically appealing can improve or facilitate cognitive performance both in young and older age. Importantly, optimal stimulation for cognition seems to depend on experiencing sufficiently stimulating environments while not too challenging. Environmental complexity is an important contributor to determining whether an environment provides such an optimal stimulation. The present paper reviews a selection of studies which have explored complexity in relation to perceptual load, environmental preference and perceived usability to propose a framework which explores direct and indirect environmental influences on cognition, and to understand these influences in relation to aging processes. We identify ways to define complexity at different environmental scales, going from micro low-level perceptual features of scenes, to design qualities of proximal environments (e.g., streets, neighborhoods), to broad geographical areas (i.e., natural vs. urban environments). We propose that studying complexity at these different scales will provide new insight into the design of cognitive-friendly environments.

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Introduction: ADHD is a chronic medical condition that affects 3-7% of school-aged children. Over the last few years, there has been increased attention with children in the preschool age range. The American Academy of Pediatrics (AAP) recommends that treatment for ADHD in the preschool age range should take the form of behavior modification first, with medication only considered after behavior modification is not effective alone in treating the symptoms (AAP, 2011). However, little research has been done to examine parent perceptions of evidence-based treatment approaches for children in the preschool age range. Objective: This study sought to examine parent perceptions of psychotropic medication use for preschool age (4-6 years) children with or at-risk of ADHD. Method: Data was collected from 176 families who presented for treatment at a clinic in southeast Florida. Parents completed questionnaires about their family background, their child’s behavior, behavioral functioning, and their perceptions of medication treatment. Results: Preliminary results indicate that 50% of parents were not open to the possibility of medication, 44.6% of parents were open to the possibility of medication, and 5.4% of parents chose against medication when a physician recommended it. Results examining the extent to which severity of child behavior problems impacts parent perceptions of medication will also be presented. Conclusion: These findings demonstrate that parents of preschool children are hesitant to consider medication as a treatment option for their young children. The findings of this study are important as more and more young children are being diagnosed with ADHD each year

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Complexity science is the multidisciplinary study of complex systems. Its marked network orientation lends itself well to transport contexts. Key features of complexity science are introduced and defined, with a specific focus on the application to air traffic management. An overview of complex network theory is presented, with examples of its corresponding metrics and multiple scales. Complexity science is starting to make important contributions to performance assessment and system design: selected, applied air traffic management case studies are explored. The important contexts of uncertainty, resilience and emergent behaviour are discussed, with future research priorities summarised.

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Ecosystem engineers that increase habitat complexity are keystone species in marine systems, increasing shelter and niche availability, and therefore biodiversity. For example, kelp holdfasts form intricate structures and host the largest number of organisms in kelp ecosystems. However, methods that quantify 3D habitat complexity have only seldom been used in marine habitats, and never in kelp holdfast communities. This study investigated the role of kelp holdfasts (Laminaria hyperborea) in supporting benthic faunal biodiversity. Computer-aided tomography (CT-) scanning was used to quantify the three-dimensional geometrical complexity of holdfasts, including volume, surface area and surface fractal dimension (FD). Additionally, the number of haptera, number of haptera per unit of volume, and age of kelps were estimated. These measurements were compared to faunal biodiversity and community structure, using partial least-squares regression and multivariate ordination. Holdfast volume explained most of the variance observed in biodiversity indices, however all other complexity measures also strongly contributed to the variance observed. Multivariate ordinations further revealed that surface area and haptera per unit of volume accounted for the patterns observed in faunal community structure. Using 3D image analysis, this study makes a strong contribution to elucidate quantitative mechanisms underlying the observed relationship between biodiversity and habitat complexity. Furthermore, the potential of CT-scanning as an ecological tool is demonstrated, and a methodology for its use in future similar studies is established. Such spatially resolved imager analysis could help identify structurally complex areas as biodiversity hotspots, and may support the prioritization of areas for conservation.

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Ecosystem engineers that increase habitat complexity are keystone species in marine systems, increasing shelter and niche availability, and therefore biodiversity. For example, kelp holdfasts form intricate structures and host the largest number of organisms in kelp ecosystems. However, methods that quantify 3D habitat complexity have only seldom been used in marine habitats, and never in kelp holdfast communities. This study investigated the role of kelp holdfasts (Laminaria hyperborea) in supporting benthic faunal biodiversity. Computer-aided tomography (CT-) scanning was used to quantify the three-dimensional geometrical complexity of holdfasts, including volume, surface area and surface fractal dimension (FD). Additionally, the number of haptera, number of haptera per unit of volume, and age of kelps were estimated. These measurements were compared to faunal biodiversity and community structure, using partial least-squares regression and multivariate ordination. Holdfast volume explained most of the variance observed in biodiversity indices, however all other complexity measures also strongly contributed to the variance observed. Multivariate ordinations further revealed that surface area and haptera per unit of volume accounted for the patterns observed in faunal community structure. Using 3D image analysis, this study makes a strong contribution to elucidate quantitative mechanisms underlying the observed relationship between biodiversity and habitat complexity. Furthermore, the potential of CT-scanning as an ecological tool is demonstrated, and a methodology for its use in future similar studies is established. Such spatially resolved imager analysis could help identify structurally complex areas as biodiversity hotspots, and may support the prioritization of areas for conservation.

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Using online knowledge communities (OKCs) as informal learning environments poses the question how likely these will integrate newcomers as peripheral participants. Previous research has identified surface characteristics of the OKC dialog as integrativity predictors. Yet, little is known about the role of dialogic textual complexity. This contribution proposes a comprehensive approach based on previously validated textual complexity indexes and applies it to predict OKC integrativity. The dialog analysis of N = 14 blogger communities with a total of 1937 participants identified three main components of textual complexity: dialog participation, structure and cohesion. From these, dialog cohesion was higher in integrative OKCs, thus significantly predicting OKC integrativity. This result adds to previous OKC research by uncovering the depth of OKC discourse. For educational practice, the study suggests a way of empowering learners by automatically assessing the integrativity of OKCs in which they may attempt to participate and access community knowledge.

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Social media tools are increasingly popular in Computer Supported Collaborative Learning and the analysis of students' contributions on these tools is an emerging research direction. Previous studies have mainly focused on examining quantitative behavior indicators on social media tools. In contrast, the approach proposed in this paper relies on the actual content analysis of each student's contributions in a learning environment. More specifically, in this study, textual complexity analysis is applied to investigate how student's writing style on social media tools can be used to predict their academic performance and their learning style. Multiple textual complexity indices are used for analyzing the blog and microblog posts of 27 students engaged in a project-based learning activity. The preliminary results of this pilot study are encouraging, with several indexes predictive of student grades and/or learning styles.

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Several north temperate marine species were recorded on subtidal hard-substratum reef sites selected to produce a gradient of structural complexity. The study employed an established scuba-based census method, the belt transect. The three types of reef examined, with a measured gradient of increasing structural complexity, were natural rocky reef, artificial reef constructed of solid concrete blocks, and artificial reef made of concrete blocks with voids. Surveys were undertaken monthly over a calendar year using randomly placed fixed rope transects. For a number of conspicuous species of fish and invertebrates, significant differences were found between the levels of habitat complexity and abundance. Overall abundance for many of the species examined was 2-3 times higher on the complex artificial habitats than on simple artificial or natural reef habitats. The enhanced habitat availability produced by the increased structural complexity delivered through specifically designed artificial reefs may have the potential to augment faunal abundance while promoting species diversity. 

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Background: Increased exposure to anticholinergic medication is problematic, particularly in those aged 80 years and older.

Objective: The aim of this systematic review was to identify tools used to quantify anticholinergic medication burden and determine the most appropriate tool for use in longitudinal research, conducted in those aged 80 years and older.

Methods: A systematic literature search was conducted across six electronic databases to identify existing tools. Data extraction was conducted independently by two researchers; studies describing the development of each tool were also retrieved and relevant data extracted. An assessment of quality was completed for all studies. Tools were assessed in terms of their measurement of the association between anticholinergic medication burden and a defined set of clinical outcomes, their development and their suitability for use in longitudinal research; the latter was evaluated on the basis of criteria defined as the key attributes of an ideal anticholinergic risk tool.

Results: In total, 807 papers were retrieved, 13 studies were eligible for inclusion and eight tools were identified. Included studies were classed as ‘very good’ or ‘good’ following the quality assessment analysis; one study was unclassified. Anticholinergic medication burden as measured in studies was associated with impaired cognitive and physical function, as well as an increased frequency of falls. The Drug Burden Index (DBI) exhibited most of the key attributes of an ideal anticholinergic risk tool.

Conclusion: This review identified the DBI as the most appropriate tool for use in longitudinal research focused on older people and their exposure to anticholinergic medication burden.

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Objective. The aim of this study was to survey GPs and community pharmacists (CPs) in Ireland regarding current practices of medication management, specifically medication reconciliation, communication between health care providers and medication errors as patients transition in care.
Methods. A national cross-sectional survey was distributed electronically to 2364 GPs, 311 GP Registrars and 2382 CPs. Multivariable associations comparing GPs to CPs were generated and content analysis of free text responses was undertaken.
Results. There was an overall response rate of 17.7% (897 respondents—554 GPs/Registrars and 343 CPs). More than 90% of GPs and CPs were positive about the effects of medication reconciliation on medication safety and adherence. Sixty per cent of GPs reported having no formal system of medication reconciliation. Communication between GPs and CPs was identified as good/very good by >90% of GPs and CPs. The majority (>80%) of both groups could clearly recall prescribing errors, following a transition of care, they had witnessed in the previous 6 months. Free text content analysis corroborated the positive relationship between GPs and CPs, a frustration with secondary care communication, with many examples given of prescribing errors.
Conclusions. While there is enthusiasm for the benefits of medication reconciliation there are limited formal structures in primary care to support it. Challenges in relation to systems that support inter-professional communication and reduce medication errors are features of the primary/secondary care transition. There is a need for an improved medication management system. Future research should focus on the identified barriers in implementing medication reconciliation and systems that can improve it.

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Many have called for medical students to learn how to manage complexity in healthcare. This study examines the nuances of students' challenges in coping with a complex simulation learning activity, using concepts from complexity theory, and suggests strategies to help them better understand and manage complexity.Wearing video glasses, participants took part in a simulation ward-based exercise that incorporated characteristics of complexity. Video footage was used to elicit interviews, which were transcribed. Using complexity theory as a theoretical lens, an iterative approach was taken to identify the challenges that participants faced and possible coping strategies using both interview transcripts and video footage.Students' challenges in coping with clinical complexity included being: a) unprepared for 'diving in', b) caught in an escalating system, c) captured by the patient, and d) unable to assert boundaries of acceptable practice.Many characteristics of complexity can be recreated in a ward-based simulation learning activity, affording learners an embodied and immersive experience of these complexity challenges. Possible strategies for managing complexity themes include: a) taking time to size up the system, b) attuning to what emerges, c) reducing complexity, d) boundary practices, and e) working with uncertainty. This study signals pedagogical opportunities for recognizing and dealing with complexity.