- Beyond "implementation": digital health innovation and service design. [Review]
- NDNPJ Digit Med 2018; 1:48
- Digital tools have shown great potential to enhance health services' capacity to achieve the goals of the triple aim (enhance patient experience, improve health outcomes, and control or reduce costs)…
Digital tools have shown great potential to enhance health services' capacity to achieve the goals of the triple aim (enhance patient experience, improve health outcomes, and control or reduce costs), but their actual impact remains variable. In this commentary, we suggest that shifting from a perspective focused on "implementing" new digital tools in health care settings toward one focused on "service design" will help teams execute more successful digital technology adoption projects. We present value proposition design (VPD) as a service design strategy requiring that stakeholders are brutally honest in determining the value of a new digital tool for their everyday work. Incorporating a perspective focused on how the value proposition of a technology is understood by each team member, and implications for their work routines, will help project teams to better understand how services can be reinvented during technology adoption initiatives. We present the simple heuristic [Tool+Team+Routine] as a reminder of the central considerations that make up a service design initiative, and present an illustrative case scenario of designing the use of a digital care coordination platform in an actual digital technology adoption project. We conclude by outlining two important challenges that need to be addressed to advance service design approaches to technology adoption in health care.
- Fire as a key driver of Earth's biodiversity. [Journal Article]
- BRBiol Rev Camb Philos Soc 2019 Jul 12
- Many terrestrial ecosystems are fire prone, such that their composition and structure are largely due to their fire regime. Regions subject to regular fire have exceptionally high levels of species r…
Many terrestrial ecosystems are fire prone, such that their composition and structure are largely due to their fire regime. Regions subject to regular fire have exceptionally high levels of species richness and endemism, and fire has been proposed as a major driver of their diversity, within the context of climate, resource availability and environmental heterogeneity. However, current fire-management practices rarely take into account the ecological and evolutionary roles of fire in maintaining biodiversity. Here, we focus on the mechanisms that enable fire to act as a major ecological and evolutionary force that promotes and maintains biodiversity over numerous spatiotemporal scales. From an ecological perspective, the vegetation, topography and local weather conditions during a fire generate a landscape with spatial and temporal variation in fire-related patches (pyrodiversity), and these produce the biotic and environmental heterogeneity that drives biodiversity across local and regional scales. There have been few empirical tests of the proposition that 'pyrodiversity begets biodiversity' but we show that biodiversity should peak at moderately high levels of pyrodiversity. Overall species richness is greatest immediately after fire and declines monotonically over time, with postfire successional pathways dictated by animal habitat preferences and varying lifespans among resident plants. Theory and data support the 'intermediate disturbance hypothesis' when mean patch species diversity is correlated with mean fire intervals. Postfire persistence, recruitment and immigration allow species with different life histories to coexist. From an evolutionary perspective, fire drives population turnover and diversification by promoting a wide range of adaptive responses to particular fire regimes. Among 39 comparisons, the number of species in 26 fire-prone lineages is much higher than that in their non-fire-prone sister lineages. Fire and its byproducts may have direct mutagenic effects, producing novel genotypes that can lead to trait innovation and even speciation. A paradigm shift aimed at restoring biodiversity-maintaining fire regimes across broad landscapes is required among the fire research and management communities. This will require ecologists and other professionals to spread the burgeoning fire-science knowledge beyond scientific publications to the broader public, politicians and media.
- Muscle fibre activation is unaffected by load and repetition duration when resistance exercise is performed to task failure. [Journal Article]
- JPJ Physiol 2019 Jul 11
- CONCLUSIONS: Performing resistance exercise with heavier loads is often proposed to be necessary for the recruitment of larger motor units and activation of type II muscle fibres, leading to type II fibre hypertrophy. Indirect measures (surface electromyography - EMG) have been used to support this thesis, but we propose that lighter loads lifted to task failure (i.e., volitional fatigue) result in similar activation of type II fibres. In this study we had participants perform resistance exercise to task failure with heavier and lighter loads with both a normal and longer repetition duration (i.e., time under tension). Type I and type II muscle fibre glycogen depletion was determined by neither load nor repetition duration during resistance exercise performed to task failure. Surface EMG amplitude was not related to muscle fibre glycogen depletion or anabolic signalling; however, muscle fibre glycogen depletion and anabolic signalling were related. Performing resistance exercise to task failure, regardless of load lifted or repetition duration, necessitates the activation of type II muscle fibres.
- When bodies think: panpsychism, pluralism, biopolitics. [Journal Article]
- MHMed Humanit 2019; 45(2):116-123
- Cultivating a speculative orientation to the medical humanities, the aim of this essay is to explore some dimensions of the recent calls for more participatory forms of medicine and healthcare under …
Cultivating a speculative orientation to the medical humanities, the aim of this essay is to explore some dimensions of the recent calls for more participatory forms of medicine and healthcare under the sign of what, after Michel Foucault, I call the 'biopolitical problematic'. That is, the divergent encounter between techniques of biopower that seek to take hold of life and the body, and a plurality of living bodies that persistently respond, challenge and escape its grasp. If critics of 'participatory medicine' have warned that the turn to 'participation' in healthcare functions as a form of biopower that seeks to gain access to bodies, and in so doing take a better hold of life, in this essay, I propose we experiment with the question of what kinds of conceptual tools may be required to make perceptible the ways in which a plurality of participating bodies may become capable of responding, challenging and escaping 'participation's' grasp. After problematising the ontology of participation involved in contemporary debates around participatory medicine, I draw on the work of William James and Alfred North Whitehead, among others, to argue for the need to reclaim a pluralistic panpsychism-in short, the proposition that all things think-as a pragmatic tool to envisage the possibility of a plurality of thinking bodies capable of unruly forms of participation all the way down.
- Exploring the ripple effects of an Australian hospital redevelopment: a protocol for a longitudinal, mixed-methods study. [Journal Article]
- BOBMJ Open 2019 Jul 09; 9(7):e027186
- Hospital redevelopment projects typically intend to improve hospital functioning and modernise the delivery of care. There is research support for the proposition that redevelopment along evidence-ba…
Hospital redevelopment projects typically intend to improve hospital functioning and modernise the delivery of care. There is research support for the proposition that redevelopment along evidence-based design principles can lead to improved quality and safety. However, it is not clear how redevelopment influences the wider context of the hospital and its functioning. That is, beyond a limited examination of intended outcomes (eg, improved patient satisfaction), are there additional consequences (positive, negative or unintended) occurring within the hospital after the physical environment is changed? Is new always better? The primary purpose of this study is to explore the ripple effects of how hospital redevelopment may influence the organisation, staff and patients in both intended and unintended ways.
- The experience of patients and family caregivers during hospital-at-home in France. [Journal Article]
- BHBMC Health Serv Res 2019 Jul 09; 19(1):470
- CONCLUSIONS: HAH strongly involved the patient's caregiver(s) all along the process. HAH's development necessitates to associate both patients and caregivers and to take into account their needs at every step. This study highlights the need to better assess the ability of the caregiver to cope with his or her relative in HAH with acute and subacute care at home.
- Comparative effectiveness of treatments for high-risk prostate cancer patients. [Journal Article]
- UOUrol Oncol 2019 Jul 05
- CONCLUSIONS: Our results also demonstrate long-term overall survival benefits for EBRT + BT ± ADT, and greater bowel and bladder side effects over a decade, compared to RP. The RP group had advantage for long-term prostate-cancer specific mortality, compared to EBRT + ADT group. Thus, RP can provide superior cancer control with clear cost advantage for older men with high-risk disease. In terms of value proposition, our results support RP as preferred treatment option, compared to EBRT + ADT and EBRT + BT ± ADT for high-risk prostate cancer patients.
- SVRG-MKL: A Fast and Scalable Multiple Kernel Learning Solution for Features Combination in Multi-Class Classification Problems. [Journal Article]
- ITIEEE Trans Neural Netw Learn Syst 2019 Jul 04
- In this paper, we present a novel strategy to combine a set of compact descriptors to leverage an associated recognition task. We formulate the problem from a multiple kernel learning (MKL) perspecti…
In this paper, we present a novel strategy to combine a set of compact descriptors to leverage an associated recognition task. We formulate the problem from a multiple kernel learning (MKL) perspective and solve it following a stochastic variance reduced gradient (SVRG) approach to address its scalability, currently an open issue. MKL models are ideal candidates to jointly learn the optimal combination of features along with its associated predictor. However, they are unable to scale beyond a dozen thousand of samples due to high computational and memory requirements, which severely limits their applicability. We propose SVRG-MKL, an MKL solution with inherent scalability properties that can optimally combine multiple descriptors involving millions of samples. Our solution takes place directly in the primal to avoid Gram matrices computation and memory allocation, whereas the optimization is performed with a proposed algorithm of linear complexity and hence computationally efficient. Our proposition builds upon recent progress in SVRG with the distinction that each kernel is treated differently during optimization, which results in a faster convergence than applying off-the-shelf SVRG into MKL. Extensive experimental validation conducted on several benchmarking data sets confirms a higher accuracy and a significant speedup of our solution. Our technique can be extended to other MKL problems, including visual search and transfer learning, as well as other formulations, such as group-sensitive (GMKL) and localized MKL (LMKL) in convex settings.
- A Primer on Quality Assurance and Performance Improvement for Interprofessional Chronic Kidney Disease Care: A Path to Joint Commission Certification. [Journal Article]
- PPharmacy (Basel) 2019 Jul 03; 7(3)
- Interprofessional care for chronic kidney disease facilitates the delivery of high quality, comprehensive care to a complex, at-risk population. Interprofessional care is resource intensive and requi…
Interprofessional care for chronic kidney disease facilitates the delivery of high quality, comprehensive care to a complex, at-risk population. Interprofessional care is resource intensive and requires a value proposition. Joint Commission certification is a voluntary process that improves patient outcomes, provides external validity to hospital administration and enhances visibility to patients and referring providers. This is a single-center, retrospective study describing quality assurance and performance improvement in chronic kidney disease, Joint Commission certification and quality outcomes. A total of 440 patients were included in the analysis. Thirteen quality indicators consisting of clinical and process of care indicators were developed and measured for a period of two years from 2009-2017. Significant improvements or at least persistently high performance were noted for key quality indicators such as blood pressure control (85%), estimation of cardiovascular risk (100%), measurement of hemoglobin A1c (98%), vaccination (93%), referrals for vascular access and transplantation (100%), placement of permanent dialysis access (61%), discussion of advanced directives (94%), online patient education (71%) and completion of office visit documentation (100%). High patient satisfaction scores (94-96%) are consistent with excellent quality of care provided.
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- How and Why the Brain Evolves Time. [Journal Article]
- BBBehav Brain Res 2019 Jul 02; :112071
- The present work evaluates the proposition that the dimension of time is iatrogenically created. That is, time is a property that necessarily emerges alongside the genesis of living systems. Humans, …
The present work evaluates the proposition that the dimension of time is iatrogenically created. That is, time is a property that necessarily emerges alongside the genesis of living systems. Humans, as the most complex known expression of such living creatures, exhibit the most intricate and sophisticated incarnation of this fabricated temporality. Evidence is considered to support this contention; most pointedly, the problem concerning the vacuity of a temporal foundation in the brain. I argue that one can 'force' processes, that are intrinsic to brain operations, to demonstrate such a temporal base; and even necessarily confirm this synchrony. However, this insistence is a categorical error. It conflates processes in time, with time itself. I also consider the observation of the psychophysical exponent at unity represents one that indicates support for the proposition I advance. I anticipate that the fundamental proposition of temporal iatrogenesis, that founds the present work, will be rejected 'out-of-hand.' Such vehement visceral rejections, alongside an even instinctive revulsion to the fracture of the idea known as the 'phenomenological constraint,' can also be taken as one essential form of validation for this observed delusion of time.