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Despite the acceptance of best practice as a standard for quality health care delivery, the exact nature of what constitutes best practice does not share universal definition or application. The purpose of this dissertation is to propose an integrative conceptual representation of nursing best practice from the philosophical perspective of complexity science.A five-step concept clarification approach was used to identify the concept, systematize observations and descriptions, develop an operational definition, construct a model, and formulate hypotheses. An expert panel explored preliminary validity of the definition and model.Purposive recruitment of clinicians and scholars was conducted for expert panel membership. The expert panel rated the strength of the model dimensions of adequacy, representative-ness, consistency, clarity, simplicity, generalness, accessibility, importance, and relevance, as well as interest in development and application. Narrative data from open-ended questions was incorporated into model refinement.Clinician properties and context properties emerged as two principle domains of interdependent influence. Key dynamic processes included critical thinking by which clinicians operationalize properties into practice choices, and informative reflection by which the organization monitors and improves performance through information flow and learning. All aspects of the conceptual model, with the exception of consistency of relationships, were ultimately rated as strengths by the expert panel. Relationships among constructs were identified as complex, diverse, and difficult to isolate. Expert perception was that clinician and context properties most likely equally influence nursing best practice, but that context properties may have greater influence than clinician properties over time.This model incorporates a full range of interdependence across clinician and context domains of influence. This model requires further operationalization of constructs prior to formal validity testing. The application of complexity science introduces challenges to research and measurement in the study of complex adaptive systems. The model presented in this dissertation provides a perspective from which a better understanding of health care system interdependencies may arise.

T2DM continues to be a public health burden with its increasing incidence, prevalence, and mortality risks. The aim of this thesis was to examine a population-based cohort of 22,000 people with T2DM diagnosed between 1 January 2000 and 31 December 2010 within the Wirral Peninsula, UK with the aim of: Assessing factors relating to all-cause, cardivascular-, malignancy-, and non-cardiovascular mortality; evaluating the role of glycaemic control, socioeconomic status, smoking, dyslipidaemia, blood pressure, obesity, and nephropathy, as predicting risk factors for mortality; assessing the influence of age at diagnosis, duration of diabetes, year of diagnosis and gender on mortality; examining the life expectancy and mortality patterns and measuring the years of life lost as a result of a diagnosis of T2DM; applying Complexity Science to the dynamic interplay of the various factors in T2DM that lead to unpredictability in health outcomes.

This thesis deals with two related questions. The first relates to a critical inquiry into the processes of curriculum creation and formation within a medical school which has undergone a significant curriculum revision. I explore the notion that such processes can be understood as a form of practice in which the relationship between content and process is held together by what is explored in the thesis as an indivisible, paradoxical tension. Exploring curriculum as a kind of process is a novel approach in a school steeped in the traditions of the natural sciences. The common metaphors for curriculum in this setting refer to blueprints, models, behavioural competencies and objective standards. These are all founded on the belief in an objective observer who can maintain some form of distance between themselves and the subject in question. Issues of method are, therefore, central to my explorations of how we might, instead, locate curriculum in social processes and acts of evaluation involving power relations, conflict and the continuous negotiation of how it is we work together. The paradox of process and content in this way of understanding is that participants in curricular practice are simultaneously forming and being formed by their participation. In this way of thinking, it makes no sense to say one can either “step back” to “reflect” on their participation or that there is a way to approach participation “objectively.” The other question I address in this thesis has to do with the emergence of excellence. By emergence, I refer to thinking in the complexity sciences which attempts to explain phenomena which have a coherence which cannot be planned for or known in advance. “Excellence” is a kind of idealization which has no meaning until it is taken up and “functionalized” within specific settings and situations. In the setting of participating in curriculum formation, excellence may be understood as one possible outcome of persisting engagement and continuous inquiry which itself influences the ongoing conversation of how excellence is recognized and understood. In other words, excellence emerges in social processes as a theme simultaneously shaping and being shaped by curricular practice. This research was initiated as a result of a mandate to establish a program which could demonstrate excellence in the area of relationships in health care. The magnitude of this mandate felt overwhelming at the time and raised a lot of anxiety. I found that the traditional thinking regarding participation in organizational change processes (which, within my setting, could be understood as “set your goal and work backwards”) did not satisfactorily account for the uncertainties and surprises of working with colleagues to create something new. The method of inquiry can be read as another example of a process / content paradox through which my findings regarding curriculum and excellence emerged. This method involved taking narratives from my experience as an educator and clinician and a participant in varied forms of curricular processes and inquiring into them further by both locating them within relevant discourses from sociology, medical education and organizational studies and also sharing them with peers in my doctoral program as well as colleagues from my local setting. This method led to an inquiry and series of findings which was substantively different from my starting point. This movement in thinking offers another demonstration of an emergent methodology in which original findings are “discovered” through the course of inquiry. These findings continue to affect my practice and my approach to inquiry within the setting of medical education. The original contributions to thinking in medical education occur in several ways. One is in the demonstration of a research method which takes my own original experience seriously and seeks to challenge taken for granted assumptions about a separation of process and content, instead exploring the implications of understanding these in a relation of paradox. By locating my work within social processes of engagement and recognition, I explore the possibility that excellence can also be understood as an emergent property of interaction which is under continuous negotiation which itself forms the basis for further recognition and exploration of “excellence.” The social processes which shape and are shaped by “excellence” are fundamental to the practice of curriculum itself. Both curricula and “excellence” emerge within the interactions of people with a stake in the desired outcomes as the product of continued involvement and consideration of ongoing experience. Finally, a process view of medical education is presented as a contribution to understanding the work of training physicians who are comfortable with the uncertainties and contingencies involved in the humane care of their patients.

Thesis advisor: Robert J. Starratt / Despite its provision of sustained, targeted, job-embedded professional development to teachers, instructional coaching, which school districts across the United States have introduced in efforts to midwife instructional improvement, has occasionally suffered the same fate as countless other attempts at school reform. While programs of instructional coaching have endured and become institutionalized in many districts, they have been discontinued in others. Additionally, while the literature reports that instructional coaching in this country originated, and has remained popular, in urban school districts, it is all-but-silent about programs in suburban settings. The present, qualitative research study examined three suburban school districts in efforts to answer the following research question: How do suburban school districts' unique contexts impact the implementation, maintenance, and success of their instructional coaching programs? Case studies of three suburban school districts in Massachusetts were assembled from data collected during semi-structured interviews with twenty-two educators from across the three districts. Resulting data were analyzed across cases through the lens of complexity science, in order that the three school districts, and their programs of instructional coaching, could be explored - if not completely understood - in all their complexity. This investigation found that, while the roll-out of a district's instructional coaching program need not have been a grand event, it was nevertheless essential for faculty members to understand the rationale for the establishment of the program and the role to be played by their schools' coaches. It confirmed assertions in the existing literature that trust is an essential ingredient in any instructional coaching program. It also served to confirm that administrators contribute to the success of instructional coaching programs when they are actively engaged in supporting them. This investigation found, further, that instructional coaching programs, and the schools in which they function, demonstrate key aspects of complex systems. / Thesis (PhD) — Boston College, 2012. / Submitted to: Boston College. Lynch School of Education. / Discipline: Education.

A fundamental question in Complexity Science is how numerous dynamic processes coordinate with each other on multiple levels of description to form a complex whole - a multiscale coordinative structure (e.g. a community of interacting people, organs, cells, molecules etc.). This dissertation includes a series of empirical, theoretical and methodological studies of rhythmic coordination between multiple agents to uncover dynamic principles underlying multiscale coordinative structures. First, a new experimental paradigm was developed for studying coordination at multiple levels of description in intermediate-sized (N = 8) ensembles of humans. Based on this paradigm, coordination dynamics in 15 ensembles was examined experimentally, where the diversity of subjects movement frequency was manipulated to induce di erent grouping behavior. Phase coordination between subjects was found to be metastable with inphase and antiphase tendencies. Higher frequency diversity led to segregation between frequency groups, reduced intragroup coordination, and dispersion of dyadic phase relations (i.e. relations at di erent levels of description). Subsequently, a model was developed, successfully capturing these observations. The model reconciles the Kuramoto and the extended Haken-Kelso-Bunz model (for large- and small-scale coordination respectively) by adding the second-order coupling from the latter to the former. The second order coupling is indispensable in capturing experimental observations and connects behavioral complexity (i.e. multistability) of coordinative structures across scales. Both the experimental and theoretical studies revealed multiagent metastable coordination as a powerful mechanism for generating complex spatiotemporal patterns. Coexistence of multiple phase relations gives rise to many topologically distinct metastable patterns with di erent degrees of complexity. Finally, a new data-analytic tool was developed to quantify complex metastable patterns based on their topological features. The recurrence of topological features revealed important structures and transitions in high-dimensional dynamic patterns that eluded its non-topological counterparts. Taken together, the work has paved the way for a deeper understanding of multiscale coordinative structures. / Includes bibliography. / Dissertation (Ph.D.)--Florida Atlantic University, 2018. / FAU Electronic Theses and Dissertations Collection

abstract: This dissertation investigates the long-term consequences of human land-use practices in general, and in early agricultural villages in specific. This pioneering case study investigates the "collapse" of the Early (Pre-Pottery) Neolithic lifeway, which was a major transformational event marked by significant changes in settlement patterns, material culture, and social markers. To move beyond traditional narratives of cultural collapse, I employ a Complex Adaptive Systems approach to this research, and combine agent-based computer simulations of Neolithic land-use with dynamic and spatially-explicit GIS-based environmental models to conduct experiments into long-term trajectories of different potential Neolithic socio-environmental systems. My analysis outlines how the Early Neolithic "collapse" was likely instigated by a non-linear sequence of events, and that it would have been impossible for Neolithic peoples to recognize the long-term outcome of their actions. The experiment-based simulation approach shows that, starting from the same initial conditions, complex combinations of feedback amplification, stochasticity, responses to internal and external stimuli, and the accumulation of incremental changes to the socio-natural landscape, can lead to widely divergent outcomes over time. Thus, rather than being an inevitable consequence of specific Neolithic land-use choices, the "catastrophic" transformation at the end of the Early Neolithic was an emergent property of the Early Neolithic socio-natural system itself, and thus likely not an easily predictable event. In this way, my work uses the technique of simulation modeling to connect CAS theory with the archaeological and geoarchaeological record to help better understand the causes and consequences of socio-ecological transformation at a regional scale. The research is broadly applicable to other archaeological cases of resilience and collapse, and is truly interdisciplinary in that it draws on fields such as geomorphology, computer science, and agronomy in addition to archaeology. / Dissertation/Thesis / Ph.D. Anthropology 2013

The relationship between the energy-food-water nexus and the climate is non-linear, multi-sectoral and time sensitive, incorporating aspects of complexity and risk in climate related decision-making. This paper seeks to explore how knowledge co-production can help identify opportunities for building more effective, sustainable, inclusive and legitimate decision making processes on climate change. This would enable more resilient responses to climate risks impacting the nexus while increasing transparency, communication and trust among key actors. We do so by proposing the operationalization of an interdisciplinary approach of analysis applying the novel methodology developed in Howarth and Monasterolo (2016). Through a bottom-up, participative approach, we present results of five themed workshops organized in the UK (focusing on: shocks and hazards, infrastructure, local economy, governance and governments, finance and insurance) featuring 78 stakeholders from academia, government and industry. We present participant's perceptions of opportunities that can emerge from climate and weather shocks across the energy-food-water nexus. We explore opportunities offered by the development and deployment of a transdisciplinary approach of analysis within the nexus boundaries and we analyse their implications. Our analysis contributes to the current debate on how to shape global and local responses to climate change by reflecting on lessons learnt and best practice from cross-stakeholder and cross-sectorial engagement. In so doing, it helps inform a new generation of complex systems models to analyse climate change impact on the food-water-energy Nexus.

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