Spiraling Risk: Visualizing the multilevel factors that socially pattern HIV risk among gay, bisexual & other men who have sex with men using Complex Systems Theory.

PURPOSE OF REVIEW: Global disparities in HIV infection, particularly among gay, bisexual, and other men who have sex with men (GBMSM), indicate the importance of exploring the multi-level processes that shape HIV's spread. We used Complex Systems Theory and the PRISMA guidelines to conduct a systematic review of 63 global reviews to understand how HIV is socially patterned among GBMSM. The purpose was to conduct a thematic analysis of the reviews to (1) synthesize the multi-level risk factors of HIV risk, (2) categorize risk across the socioecological model, and (3) develop a conceptual model that visualizes the interrelated factors that shape GBMSMS's HIV "risk." RECENT FINDINGS: We included 49 studies of high and moderate quality studies. Results indicated that GBMSM's HIV risk stems from the individual, interpersonal, and structural levels of the socioecological model. We identified a few themes that shape GBMSM's risk of HIV infection related to biomedical prevention methods; sexual and sex-seeking behaviors; behavioral prevention methods; individual-level characteristics and syndemic infections; lived experiences and interpersonal relationships; country-level income; country-level HIV prevalence; and structural stigma. The multi-level factors, in tandem, serve to perpetuate GBMSM's risk of HIV infection globally. The amalgamation of our thematic analyses from our systematic reviews of reviews suggests that the risk of HIV infection operates in an emergent, dynamic, and complex nature across multiple levels of the socioecological model. Applying complex systems theory indicates how multilevel factors create a dynamic and reinforcing system of HIV risk among GBMSM.

Mitigating the impact of air pollution on dementia and brain health: Setting the policy agenda.

BACKGROUND: Emerging research suggests exposure to high levels of air pollution at critical points in the life-course is detrimental to brain health, including cognitive decline and dementia. Social determinants play a significant role, including socio-economic deprivation, environmental factors and heightened health and social inequalities. Policies have been proposed more generally, but their benefits for brain health have yet to be fully explored. OBJECTIVE AND METHODS: Over the course of two years, we worked as a consortium of 20+ academics in a participatory and consensus method to develop the first policy agenda for mitigating air pollution's impact on brain health and dementia, including an umbrella review and engaging 11 stakeholder organisations. RESULTS: We identified three policy domains and 14 priority areas. Research and Funding included: (1) embracing a complexities of place approach that (2) highlights vulnerable populations; (3) details the impact of ambient PM2.5 on brain health, including current and historical high-resolution exposure models; (4) emphasises the importance of indoor air pollution; (5) catalogues the multiple pathways to disease for brain health and dementia, including those most at risk; (6) embraces a life course perspective; and (7) radically rethinks funding. Education and Awareness included: (8) making this unrecognised public health issue known; (9) developing educational products; (10) attaching air pollution and brain health to existing strategies and campaigns; and (11) providing publicly available monitoring, assessment and screening tools. Policy Evaluation included: (12) conducting complex systems evaluation; (13) engaging in co-production; and (14) evaluating air quality policies for their brain health benefits. CONCLUSION: Given the pressing issues of brain health, dementia and air pollution, setting a policy agenda is crucial. Policy needs to be matched by scientific evidence and appropriate guidelines, including bespoke strategies to optimise impact and mitigate unintended consequences. The agenda provided here is the first step toward such a plan.

Understanding human encounters goes beyond explaining musculoskeletal coordination: a review.

Complex systems theory has become one of the main frameworks to understand, model and explain interactional phenomena such as interpersonal coordination. In her paper, Butler (this issue) applies this approach to theorise about coordination at large, including human interactions. We argue that the all-encompassing language of complex systems theory leads to overemphasising the physical aspects that human interactions share with other coordinated systems in nature. This emphasis ultimately disregards the meaningful dimension implied in any human movement, understanding it as mechanical motion, rather than expressive actions.

The evolution and inter-sectoral interaction mechanism of China's national medical alliance: An analysis based on complex systems theory.

This work investigates the performance and inter-sectoral interaction mechanism of China's largest vertically integrated care network, the national medical alliance (NMA). The data collected derive from the China Health Statistics Bulletin and the China Health Statistical Yearbook for the period 2009-2018. The data include 64 observation indicators for five medical sectors in the NMA, namely, tertiary hospitals (THS), secondary hospitals (SHS), community health centres (CHCS), township hospitals (TsHS) and professional public health institutions (PPHIS). This research combines complex systems theory with a multilevel structural dynamic factor model, and yields two main results. First, although the trend for the NMA's global factor is increasing, the evolutionary paths for sectoral factors differ substantially. Among the sectoral factors, the sectoral factor of THS continued to decline, and neither the sectoral factor of CHCS nor the sectoral factor of TsHS has significantly improved. Then, the interaction mechanism between the various NMA sectors is investigated. While a close relationship has been formed between THS and CHCS and between SHS and CHCS, there remains no close two-way relationship between either THS and TsHS or THS and SHS. Thus, going forward, to reach the policy expectations, China's NMA implementation must consider the interaction between different constituent sectors.

Stretching resilience and adaptive transport systems capacity in South Africa: Imperfect or perfect attempts at closing COVID -19 policy and planning emergent gaps.

The COVID-19 pandemic has presented a new wave of health, infrastructure and built environment challenges and opportunities. The COVID-19 pandemic induced environment presents a divide between the "new and old normal" with policy and planning implications for health, transport and general socio-economic growth and development. Multiple and complex nuanced transport matters cascade all geographic scales and pervade all sectors of the economy. The extent to which existing transport systems capacities are resilient, adaptive, and optimized for complete disaster planning, management and sustainability is questioned. This paper critically reviews how the COVID-19 pandemic has stretched the resilience and adaptive transport systems capacities in South Africa. A critical question interrogated is whether on-going policy and planning interventions constitute imperfect or perfect attempts at closing COVID -19 policy and planning emergent gaps. The paper makes use of South Africa as a case study, referencing the Disaster Management Act (No. 57 of 2002) and logical Disaster Management Act: Regulations relating to COVID-19 (Government Notice 318 of 2020), with specific reference to the transport sector lockdown regulations in unravelling policy and planning implications. Drawing from the complex systems adaptive theory (CSAT), sustainability theory (ST), innovation theory (IT), transitions theory (TT), thematic COVID -19 transport planning and policy adaptation, mitigation measures in the South African transportation sector are discussed. Emergent lessons with respect to developing and advancing a new generation of resilient, adaptive, and optimized transport proof infrastructure and services including revising transport and related policies that navigates through various waves and cycles of induced pandemic and shocks is suggested.

A complex systems approach to the study of change in psychotherapy.

BACKGROUND: A growing body of research highlights the limitations of traditional methods for studying the process of change in psychotherapy. The science of complex systems offers a useful paradigm for studying patterns of psychopathology and the development of more functional patterns in psychotherapy. Some basic principles of change are presented from subdisciplines of complexity science that are particularly relevant to psychotherapy: dynamical systems theory, synergetics, and network theory. Two early warning signs of system transition that have been identified across sciences (critical fluctuations and critical slowing) are also described. The network destabilization and transition (NDT) model of therapeutic change is presented as a conceptual framework to import these principles to psychotherapy research and to suggest future research directions. DISCUSSION: A complex systems approach has a number of implications for psychotherapy research. We describe important design considerations, targets for research, and analytic tools that can be used to conduct this type of research. CONCLUSIONS: A complex systems approach to psychotherapy research is both viable and necessary to more fully capture the dynamics of human change processes. Research to date suggests that the process of change in psychotherapy can be nonlinear and that periods of increased variability and critical slowing might be early warning signals of transition in psychotherapy, as they are in other systems in nature. Psychotherapy research has been limited by small samples and infrequent assessment, but ambulatory and electronic methods now allow researchers to more fully realize the potential of concepts and methods from complexity science.

Measuring resilience prospectively as the speed of affect recovery in daily life: a complex systems perspective on mental health.

INTRODUCTION: There is growing evidence that mental disorders behave like complex dynamic systems. Complex dynamic systems theory states that a slower recovery from small perturbations indicates a loss of resilience of a system. This study is the first to test whether the speed of recovery of affect states from small daily life perturbations predicts changes in psychopathological symptoms over 1 year in a group of adolescents at increased risk for mental disorders. METHODS: We used data from 157 adolescents from the TWINSSCAN study. Course of psychopathology was operationalized as the 1-year change in the Symptom Checklist-90 sum score. Two groups were defined: one with stable and one with increasing symptom levels. Time-series data on momentary daily affect and daily unpleasant events were collected 10 times a day for 6 days at baseline. We modeled the time-lagged effect of daily unpleasant events on negative and positive affect after each unpleasant event experienced, to examine at which time point the impact of the events is no longer detectable. RESULTS: There was a significant difference between groups in the effect of unpleasant events on negative affect 90 min after the events were reported. Stratified by group, in the Increase group, the effect of unpleasant events on both negative (B = 0.05, p < 0.01) and positive affect (B = - 0. 08, p < 0.01) was still detectable 90 min after the events, whereas in the Stable group this was not the case. CONCLUSION: Findings cautiously suggest that adolescents who develop more symptoms in the following year may display a slower affect recovery from daily perturbations at baseline. This supports the notion that mental health may behave according to the laws of a complex dynamic system. Future research needs to examine whether these dynamic indicators of system resilience may prove valuable for personalized risk assessment in this field.

Research topics and trends in medical education by social network analysis.

BACKGROUND: As studies analyzing the networks and relational structures of research topics in academic fields emerge, studies that apply methods of network and relationship analysis, such as social network analysis (SNA), are drawing more attention. The purpose of this study is to explore the interaction of medical education subjects in the framework of complex systems theory using SNA and to analyze the trends in medical education. METHODS: The authors extracted keywords using Medical Subject Headings terms from 9,379 research articles (162,866 keywords) published in 1963-2015 in PubMed. They generated an occurrence frequency matrix, calculated relatedness using Weighted Jaccard Similarity, and analyzed and visualized the networks with Gephi software. RESULTS: Newly emerging topics by period units were identified as historical trends, and 20 global-level topic clusters were obtained through network analysis. A time-series analysis led to the definition of five historical periods: the waking phase (1963-1975), the birth phase (1976-1990), the growth phase (1991-1996), the maturity phase (1997-2005), and the expansion phase (2006-2015). CONCLUSIONS: The study analyzed the trends in medical education research using SNA and analyzed their meaning using complex systems theory. During the 53-year period studied, medical education research has been subdivided and has expanded, improved, and changed along with shifts in society's needs. By analyzing the trends in medical education using the conceptual framework of complex systems theory, the research team determined that medical education is forming a sense of the voluntary order within the field of medicine by interacting with social studies, philosophy, etc., and establishing legitimacy and originality.

Mortality, fertility, and the OY ratio in a model hunter-gatherer system.

An agent-based model (ABM) is used to explore how the ratio of old to young adults (the OY ratio) in a sample of dead individuals is related to aspects of mortality, fertility, and longevity experienced by the living population from which the sample was drawn. The ABM features representations of rules, behaviors, and constraints that affect person- and household-level decisions about marriage, reproduction, and infant mortality in hunter-gatherer systems. The demographic characteristics of the larger model system emerge through human-level interactions playing out in the context of "global" parameters that can be adjusted to produce a range of mortality and fertility conditions. Model data show a relationship between the OY ratios of living populations (the living OY ratio) and assemblages of dead individuals drawn from those populations (the dead OY ratio) that is consistent with that from empirically known ethnographic hunter-gatherer cases. The dead OY ratio is clearly related to the mean ages, mean adult mortality rates, and mean total fertility rates experienced by living populations in the model. Sample size exerts a strong effect on the accuracy with which the calculated dead OY ratio reflects the actual dead OY ratio of the complete assemblage. These results demonstrate that the dead OY ratio is a potentially useful metric for paleodemographic analysis of changes in mortality and mean age, and suggest that, in general, hunter-gatherer populations with higher mortality, higher fertility, and lower mean ages are characterized by lower dead OY ratios.

Identification of required capabilities of digital health ecosystems when preventing and managing non-communicable diseases.

Objective: Non-communicable diseases cause annual mortality for 41 million people worldwide. These diseases include coronary heart disease, cancer, stroke, diabetes, and musculoskeletal as well as mental disorders. Innovation ecosystems in healthcare are multifactor networks in which different stakeholders interact together to create socio-economic (patient and cost) value via research, co-creation, and traditional market activities. Although there is much evidence about the impact of digital health interventions and the capabilities needed to support individual actors and specific diseases in non-communicable disease prevention and management, the current understanding of the concept of innovation ecosystems associated with theories is not well understood. There is also a lack of research about innovation ecosystems in the healthcare context. Or understanding of the holistic perspective of the capabilities needed in innovation ecosystems to support future digital health. The objective of this study was to answer this research gap by identifying what capabilities are needed in future digital health ecosystems related to people with non-communicable diseases or at risk of non-communicable diseases. By doing this, the study will help different organisations and policies address this very challenging situation. Methods: To answer this objective, a qualitative interview-based study including 34 semi-structured interviews was conducted in Finland. Complex adaptive systems theory was used as a theoretical lens to analyse empirical data. Results and conclusion: Several new capabilities were identified for digital health innovation ecosystems to make organisation managers and policymakers aware of how to deal with future health system demands. From the organisational perspective, capabilities are needed to use non-medical and heterogeneous data to support better treatments and clinical decision-making and provide better and safer data access. From the management perspective, hospitals need capabilities to allow critical experts to participate in innovation work, and overall, all ecosystem actors need capabilities to orchestrate research and innovation actions in the area of digital health.

Pattern breaking: a complex systems approach to psychedelic medicine.

Recent research has demonstrated the potential of psychedelic therapy for mental health care. However, the psychological experience underlying its therapeutic effects remains poorly understood. This paper proposes a framework that suggests psychedelics act as destabilizers, both psychologically and neurophysiologically. Drawing on the 'entropic brain' hypothesis and the 'RElaxed Beliefs Under pSychedelics' model, this paper focuses on the richness of psychological experience. Through a complex systems theory perspective, we suggest that psychedelics destabilize fixed points or attractors, breaking reinforced patterns of thinking and behaving. Our approach explains how psychedelic-induced increases in brain entropy destabilize neurophysiological set points and lead to new conceptualizations of psychedelic psychotherapy. These insights have important implications for risk mitigation and treatment optimization in psychedelic medicine, both during the peak psychedelic experience and during the subacute period of potential recovery.

Dynamic ecological system analysis: A holistic analysis of compartmental systems.

This article develops a new mathematical method for holistic analysis of nonlinear dynamic compartmental systems in the context of ecology. The method is based on the novel dynamic system and subsystem partitioning methodologies through which compartmental systems are decomposed to the utmost level. The dynamic system and subsystem partitioning enable tracking the evolution of the initial stocks, environmental inputs, and intercompartmental system flows, as well as the associated storages derived from these stocks, inputs, and flows individually and separately within the system. Moreover, the transient and the dynamic direct, indirect, acyclic, cycling, and transfer (diact) flows and associated storages transmitted along a given flow path or from one compartment, directly or indirectly, to any other are analytically characterized, systematically classified, and mathematically formulated. Further, the article develops a dynamic technique based on the diact transactions for the quantitative classification of interspecific interactions and the determination of their strength within food webs. Major concepts and quantities of the current static network analyses are also extended to nonlinear dynamic settings and integrated with the proposed dynamic measures and indices within the proposed unifying mathematical framework. Therefore, the proposed methodology enables a holistic view and analysis of ecological systems. We consider that this methodology brings a novel complex system theory to the service of urgent and challenging environmental problems of the day and has the potential to lead the way to a more formalistic ecological science.

The controversy around the concept of archetypes.

The paper reviews the course of the controversy surrounding Jung's theory of archetypes beginning in the mid 1990s and continuing to the present. Much of this controversy was concerned with the debate between the essentialism of the evolutionary position of Anthony Stevens as found in his 1983 book Archetypes: A Natural History of the Self, and the emergence model of the archetypes proposed in various publications by Hogenson, Knox and Merchant, among others. The paper then moves on to a consideration of more recent developments in theory, particularly as derived from an examination of the philosopher Gilles Deleuze, who introduces Bergson's somnambulistic unconscious into the discussion of Jung's theories. It is suggested that this largely unexamined influence on Jung may provide answers to some of the unanswered questions surrounding his theorizing. The paper concludes by suggesting that the notion of the somnambulistic unconscious may resemble Atmanspacher's argument for a dual-aspect monism interpretation of Jung.

L'article passe en revue le cours suivi par la controverse autour de la théorie de Jung sur les archétypes, commençant au milieu des années 1990 et jusqu'à aujourd'hui. Une partie importante de la controverse s'attachait au débat entre l'essentialisme de la position évolutionniste d'Anthony Stevens, telle qu'on la trouve dans son livre de 1984 Archétype : Une histoire naturelle du Soi, et le modèle de l'émergence des archétypes proposé sous des formes diverses par Hogenson, Knox et Merchant, entre autres. Cet article s'intéresse ensuite à des avancées plus récentes dans la théorie, particulièrement ce qui provient de l'examen du philosophe Gilles Deleuze. Deleuze introduit l'inconscient somnambulique de Bergson dans le débat sur les théories de Jung. Il est suggéré que cette influence sur Jung - à ce jour quasiment pas étudiée - pourrait fournir des réponses à certaines des questions ouvertes entourant ses théories. L'article conclut en suggérant que la notion d'inconscient somnambulique peut s'apparenter à l'argumentation d'Atmanspacher soutenant une interprétation de Jung selon le modèle d'un monisme à double aspect.

El trabajo presenta una revisión del curso de la controversia alrededor de la teoría de arquetipos de Jung que comenzó a mediados de 1990 y continúa hasta el presente. Mucho de dicha controversia consideraba el debate entre el esencialismo de la posición evolutiva de Anthony Stevens tal como es encontrada en su libro de 1984 Arquetipo: Una historia natural del self, y el modelo de emergencia propuesto por Hogenson, Knox y Merchant, entre otros. El trabajo luego considera un desarrollo más reciente en la teoría, que deriva particularmente de la examinación del filósofo Gilles Deleuze, quien introduce el inconsciente sonambulístico de Bergson en la discusión de las teorías de Jung. Se sugiere que esta influencia en Jung, largamente ignorada, puede ofrecer respuestas a algunas de las preguntas no respondidas de su teoría. El trabajo concluye sugiriendo que la noción de inconsciente sonambulístico puede parecerse al argumento de Atmanspacher sobre una interpretación de Jung, monista de aspecto dual.