A self-assessment maturity matrix to support large-scale change using collaborative networks in the New Zealand health system.

BACKGROUND: A maturity matrix can be a useful tool for organisations implementing large-system transformation (LST) initiatives in complex systems. Insights from implementation of a local LST initiative using collaborative networks, known as Alliances, highlighted a tool was needed to help health system leaders prompt discussions on how and where to focus their change efforts. In the New Zealand (NZ) health system, Alliances were introduced to integrate the planning and delivery of health care between primary and hospital care. METHODS: The aim of this research was to use insights from Alliance members to develop a learning tool that collaborative networks could use to assess and improve their readiness for change. We constructed a maturity matrix using the knowledge of senior NZ health system leaders, in a workshop setting. The maturity matrix was empirically tested and refined with three Alliances and with feedback from the NZ Ministry of Health Maori Health Strategy and Policy team. RESULTS: The maturity matrix described the 10 key elements that had been found to support successful implementation of LST initiatives in the NZ health system, along with success indicators and different stages of maturity from beginning to excellence. Testing of the maturity matrix with three Alliances suggested that it functioned as a learning tool and stimulated collective thinking and reflection. The Maori Health Strategy and Policy team commented on the importance of such a tool to increase health system leaders' responsiveness to improving Maori health outcomes. Comparisons with similar international matrices revealed common elements with ours. A strength of our maturity matrix is that it is specific to the NZ context and is the first practical tool to implement large-scale change in the health system that incorporates principles of the Government's treaty with Maori, the indigenous people of NZ. CONCLUSIONS: Through a regular self-assessment process, use of the maturity matrix may create feedback loops to support deliberate learning and knowledge sharing for senior health system leaders and collaborative networks. The maturity matrix fills an important gap in the NZ health system and contributes to implementation science literature internationally. OTHER: This study was approved by the Victoria University of Wellington Human Ethics Committee (Ethics Approval Number 27,356). The research was supported by the Victoria University of Wellington research grant (222,809) and from the University of Auckland Department of Medicine research fund (H10779).

Analysing the performance of a health innovation ecosystem in the COVID-19 crisis: complexity and chaos theory perspective.

BACKGROUND: This research delves into the complexity management of collaborative networks and interorganizational systems in the health innovation ecosystem on the basis of a best practice in the coronavirus disease 2019 (COVID-19) crisis. The objective is to offer specific solutions and guidelines to stakeholders in the health innovation ecosystem to control the chaos resulting from unexpected events along the ecosystem development and evolution path. METHODS: For this purpose, the performance of the Health Innovation Ecosystem in Iran (the Every Home is a Health Base plan) has been examined through a detailed and in-depth analysis of events and actions taken using documents, reports and interviews with experts. The practical application of chaos and complex adaptive system features (adaptation, time horizons, edge of chaos, sensitivity to initial conditions, state space and strange attractors) is introduced to identify and manage the transition from a state where the health innovation ecosystem is on the edge of chaos and prone to failure. Data were collected through studying documents, reports and interviews with experts, and then analysed using qualitative content analysis techniques, open and axial coding and metaphors derived from complexity and chaos theories. RESULTS: The findings indicate that to understand and embrace the complexity of the health innovation ecosystem throughout its development and evolution and manage and lead it through the edge of chaos towards successful interorganizational systems performance, it is necessary to use gap analysis to achieve consensus, establish a highly interactive governance structure with key stakeholders of the ecosystem, maintain flexibility to control bifurcations (butterfly effect), prevent transforming emergency solutions into standard routines and ensure the sustainability of the ecosystem against future threats by long-term financial security. CONCLUSIONS: This research provides insights into the dynamics of complex health systems and offers strategies for promoting successful innovation through collaborative networks and interorganizational systems in the development and evolution of the health innovation ecosystem. By embracing complexity and chaos, healthcare professionals, policy-makers and researchers can collaboratively address complex challenges and improve outcomes in health network activities. The conclusion section provides guidelines for successfully managing the complexity of the ecosystem and offers suggestions for further research.

Examining Sexual Health Organizational Networks in Urban African American Communities Using Social Network Theory.

PURPOSE: Collaboration among organizations offering sexual health and youth development services has the potential to provide youth with effective sexual health support. However, formally structured efforts (eg, coalition formation) may be impractical or unsuitable for low-income communities where resources are often already limited. Social network theories provide an alternative approach for building collaborative organizational networks. APPROACH: Research aims to evaluate the barriers and facilitators to collaboration in sexual health organizational networks. SETTING: Organizations in low income, urban, communities in Chicago and San Francisco that serve African American adolescents. PARTICIPANTS: Providers (n = 22) from organizations that offer sexual health services and youth development services. METHODS: Focus groups (n = 4) were conducted and analyzed utilizing a combination of coding strategies. RESULTS: Barriers to collaboration included resource limitations and competition, differences in organizational roles and deliverables, and prejudice and stigma. Identifying common ground among organizations was found to be a facilitator to collaboration. Social network concepts in conjunction with study findings lead to the development of a practice model that hypothesizes a pathway for organizations to improve collaboration without formally structured efforts. CONCLUSION: Our findings offer ways to encourage collaboration among organizations that support youth sexual health in low-income, urban, African American communities without relying on formal structures. Such collaborations may be critical for improving the provision of comprehensive sexual health support.

Key elements and contextual factors that influence successful implementation of large-system transformation initiatives in the New Zealand health system: a realist evaluation.

BACKGROUND: Despite three decades of policy initiatives to improve integration of health care, delivery of health care in New Zealand remains fragmented, and health inequities persist for Maori and other high priority populations. An evidence base is needed to increase the chances of success with implementation of large-system transformation (LST) initiatives in a complex adaptive system. METHODS: This research aimed to identify key elements that support implementation of LST initiatives, and to investigate contextual factors that influence these initiatives. The realist logic of enquiry, nested within the macro framing of complex adaptive systems, formed the overall methodology for this research and involved five phases: theory gleaning from a local LST initiative, literature review, interviews, workshop, and online survey. NVivo software programme was used for thematic analysis of the interview, workshop, and the survey data. We identified key elements and explained variations in success (outcomes) by identifying mechanisms triggered by various contexts in which LST initiatives are implemented. RESULTS: The research found that a set of 10 key elements need to be present in the New Zealand health system to increase chances of success with implementation of LST initiatives. These are: (i) an alliancing way of working; (ii) a commitment to te Tiriti o Waitangi; (iii) an understanding of equity; (iv) clinical leadership and involvement; (v) involved people, whanau, and community; (vi) intelligent commissioning; (vii) continuous improvement; (viii) integrated health information; (ix) analytic capability; and (x) dedicated resources and time. The research identified five contextual factors that influenced implementation of LST initiatives: a history of working together, distributed leadership from funders, the maturity of Alliances, capacity and capability for improvement, and a continuous improvement culture. The research found that the key mechanism of trust is built and nurtured over time through sharing of power by senior health leaders by practising distributed leadership, which then creates a positive history of working together and increases the maturity of Alliances. DISCUSSION: Two authors (KMS and PBJ) led the development and implementation of the local LST initiative. This prior knowledge and experience provided a unique perspective to the research but also created a conflict of interest and introduced potential bias, these were managed through a wide range of data collection methods and informed consent from participants. The evidence-base for successful implementation of LST initiatives produced in this research contains knowledge and experience of senior system leaders who are often in charge of leading these initiatives. This evidence base enables decision makers to make sense of complex processes involved in the successful implementation of LST initiatives. CONCLUSIONS: Use of informal trust-based networks provided a critical platform for successful implementation of LST initiatives in the New Zealand health system. Maturity of these networks relies on building and sustaining high-trust relationships among the network members. The role of local and central agencies and the government is to provide the policy settings and conditions in which trust-based networks can flourish. OTHER: This study was approved by the Victoria University of Wellington Human Ethics Committee (Ethics Approval Number 27,356). The research was supported by the Victoria University of Wellington research grant (222,809) and from the University of Auckland Department of Medicine research fund (H10779).

Research on the collaborative evolution process of information in public health emergencies based on complex adaptive system theory and social network analysis: a case study of the COVID-19 pandemic.

Introduction: This review aimed to elucidate the significance of information collaboration in the prevention and control of public health emergencies, and its evolutionary pathway guided by the theory of complex adaptive systems. Methods: The study employed time-slicing techniques and social network analysis to translate the dynamic evolution of information collaboration into a stage-based static representation. Data were collected from January to April 2020, focusing on the COVID-19 pandemic. Python was used to amass data from diverse sources including government portals, public commentary, social organizations, market updates, and healthcare institutions. Post data collection, the structures, collaboration objectives, and participating entities within each time slice were explored using social network analysis. Results: The findings suggest that the law of evolution for information collaboration in public health emergencies primarily starts with small-scale collaboration, grows to full-scale in the middle phase, and then reverts to small-scale in the final phase. The network's complexity increases initially and then gradually decreases, mirroring changes in collaboration tasks, objectives, and strategies. Discussion: The dynamic pattern of information collaboration highlighted in this study offers valuable insights for enhancing emergency management capabilities. Recognizing the evolving nature of information collaboration can significantly improve information processing efficiency during public health crises.

The scholarly footprint of ChatGPT: a bibliometric analysis of the early outbreak phase.

This paper presents a comprehensive analysis of the scholarly footprint of ChatGPT, an AI language model, using bibliometric and scientometric methods. The study zooms in on the early outbreak phase from when ChatGPT was launched in November 2022 to early June 2023. It aims to understand the evolution of research output, citation patterns, collaborative networks, application domains, and future research directions related to ChatGPT. By retrieving data from the Scopus database, 533 relevant articles were identified for analysis. The findings reveal the prominent publication venues, influential authors, and countries contributing to ChatGPT research. Collaborative networks among researchers and institutions are visualized, highlighting patterns of co-authorship. The application domains of ChatGPT, such as customer support and content generation, are examined. Moreover, the study identifies emerging keywords and potential research areas for future exploration. The methodology employed includes data extraction, bibliometric analysis using various indicators, and visualization techniques such as Sankey diagrams. The analysis provides valuable insights into ChatGPT's early footprint in academia and offers researchers guidance for further advancements. This study stimulates discussions, collaborations, and innovations to enhance ChatGPT's capabilities and impact across domains.

Redes de colaboración y objetos híbridos: mujeres citogenetistas en México, 1960s and 1970s / Collaborative networks and hybrid objects women cytogeneticists in Mexico, 1960-1980

Estudios recientes sobre la historia de la ciencia han enfatizado el enfoque transnacional que problematiza las narrativas eurocéntricas clásicas, las interpretaciones de difusión cultural y la oposición rígida de las categorías de «centro» y «periferia», para explicar la dinámica de los circuitos transnacionales y la circulación de conocimientos, personas, artefactos y prácticas científicas. El presente escrito intenta abonar en esta dirección al mostrar que el trabajo realizado por los genetistas mexicanos en los mil novecientos sesenta y setenta, en especial los trabajos de citogenética, no pueden caracterizarse como periféricos, pues al formar parte de redes de colaboración internacional, el conocimiento generado localmente en instituciones mexicanas y extranjeras logró circular y formar parte de la consolidación de la citogenética a escala global. En este artículo se abordarán las trayectorias de la bióloga y genetista mexicana María Cristina Cortinas, y en menor medida la de la médica y genetista mexicana de origen argentino Susana Kofman. Ellas compartieron agenda médica y de investigación además de tiempo y lugar, participaron en el diagnóstico temprano de enfermedades genéticas y revelaron la correlación entre las observaciones clínicas y el cariotipo. Este manuscrito se centrará, por un lado, en los cromosomas como objetos científicos híbridos que circularon entre la clínica y el laboratorio; por el otro, se abordarán los contextos locales, las culturas materialesy las prácticas específicas que permitieron a estas mujeres genetistas mexicanas ser parte de la producción y transmisión de conocimiento en los años mil novecientos sesenta y setenta, gracias a su pertenencia a redes científicas de colaboración nacionales e internacionales. (AU)

Recent studies on the history of science have emphasized the transnational approach that problematizes classic Eurocentric narratives, interpretations of cultural diffusion, and the rigid opposition of the categories of “center” and “periphery” to explain the dynamics of transnational circuits and the circulation of knowledge, people, artifacts, and scientific practices. This paper attempts to contribute to this direction by showing that the work carried out by Mexican geneticists in the 1960s and 1970s, especially the work on cytogenetics, cannot be characterized as peripheral because knowledge generated locally in Mexican and foreign institutions was able to circulate and become part of the consolidation of cytogenetics on a global scale, participating in international collaborative networks. This article addresses the trajectories of the Mexican biologist and geneticist María Cristina Cortinas, and to a lesser extent those of the Argentineborn Mexican physician and geneticist Susana Kofman. They shared a medical and research agenda and a time and place, participating in the early diagnosis of genetic diseases and revealing the correlation between clinical observations and the karyotype. This manuscript focuses on chromosomes as hybrid scientific objects that circulated between clinic and laboratory and on the local contexts, material cultures and specific practices that allowed these Mexican women geneticists to take part in the production and transmission of knowledge in the 1960s and 1970s, attributed to their participation in national and international scientific collaborative networks. (AU)

Collaborative approaches in sustainable and resilient manufacturing.

In recent years, the manufacturing sector is going through a major transformation, as reflected in the concept of Industry 4.0 and digital transformation. The urge for such transformation is intensified when we consider the growing societal demands for sustainability. The notion of sustainable manufacturing has emerged as a result of this trend. Additionally, industries and the whole society face the challenges of an increasing number of disruptive events, either natural or human-caused, that can severely affect the normal operation of systems. Furthermore, the growing interconnectivity between organizations, people, and physical systems, supported by recent developments in information and communication technologies, highlights the important role that collaborative networks can play in the digital transformation processes. As such, this article analyses potential synergies between the areas of sustainable and resilient manufacturing and collaborative networks. The work also discusses how the responsibility for the various facets of sustainability can be distributed among the multiple entities involved in manufacturing. The study is based on a literature survey, complemented with the experience gained from various research projects and related initiatives in the area, and is organized according to various dimensions of Industry 4.0. A brief review of proposed approaches and indicators for measuring sustainability from the networked manufacturing perspective is also included. Finally, a set of key research challenges are identified to complement strategic research agendas in manufacturing.

Impact of supervisors' research style on young biomedical scientists' capacity development as measured by REDi, a novel index of crossdisciplinarity.

The challenge for medical schools in Japan is to develop research activities for innovation. This study aimed at analyzing the connection between the research output of "promising researchers" (next-generation leaders in terms of research activity) and their supervisors' past research activities to identify those factors that impact researchers' performance. Activity was analyzed from the viewpoints of productivity, coauthorship networks, and research impact using a novel index called the Research Diversity Index (REDi) that quantifies crossdisciplinarity. Research funding, which has not yet been fully utilized in correlation studies of the characteristics of authors, was also considered in this study. For the promising researchers extracted using betweenness centrality scores within coauthorship networks, there were diachronic correlations between the records of the promising researchers and those of their supervisors. Supervisor leadership as measured by the number of last-authored publications and extent of networking had a positive effect on the promising researchers productivity. Supervisors' research style of integrating knowledge from multiple fields, as measured by REDi, was negatively correlated with the publication impact of promising researchers, suggesting that REDi is useful as a novel indicator of research quality not being captured by existing indices. It was also noted that establishing an academic presence through extensive collaborations could be advantageous for obtaining research funding, especially from top-down government programs. The possible implications of this study for promoting research activities are the importance of incorporating new doctorates into research groups at an early stage and that of promoting interinstitutional, crossdisciplinary collaborations. Classification code: MSC: 62P10 Applications of statistics to biology and medical sciences; meta-analysis.JEL: Z1Z10 Cultural Economics • Economic Sociology • Economic Anthropology- General.

Mechanism of Impact of Big Data Resources on Medical Collaborative Networks From the Perspective of Transaction Efficiency of Medical Services: Survey Study.

BACKGROUND: The application of big data resources and the development of medical collaborative networks (MCNs) boost each other. However, MCNs are often assumed to be exogenous. How big data resources affect the emergence, development, and evolution of endogenous MCNs has not been well explained. OBJECTIVE: This study aimed to explore and understand the influence of the mechanism of a wide range of shared and private big data resources on the transaction efficiency of medical services to reveal the impact of big data resources on the emergence and development of endogenous MCNs. METHODS: This study was conducted by administering a survey questionnaire to information technology staff and medical staff from 132 medical institutions in China. Data from information technology staff and medical staff were integrated. Structural equation modeling was used to test the direct impact of big data resources on transaction efficiency of medical services. For those big data resources that had no direct impact, we analyzed their indirect impact. RESULTS: Sharing of diagnosis and treatment data (ß=.222; P=.03) and sharing of medical research data (ß=.289; P=.04) at the network level (as big data itself) positively directly affected the transaction efficiency of medical services. Network protection of the external link systems (ß=.271; P=.008) at the level of medical institutions (as big data technology) positively directly affected the transaction efficiency of medical services. Encryption security of web-based data (as big data technology) at the level of medical institutions, medical service capacity available for external use, real-time data of diagnosis and treatment services (as big data itself) at the level of medical institutions, and policies and regulations at the network level indirectly affected the transaction efficiency through network protection of the external link systems at the level of medical institutions. CONCLUSIONS: This study found that big data technology, big data itself, and policy at the network and organizational levels interact with, and influence, each other to form the transaction efficiency of medical services. On the basis of the theory of neoclassical economics, the study highlighted the implications of big data resources for the emergence and development of endogenous MCNs.

A Bibliometric and Mapping Analysis of Glaucoma Research between 1900 and 2019.

PURPOSE: To explore the relevance of scientific production on glaucoma using bibliometric tools. DESIGN: Bibliographic study. PARTICIPANTS: Original articles published from 1900 through 2019. METHODS: We performed a search in Web of Science for documents published between 1900 and 2019. We used bibliometric indicators to explore documents production, dispersion, distribution, time of duplication, and annual growth, as characterized by Price's law of scientific literature growth, Lotka's law, the transient index, and the Bradford model. We also calculated the participation index of different countries and institutions. Finally, we explored with bibliometric mapping the co-occurrence networks for the most frequently used terms in glaucoma research. MAIN OUTCOME MEASURES: Bibliometric indicators for individuals, institutions, and countries. RESULTS: A total of 33 631 original articles were collected from the timeframe 1900 through 2019. Price's law showed an exponential growth. Scientific production was adjusted better to exponential growth (r = 0.967) than linear growth (r = 0.755). Literature on glaucoma research increased its growth in the last 30 years at a rate of 5.1% per year with a production that doubled its size every 13.9 years. The transience index was 60.08%; this indicates that most of the scientific production is the output of very few authors. Bradford's law showed a high concentration of articles published in a small core of specialized journals. Lotka's law indicated that the distribution of authors is concentrated heavily in small producers. The United States and University of London demonstrated the highest production of original articles. Map network visualization showed the generated term map detailing clusters of closely related terms. CONCLUSIONS: Glaucoma literature has grown exponentially. A very high rate of transience was found that indicates the presence of numerous authors who sporadically publish on this topic. No evidence of a saturation point in the glaucoma literature was observed.

Bibliometric and Visualized Analysis of Neuropathic Pain Using Web of Science and CiteSpace for the Past 20 Years.

OBJECTIVE: The purpose of our bibliometric analysis was to explore the disciplinary hotspots and collaborative networks in research on neuropathic pain (NPP) during in the past 20 years. METHODS: The studies related to NPP were obtained from Web of Science database. Global publications on NPP were analyzed for different factors, including the number of reports, citation rates, authors, institutions, countries and regions, journals, funding, and relevant partnerships and topic hotspots. RESULTS: From 2001 to 2020, 6905 studies related to NPP research were reported worldwide. The number of publications had increased continually during the past 20 years. Pain was the most productive and most frequently co-cited journal. Ralf Baron was the most productive and influential author. The most productive country and institution were the United States and Harvard University, respectively. Investigators and institutions from the United States, Japan, and China were the core research forces. We found broad and close cooperation in the field worldwide. The top authors and top institutions had collaborated relatively closely with others. CONCLUSIONS: The research of NPP is a well-developed and prospective field of medical study. The journals Pain, European Journal of Pain, and Molecular Pain showed more interested in this field. The United States, Harvard University, and Ralf Baron were the top country, institution, and author, respectively. Global research collaboration was extensive, with the top institutions and authors cooperating with others.

Renewable energy communities or ecosystems: An analysis of selected cases.

The rapid proliferation of renewable energy communities/ecosystems is an indication of their potential contribution to the ongoing energy transition. A common characteristic of these ecosystems is their complex composition, which often involves the interaction of multiple actors. Currently, the notions of "networking", "collaboration", "coordination", and "cooperation", although having different meanings, are often loosely used to describe these interactions, which creates a sense of ambiguity and confusion. To better characterize the nature of interactions in current and emerging ecosystems, this article uses the systematic literature review method to analyse 34 emerging cases. The objective is threefold (a) to study the interactions and engagements between the involved actors, aiming at identifying elements of collaboration. (b) Identify the adopted technological enablers, and (c) ascertain how the composition and functions of these ecosystems compare to virtual power plants. The outcome revealed that the interactions between the members of these ecosystems can be described as cooperation and not necessarily as collaboration, except in a few cases. Regarding technological enablers, a vast panoply of technologies, such as IoT devices, smart meters, intelligent software agents, peer-to-peer networks, distributed ledger systems/blockchain technology (including smart contracts, blockchain as a platform service, and cryptocurrencies) were found. In comparison with virtual power plants, these ecosystems have similar composition, thus, having multiple actors, comprised of decentralized and heterogeneous technologies, and are formed by aggregating various distributed energy resources. They are also supported by ICT and are characterized by the simultaneous flow of information and energy.

Combinations of Conditions for Network Effectiveness: A Fuzzy-Set Qualitative Comparative Analysis of 37 International Development Intervention Cases.

Most international development projects that aim to eradicate poverty and improve the quality of life of people in low- and middle-income countries are implemented through a collaborative network of multiple parties, including non-governmental organizations (NGOs). However, how network effectiveness in international development projects can be achieved remains unclear. Using fuzzy-set qualitative comparative analysis, this study explores the causal conditions of network effectiveness of 37 international development projects implemented by South Korean NGOs based on a theoretical lens of collaborative networks. Findings revealed two causal configurations for network effectiveness. Even under a lack of network management capacity and unintegrated networks, or under resource deficiency and lack of network management capacity, high-level local capacity or high-quality collaboration among partners was shown to produce network effectiveness. An in-depth analysis of two cases with successful network effectiveness was also conducted to achieve a more thorough and comprehensive understanding of the causal conditions. The findings suggest practical solutions to manage collaborative networks and compensate for deficiencies of diverse conditions to improve network effectiveness.

Reflecting on One Health in Action During the COVID-19 Response.

The COVID-19 pandemic, a singular disruptive event in recent human history, has required rapid, innovative, coordinated and collaborative approaches to manage and ameliorate its worst impacts. However, the threat remains, and learning from initial efforts may benefit the response management in the future. One Health approaches to managing health challenges through multi-stakeholder engagement are underscored by an enabling environment. Here we describe three case studies from state (New South Wales, Australia), national (Ireland), and international (sub-Saharan Africa) scales which illustrate different aspects of One Health in action in response to the COVID-19 pandemic. In Ireland, a One Health team was assembled to help parameterise complex mathematical and resource models. In New South Wales, state authorities engaged collaboratively with animal health veterinarians and epidemiologists to leverage disease outbreak knowledge, expertise and technical and support structures for application to the COVID-19 emergency. The African One Health University Network linked members from health institutions and universities from eight countries to provide a virtual platform knowledge exchange on COVID-19 to support the response. Themes common to successful experiences included a shared resource base, interdisciplinary engagement, communication network strategies, and looking global to address local need. The One Health approaches used, particularly shared responsibility and knowledge integration, are benefiting the management of this pandemic and future One Health global challenges.

Development of the Texas A&M Superfund Research Program Computational Platform for Data Integration, Visualization, and Analysis.

The National Institute of Environmental Health Sciences (NIEHS) Superfund Research Program (SRP) aims to support university-based multidisciplinary research on human health and environmental issues related to hazardous substances and pollutants. The Texas A&M Superfund Research Program comprehensively evaluates the complexities of hazardous chemical mixtures and their potential adverse health impacts due to exposure through a number of multi-disciplinary projects and cores. One of the essential components of the Texas A&M Superfund Research Center is the Data Science Core, which serves as the basis for translating the data produced by the multi-disciplinary research projects into useful knowledge for the community via data collection, quality control, analysis, and model generation. In this work, we demonstrate the Texas A&M Superfund Research Program computational platform, which houses and integrates large-scale, diverse datasets generated across the Center, provides basic visualization service to facilitate interpretation, monitors data quality, and finally implements a variety of state-of-the-art statistical analysis for model/tool development. The platform is aimed to facilitate effective integration and collaboration across the Center and acts as an enabler for the dissemination of comprehensive ad-hoc tools and models developed to address the environmental and health effects of chemical mixture exposure during environmental emergency-related contamination events.

Fórum das instituições filantrópicas de longa permanência para idosos: parceria em rede de apoio no cuidado institucional ao idoso / Forum of nonprofit long-term care facilities for older adults: partnership with support networks for the institutional care of older adults

Resumo O artigo descreve o histórico, a metodologia e a evolução do Fórum das Instituições Filantrópicas de Longa Permanência para Idosos (ILPI) da Região Metropolitana de São Paulo, e contextualiza sua trajetória diante dos avanços normativos que regulamentam essas instituições atualmente. Foi realizado um estudo retrospectivo, descritivo, de abordagem qualitativa, por meio da leitura e análise das atas das reuniões no período entre 1999 e 2015. Observou-se que a articulação em rede, proporcionada pelas reuniões ao longo dos 16 anos de atividade, pode auxiliar a organização, o planejamento e a manutenção das ILPI, contribuindo para melhorar a qualidade da prestação dos serviços conforme a legislação vigente, promovendo aproximação e engajamento de parceiros na busca pela profissionalização dos cuidados institucionais de longa duração e pela excelência na assistência ao idoso, e no aprimoramento e capacitação dos profissionais, processos e protocolos institucionais.

Abstract This study describes the history, methodology and evolution of the Forum of NonProfit Long-Term Care Facilities for Older Adults (LTCF - Fórum das Instituições Filantrópicas de Longa Permanência para Idosos) of the São Paulo Metropolitan Region, Brazil, and contextualizes its path towards the normative advances that regulate these institutions nowadays. By reading and analyzing the reports of the meetings that occurred between the years 1999 and 2015 a descriptive, qualitative and retrospective study was performed. We observed that the network articulation provided by the meetings during the 16 years of activity can help with the organization, planning and maintenance of LTCFs, improving the quality of the services in accordance to the current legislation, promoting the approximation and engagement of partners in the search for professionalism of long-term institutional care and excellence in care for older adults, and on the improvement and qualification of professionals, processes and institutional protocols.

Identifying collaborative care teams through electronic medical record utilization patterns.

OBJECTIVE: The goal of this investigation was to determine whether automated approaches can learn patient-oriented care teams via utilization of an electronic medical record (EMR) system. MATERIALS AND METHODS: To perform this investigation, we designed a data-mining framework that relies on a combination of latent topic modeling and network analysis to infer patterns of collaborative teams. We applied the framework to the EMR utilization records of over 10 000 employees and 17 000 inpatients at a large academic medical center during a 4-month window in 2010. Next, we conducted an extrinsic evaluation of the patterns to determine the plausibility of the inferred care teams via surveys with knowledgeable experts. Finally, we conducted an intrinsic evaluation to contextualize each team in terms of collaboration strength (via a cluster coefficient) and clinical credibility (via associations between teams and patient comorbidities). RESULTS: The framework discovered 34 collaborative care teams, 27 (79.4%) of which were confirmed as administratively plausible. Of those, 26 teams depicted strong collaborations, with a cluster coefficient > 0.5. There were 119 diagnostic conditions associated with 34 care teams. Additionally, to provide clarity on how the survey respondents arrived at their determinations, we worked with several oncologists to develop an illustrative example of how a certain team functions in cancer care. DISCUSSION: Inferred collaborative teams are plausible; translating such patterns into optimized collaborative care will require administrative review and integration with management practices. CONCLUSIONS: EMR utilization records can be mined for collaborative care patterns in large complex medical centers.