Author: Caldwell Palmer Research

My applied research work currently combines complexity sciences with commensurable dynamic views and measures of human body and mind from the theoretical perspective of integrated and coherent variability as health and its impairment or loss as disease and illness. These evidence-based concepts are used for the design and implementation of applied research projects for clinical care improvement. For example, I have a multi-year program underway to develop and validate prognostic biomarkers for COPD exacerbations. I also teach and apply my narrative concordance model for improving interpersonal healthcare interactions to better understand patient adherence and its increase. Narrative concordance also is applicable to care team coordination and care continuity. Future applied projects will concern and include how economic aspects intertwine with healthcare/medical issues by using, as does my current work, my human ontology construct of the Processual Interdependent Phenotype. My basic research focuses on developing my human ontology theory and its construct, the Processual Interdependent Phenotype; the associated evidence base; the empirical scaffolding; and networking with other commensurable theories. My doctoral research degree is in complex responsive processes taught as a highly integrated, radically social/personal psychology. Complex responsive processes is a particular one of multiple fields of complexity sciences. The Complexity and Management doctoral programme is taught at the University of Hertfordshire. I have worked in healthcare for fifteen years. My education was originally as an Economist at the University of Chicago and Texas Christian University.

Horses for Courses — Dynamic Measures for Dynamic Humans

Everything flows.  Lucretius

The human being, and all around us – others and environments, and in us (!) – biome, is characterized by continuous dynamic variability.  But for reasons historical, and for ease of data gathering, and in accordance with various views of the human being we often use static, point (current pulse, blood pressure) or threshold (is Respiratory Rate >= 20, in SIRS criteria).

Advances make more useful, more insightful, discriminant measures and analytics available to understand the non-linear, continuous dynamics, physiological and psychological of being human.  Even attention to dynamics (blood pressure variability) versus static/point measures while using basic analysis like descriptive stats like average, sd, etc. are providing vital insights. (see Rothwell on BPV) Important examples include:

  1. Physiological process/functions

Heart Rate Variability:  HRV in sleep and sleep apnea [14] T. Penzel, J. W. Kantelhardt, L. Grote, J. H. Peter, and A. Bunde, “Comparison of detrended fluctuation analysis and spectral analysis for heart rate variability in sleep and sleep apnea,” IEEE Trans. Biomed. Eng., vol. 50, no. 10, pp. 1143–1151, Oct. 2003

Blood Pressure – Rothwell, Peter M. (2010) Limitations of the usual blood-pressure hypothesis and importance of variability, instability, and episodic hypertension, Lancet 2010; 375: 938–48

Temperature Curve Complexity – Varela, Manuel, et al. (2006) Temperature Curve Complexity Predicts Survival in Critically Ill Patients, Am J Respir Crit Care Med, Vol 174. pp 290–298

Anesthesia/EEG: M. Jospin, P. Caminal, E. W. Jensen, H. Litvan, M. Vallverdu,M. Struys, H. E. Vereecke, and D. T. Kaplan, “Detrended fluctuation analysis of EEG as a measure of depth of anesthesia,” IEEE Trans. Biomed. Eng., vol. 54, no. 5, pp. 840–846, May 2007.

Gait Variability: Chau T. A review of analytical techniques for gait data. Part 1: Fuzzy, statisticaland fractal methods. Gait Posture 2000;13:49–66.

> Peng CK, Hausdorff JM, Goldberger AL. Fractal mechanisms in neural control: Human heartbeat and gait dynamics in health and disease. In Nonlinear Dynamics, Self- Organization, and Biomedicine. Cambridge, UK: Cambridge University Press, 2000; 66–96

Peak Expiratory Variability: G. C. Donaldson, T.A.R. Seemungal, JR Hurst, JA Wedzicha, (2012) Detrended fluctuation analysis of peak expiratory flow and exacerbation frequency in COPD, European Respiratory Journal, Feb 9, 2012

Intracranial pressure: Robert L. Burr*, Senior Member, IEEE, Catherine J. Kirkness, and Pamela H. Mitchell, (2008) Detrended Fluctuation Analysis of Intracranial Pressure Predicts Outcome Following Traumatic,  Brain Injury, IEEE TRANSACTIONS ON BIOMEDICAL ENGINEERING, VOL. 55, NO. 11, NOVEMBER 2008

2. Physiological – Structures

Retinal Vasculature: Masters, Barry R. (2004) FRACTAL ANALYSIS OF THE VASCULAR TREE IN THE HUMAN RETINA, Annu. Rev. Biomed. Eng. 6:427–52

> Sng, C.C.A et al. (2010) Fractal analysis of the retinal vasculature and chronic kidney disease, Nephrol Dial Transplant 25: 2252-2258.

Lung: Boser, Stacey R., Hannah Park, Steven F. Perry, M. G. Ménache and Francis H. Y. Green (2005) Fractal Geometry of Airway Remodeling in Human Asthma, Am J Respir Crit Care Med, Vol 172, pp 817–823.

Tumor architecture: Gazit, et al (1997) Fractal characteristics of tumor vascular architecture during tumor growth and regression, Microcirculation. 1997 Dec;4(4):395-402.

Trabecular Bone:  Wolski M, Podsiadlo P, Stachowiak GW, Lohmander LS, Englund M (2010) Differences in trabecular bone texture between knees with and without radiographic osteoarthritis detected by directional fractal signature method. Osteoarthritis Cartilage. 2010 May;18(5):684-90. doi: 10.1016/j.joca.2010.01.002.

Pain:  Jennifer M. Foss, A.Vania Apkarian, and Dante R. Chialvo (2006) Dynamics of Fractal Dimension of Temporal Variability of Spontaneous Pain Differentiates Between Pain States, J Neurophysiol 95: 730–736, 2006

Rheumatoid arthritis:  Kamal, 2007, Assessment of autonomic function in patients with rheumatoid arthritis using spectral analysis and approximate entropy method, Neurosciences 2007; Vol. 12 (2): 136-139

3. Psychological 

Narrative Sense-Making

Narrative Coherence: Sense of Coherence, SOC-13:  Eriksson, Monica, Lindstrom, Validity of Antonovsky’s sense of coherence scale: A systematic review, J Epidemiol Community Health 2005;59: 460-466.

Sense of Coherence & Transplants: Liver transplant recipients’ ability to cope during the first 12 months after transplantation – a prospective study, Forsberg, Anna; Bäckman, Lars1; Svensson, Elisabeth , Scand J Caring Sci; 2002; 16; 345-352

4. Integrated Variability

Emotional Regulation: Endre Visted, et al (2017) The Association between Self-Reported Difficulties in Emotion Regulation and Heart Rate Variability: The Salient Role of Not Accepting Negative Emotions, Front. Psychol. 8:328

> Appelhans, Bradley and Linda J. Luecken, 2006, Heart Rate Variability as an Index of Regulated Emotional Responding, Review of General Psychology, 2006, 10, 3:229-240.

Heart – Brain integration: Thayer, Julian F. and Richard D. Lane, 2009, Claude Bernard and the heart-brain connection: Further elaboration of a model of Neurovisceral integration, Neuroscience and Biobehavioral Reviews, 2009, 33: 81-88

 

 

 

 

 

 

 

 

HRV Heart Rate Variability Dynamics

Heart Rate Variability dynamics is a widely studied non-invasive biomarker.  HRV is generally analyzed as the R-R interval.

Applications, RCTs and clinical studies include:

  • 24 hour prognostic window for earlier detection of infection/sepsis risk in neonatal ICUs.  Mortality reductions up to 20%, and reduced and improved use of antibiotics in about thirty NICUs in US and Europe. Validated by RCT involving 3000 infants.Karen D. Fairchild, MD, T. Michael O’Shea, MD (2010) Heart Rate Characteristics: Physiomarkers for Detection of Late-Onset Neonatal Sepsis, download free at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2933427/
  • Clinical retrospective study of ambulatory post-Bone Marrow Transplant patients in Canada.  A 25% decline from HRV baseline provided an average of 64 hours prognostic notice of infection/sepsis, taken as time of administration of antibiotics. Ahmad, 2009.
  • Clinical study: progression to septic shock in ED patients.Chen WL and Kuo CD (2007) Characteristics of heart rate variability can predict impending septic shock in emergency department patients with sepsis. Academic Emergency Medicine. 2007 May;14 (5):392-7. Epub 2007 Mar 26.
  • Pulmonary infections post cardiac surgeryCorrêa, Paulo Roggerio et al. (2010) Heart Rate Variability and Pulmonary Infections after Myocardial Revascularization, Arq Bras Cardiol 2010; 95(4): p448-456.
  • As integrated biomarker – HRV and poly-trauma and PTSD in soldiers -Tan (2009) Associations among Pain, PTSD, mTBI, and Heart Rate Variability in Veterans of Operation Enduring and Iraqi Freedom: A Pilot Study, PAIN MEDICINE Vol 10, Number 7.

 

Variability is Viability

This is the post excerpt.

This is an opening post for Human Variability.  A key proposition here is that all of human interactions as self, others, and environments –  built and natural – are characterized by continuous, dynamic variability.  Humans have evolved, biologically and socially to survive, reproduce and thrive in that context of continuous change.   A corollary proposition then is that we persist, we are viable, not just by resilience or resistance, though we can do both — but because our persistence is by means of interacting fully with change, of leveraging change, initiating change, redirecting change.

This site seeks to share and build, apply and implement, an integrated view of human variability.  Physiological variability will include, for example, Heart Rate Variability Dynammics, Respiratory Rate variability, temperature curve complexity, blood pressure variability.  Psychological variability is understood with such measures as emotional regulation, alexithymia, depression, sense of coherence (SOC-13).  The work here includes how to integrate such markers.

To paraphrase Merleau-Ponty we do not just inhabit the context of change – we haunt it.  Change is not the name for a niche imposed upon us — but the niches we co-create and sustain.

The implications of continuous dynamic variability include indications for how to most usefully conceptualize humans and measure our interactions – here for purposes of healthcare improvement.  The dynamics of human existence call for dynamic analytics.

Another corollary is that the continuous variability of humans is integrated and coherent, appropriate and timely.  That concept will help guide and illuminate the conceptual and methodological discussions here and how to think about design and implementation of pragmatic projects and programs to improve clinical care and healthcare services.

 

 

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