Aims And Objectives: To discuss multiple organ dysfunction syndrome (MODS) from a complex systems' theory perspective and to delineate a conceptual framework for the development and care of MODS.
Background: MODS is an intricate and devastating manifestation of critical illness characterized by widespread aberrant molecular, cellular and systemic responses.
Design And Methods: Narrative literature review (MEDLINE, CINAHL databases) and knowledge synthesis with the theoretical assertions of chaos and complex systems' theory. Cellular and systemic response paradoxes in MODS (including cellular hypoxia, cell death and signalling) are reviewed.
Results: The diseased person is depicted as a complex adaptive system. The relevancy of some of the principles of complex chaotic systems' theory to the proposed model is illustrated, including sensitive dependence on initial conditions, emergence, attractors, self-organization, self-organized criticality and emerging order. The transition from life-supporting to death-related organismic responses is illustrated as a critical event in MODS and care implications are drawn.
Conclusions: Patient responses in MODS appear to conform to the principles of chaotic systems. Death is illustrated not as a consequence of homeostatic failure but as a 'deliberate' self-organized phenomenon entailing multiple dynamically evolving mechanisms.
Relevance To Clinical Practice: Some of the principles of chaotic complex systems may need to be taken into account to advance care in MODS. An alternative theoretical perspective may support nurses to conceptualize both MODS and their role in a way that will help them to cope better with this devastating syndrome and develop practice.
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http://dx.doi.org/10.1111/j.1478-5153.2008.00289.x | DOI Listing |
J Med Internet Res
January 2025
Working Group for Data-Driven Innovation, Hamburg University of Technology, Hamburg, Germany.
Background: Health care innovation faces significant challenges, including system inertia and diverse stakeholders, making regulated market access pathways essential for facilitating the adoption of new technologies. The German Digital Healthcare Act, introduced in 2019, offers a model by enabling digital health applications (DiGAs) to be reimbursed by statutory health insurance, improving market access and patient empowerment. However, the factors influencing the success of these pathways in driving innovation remain unclear.
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Department of Health Policy and Management, School of Public Health, Ben-Gurion University of the Negev, Beer Sheva, Israel.
In the pursuit of equitable diabetes care, international knowledge exchange (iKE) serves as a crucial mechanism for narrowing the gaps in quality within and between countries. Little is known about the process of quality measurement exchange among stakeholders from high-income countries (HICs), low- and middle-income countries (LMICs), and international organizations. This study aims to analyze recent international exchanges of quality measures in diabetes care and propose a framework for enhancing quality, focusing on LMICs.
View Article and Find Full Text PDFChem Commun (Camb)
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Institute for Carbon Neutralization Technology, College of Chemistry and Materials Engineering, Wenzhou University, Wenzhou, Zhejiang 325035, China.
Single-atom catalysts (SACs) have become the forefront and hotspot in energy storage and conversion research, inheriting the advantages of both homogeneous and heterogeneous catalysts. In particular, carbon-supported SACs (CS-SACs) are excellent candidates for many energy storage and conversion applications, due to their maximum atomic efficiency, unique electronic and coordination structures, and beneficial synergistic effects between active catalytic sites and carbon substrates. In this review, we briefly review the atomic-level regulation strategies for optimizing CS-SACs for energy storage and conversion, including coordination structure control, nonmetallic elemental doping, axial coordination design, and polymetallic active site construction.
View Article and Find Full Text PDFJ Phys Chem A
January 2025
INSTM, via G. Giusti 9, Firenze 50121, Italy.
The structures and rotational constants of prototypical monocyclic terpenes and terpenoids have been analyzed by a general computational strategy based on recent Pisa composite schemes (PCS) and vibrational perturbation theory at second order (VPT2). Concerning equilibrium geometries, a one-parameter empirical correction is added to bond lengths obtained by the revDSD-PBEP86 double hybrid functional in conjunction with a slightly modified cc-pVTZ-F12 basis set. The same functional and basis set give accurate harmonic frequencies, whereas the cheaper B3LYP hybrid functional in conjunction with a double-ζ basis set is employed to compute the semidiagonal cubic force constants needed to obtain vibrational corrections to the rotational constants in the framework of the VPT2 model.
View Article and Find Full Text PDFEur J Psychotraumatol
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The Sliver School of Social Work, New York University, New York, NY, USA.
There is a risk of re-traumatisation for survivors of trauma who engage with the Justice system, given their high propensity to encounter situations that trigger traumatic responses. While a growing body of research has explored the experience of trauma informed practice (TIP) from service user perspectives, little research has incorporated the views and experiences of practitioners working in the Justice system in terms of the implementation of TIP in their service setting. An exploratory, qualitative research design based on semi-structured, in-depth interviews.
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