Complex Situations Research Articles

Project management approaches and their selection in the digital age: Overview, challenges and decision models

Digital transformation is a challenge that also impacts the selection of tools for implementing projects. Which tools are suitable for handling complex digital twins? Project management must respond to this with suitable approaches. The challenge for decision-makers is to choose the right one. Based on literature research and a case study, influencing factors are derived and practice-relevant project management approaches are collected. Furthermore, a decision model is developed that, on the one hand, supports the decision-maker in selecting tools before and during the project, and on the other hand makes empirical values from past projects usable for future decisions. The results show that the number of influencing factors is large, and the approaches are di-verse. In complex projects, this can lead to complex decision-making situations that require appropriate decision models. The developed “Supervised Decision Model – L5” is based on five levels (L): (L1) Building a database; (L2) Derivation of algorithms; (L3) Initial approach selection; (L4) Review of the initial selection; (L5) Using experiences for future decisions. In practice it turns out that complex projects – like Digital Twins - often fail. Modified decision models for selecting suitable approaches should therefore take the following as-pects into account: (a) decision-makers are actively supported in the initial decision phase; (b) initial decisions once made are checked in the early phase of the project and corrected if necessary; (c) the lessons learned are recorded in the database as empirical value and used for future decisions.

Techniques for the formation of the natural and ecological framework of riverine cities (on the example of Rostov-on-Don)

The article deals with the formation of the landscape of the territories of riverine towns in time and space. Special attention is paid to the formation of the natural and ecological framework of the riverine city and its elements that contribute to the sustainable development of its territories, as well as the creation of comfortable living conditions for the population. The use of methods of an integrated approach in combination with elements of factorial and system analysis required consideration of various aspects in this work. On the example of the city of Rostov-on-Don, the main historical stages of the development of the city territory are presented, taking into account the peculiarities of its natural landscape. The landscape of the territories contributed to the development of settlements from isolated dotted ones to their linear fusion along the water area and their transformation into large urban formations with a complex ecological situation. The current situation is due to a number of mistakes made, including urban planning. In order to create a comfortable urban environment, a developed conceptual model of the natural and ecological framework of the city of Rostov-on-Don with a spatial structure and vertical tiering is presented. Recommendations have been developed for the restoration and formation of sustainable development of the territories of riverine cities by transforming their landscape structure as a whole, as well as the creation of urban landscape parks in order to improve the comfort of the environment for the population to live.

Does the priority of ambulance guarantee no delay? a MIPSSTW model of emergency vehicle routing optimization considering complex traffic conditions for highway incidents.

Globally, traffic accidents on the highway network contribute significantly to a high fatality rate, drawing considerable attention from health institutions. The efficiency of transportation plays a vital role in mitigating the severe consequences of these incidents. This study delves into the issues of emergency vehicles experiencing delays despite having priority. Therefore, we construct mixed-integer linear programming with semi-soft time windows (MIPSSTW) model for optimizing emergency vehicle routing in highway incidents. We analyze the time-varying and complex traffic situations and respectively propose corresponding estimation approaches for the travel time of road segments, intersections on the urban road network, and ramp-weave sections on the highway network. Furthermore, we developed a modified cuckoo search(MCS) algorithm to solve this combinatorial problem. Optimization strategies of Lévy flight and dynamic inertial weight strategy are introduced to strengthen the exploration capability and the diversity of solution space of the CS algorithm. Computational experiments based on the Chinese emergency medical system data are designed to validate the efficacy and effectiveness of the MIPSSTW model and MCS algorithm. The results show that our works succeed in searching for high-quality solutions for emergency vehicle routing problems and enhance the efficacy of strategic decision-making processes in the realm of incident management and emergency response systems.

Proposing a sales performance motivational framework for B2B sellers in services firms

This study tests a framework of business-to-business (B2B) sellers’ sales performance motivations in services firms. An exploratory-descriptive research design was used and data was collected from 389 respondents working in the services-orientated business sector of Norway. The study's results verify that B2B service sales are complex contexts and situations for B2B seller services firms and their B2B customers to handle. Many elements are required to reach a final deal. Therefore, services firms must maintain seller motivation throughout the B2B services sales process, which is usually hard and may involve psychological wear-out. Consequently, this study examines and verifies an important area of sales performance indicators, namely B2B sellers’ motivations in services firms, and explains B2B sellers’ intrinsic and extrinsic motivations.

ChatGPT Yields a Passing Score on a Pediatric Board Preparatory Exam but Raises Red Flags.

We aimed to evaluate the performance of a publicly-available online artificial intelligence program (OpenAI's ChatGPT-3.5 and -4.0, August 3 versions) on a pediatric board preparatory examination, 2021 and 2022 PREP® Self-Assessment, American Academy of Pediatrics (AAP). We entered 245 questions and answer choices from the Pediatrics 2021 PREP® Self-Assessment and 247 questions and answer choices from the Pediatrics 2022 PREP® Self-Assessment into OpenAI's ChatGPT-3.5 and ChatGPT-4.0, August 3 versions, in September 2023. The ChatGPT-3.5 and 4.0 scores were compared with the advertised passing scores (70%+) for the PREP® exams and the average scores (74.09%) and (75.71%) for all 10 715 and 6825 first-time human test takers. For the AAP 2021 and 2022 PREP® Self-Assessments, ChatGPT-3.5 answered 143 of 243 (58.85%) and 137 of 247 (55.46%) questions correctly on a single attempt. ChatGPT-4.0 answered 193 of 243 (79.84%) and 208 of 247 (84.21%) questions correctly. Using a publicly-available online chatbot to answer pediatric board preparatory examination questions yielded a passing score but demonstrated significant limitations in the chatbot's ability to assess some complex medical situations in children, posing a potential risk to this vulnerable population.

Failed nonunion subtrochanteric femur fracture managed with uncemented total hip replacement

Abstract Subtrochanteric fracture is a fracture between the lesser trochanter and 5 cm distal to the lesser trochanter. It accounts approximately for 10%–30% of all hip fractures and affects persons more than 60 years of age. Bimodal distribution has greater incidences in 20–40 years of age and persons more than 60 years of age. Deforming forces on the proximal fragment are abduction by the gluteus medius and minimus, flexion by iliopsoas, and external rotation by short external rotators; whereas, deforming forces on the distal fragment are adduction and varus by adductors. Failure of subtrochanteric fracture treatment is frequently associated with unstable fracture patterns, poor bone quality, or suboptimal position of fixation devices. Such complications following treatment failure may result in nonunion, leading to pain or malunion, severe bone defects, infection, articular cartilage damage, and even post-traumatic arthritis hip, which poses a significant challenge in subsequent surgeries. Therefore, in this particular case, we were left with only two options, such as (1) re-osteosynthesis using limb reconstruction surgeries (LRS) and (2) and prosthetic replacement. We opted for uncemented long stem total hip replacement to get diaphyseal hold as it has many advantages over LRS like a high success rate, a better quality of life, improved early mobility, and life-long lasting results. LRS was not opted as a choice of surgery as it has some disadvantages like pin-tract infection, more maintenance and compliance needed, the frame being bulky and cumbersome, and the risk of fracture at the pinhole site. Moreover, in this particular case, bone grafts from all accessible sites were used from previous surgeries. Uncemented long-stem total hip replacement can serve as an efficient salvage procedure in such cases. Post-operatively on follow-up at 2 months, the patient was able to fully bear weight without support. The range of motion at the right hip joint where the patient was able to do flexion 100ʹ, abduction 50ʹ, and adduction 30ʹ. We were able to correct limb length discrepancy by 5 cm (pre-operative discrepancy was 7 cm). Our achievement shows that uncemented long stem total hip replacement is a beneficial and effective procedure for salvaging the failed treatment of subtrochanteric fractures. Such procedures have shown satisfactory functional outcomes, stable fixation, and survival rates for these complex situations.

Subjective factors of travel activity for the purpose of cultural support of biological diversity for individuals with different success levels

It is shown that the activity of a person’s travels is associated with his psychological characteristics, ideological attitudes, needs for new connections and knowledge. Travel is endowed with a psychological resource that allows you to actualize the motivation for positive personality transformations. A system of internal factors for personal travel activity is identified and described: direction, tolerance for uncertainty, interests, tendency to accept novelty and test one’s capabilities. The factors that determine the specificity of travel trajectory choice and tourist programs’ types in the conditions of modern realities are described. The content of external and internal factors that can enhance the psychological resource of travel as a platform for self-development and personal improvement is shown. The role of travel in cognitive, communicative and personal transformations, in the development of the subject’s ability to productively solve complex situations and effective activity in conditions of uncertainty is shown. The novelty of the study lies in the identification and subjective factors’ description of travel activity for individuals with different success levels. Empirically, studies have identified severity indicators of tolerance and intolerance to uncertainty among participants in tourism programs with different statuses of success and self-efficacy.

Children and youth in street situations in Nairobi. A study for a comprehensive model of care

We investigated the profiles of children and youth in street situations in Mlango Kubwa slum in Nairobi. Through a quanti-qualitative questionnaire, we collected the responses of 300 children and youth, starting from the social determinants of health as indicators of vulnerability. The foremost objective is to understand their social and health conditions as vulnerable/at-risk street groups. The secondary goal is to identify the populations' strengths, inspecting protection mechanisms, survival strategies and dreams. The data show a complex situation: experiences of trauma, violence, conflict and abandonment; ambivalent family ties, school drop-out, lack of legal and physical protection, homelessness, living below the limit of extreme poverty. The street has activated survival strategies, mostly on an individual level, but functioning as a "base system" the street seems to act as a protective system and a possible scenario in which to create a different future together with youth workers: reconnecting with the family, liaising with expert figures in order to return to school or look for suitable training. Working with children and youth in street situations highlights the complexity of their vulnerability. This could be addressed through an integrated approach and a comprehensive primary health care model.

Reinforced Computer-aided Framework for Diagnosing Thyroid Cancer.

Thyroid cancer is the most pervasive disease in the endocrine system and is getting extensive attention. The most prevalent method for an early check is ultrasound examination. Traditional research mainly concentrates on promoting the performance of processing a single ultrasound image using deep learning. However, the complex situation of patients and nodules often makes the model dissatisfactory in terms of accuracy and generalization. Imitating the diagnosis process in reality, a practical diagnosis-oriented computer-aided diagnosis (CAD) framework towards thyroid nodules is proposed, using collaborative deep learning and reinforcement learning. Under the framework, the deep learning model is trained collaboratively with multiparty data; afterward classification results are fused by a reinforcement learning agent to decide the final diagnosis result. Within the architecture, multiparty collaborative learning with privacy-preserving on large-scale medical data brings robustness and generalization, and diagnostic information is modeled as a Markov decision process (MDP) to get final precise diagnosis results. Moreover, the framework is scalable and capable of containing more diagnostic information and multiple sources to pursue a precise diagnosis. A practical dataset of two thousand thyroid ultrasound images is collected and labeled for collaborative training on classification tasks. The simulated experiments have shown the advancement of the framework in promising performance.

Generative interpolation via a diffusion probabilistic model

Seismic data interpolation is essential in a seismic data processing workflow, recovering data from sparse sampling. Traditional and deep-learning-based methods have been widely used in the seismic data interpolation field and have achieved remarkable results. In this paper, we develop a seismic data interpolation method through the novel application of diffusion probabilistic models (DPMs). DPM transforms the complex end-to-end mapping problem into a progressive denoising problem, enhancing the ability to reconstruct complex situations of missing data, such as large proportions and large-gap missing data. The interpolation process begins with a standard Gaussian distribution and seismic data with missing traces and then removes noise iteratively with a UNet trained for different noise levels. Our DPM-based interpolation method allows interpolation for various missing cases, including regularly missing, irregularly missing, consecutively missing, noisy missing, and different ratios of missing cases. The ability to generalize to different seismic data sets is also discussed in this paper. Numerical results of synthetic and field data indicate satisfactory interpolation performance of the DPM-based interpolation method in comparison with the f- x prediction filtering method, the curvelet transform method, the low-dimensional manifold method (LDMM), and the coordinate attention-based UNet method, particularly in cases with large proportions and large-gap missing data. Diffusion is all we need for seismic data interpolation.

Application of the Investigator Argus X-12 QS Kit and the Famlinkx Software for Solving Complex Kinship Forensic Genetics Cases in Colombia: Case Report

X-chromosome short tandem repeats (X-STRs) genotyping is a powerful ¬tool in forensic genetics for resolving intricate kinship cases due to its distinctive inheritance pattern. It proves particularly valuable in scenarios where the application of autosomal (A-STR) and Y-chromosomal STR (Y-STR) markers falls short in addressing such cases, especially those involving complex situations and kinship analyses encompassing extensive and incomplete pedigrees. The recent advancement and implementation of the Argus X-12 QS kit along with the FamilinkX software for X-STR analysis have facilitated the resolution of forensic cases that were formerly inconclusive or not received by the laboratory due to their high complexity. This article delineates seven intricate cases of kinship and identification conducted at the Forensic Genetics Laboratory of the National Institute of Legal Medicine and Forensic Sciences in Bogotá, Colombia, in instances where autosomal STRs yielded non-conclusive or weak likelihood ratio (LR) values, the combination of the Argus X-12 QS kit and the FamilinkX software proved instrumental in elucidating and enhancing LR values, thereby leading to conclusive outcomes. The article details a case involving the confirmation of the identity of a body retrieved from water, which was subsequently returned to the institute by its relatives for identification. It also encompasses cases involving maternal half-siblings, complex pedigrees with paternal half-aunts, and others. In each scenario, the total LR was estimated by combining the LR of autosomal STRs (LR AS-STR) with the LR of X-STRs (LR X-STR), utilizing the population frequency database specific to Colombia. Additionally, the LRs of X-STRs obtained using population frequency data from Colombia were compared with those from Mexico. The data derived from both the Mexican and Colombian populations exhibited a high degree of similarity. The collective LR values substantiate the efficacy of X-STR markers, particularly in resolving cases of maternal half-siblings. The analysis underscores the robust informativeness of the 12 X-STR loci examined in the context of forensic testing

Impact of the Democratic Leadership Style of Project Manager on Project Success: The Mediating Role of Innovative Work Behavior

The project manager has a great responsibility to their subordinates and achieves the organizational objective and allocates resources to meet the project objective and motivate the project team by providing a vision of an ideal outcome. Project management skills are very crucial to the success of a project. Many projects have failed due to the ineffective leadership style of the project managers in such a way that insufficient planning, lack of authority, and poor communication forest the lack of transparency. This study aims to analyze the impact of democratic leadership style of a project manager on project success by analyzing the mediating role of innovative work behavior. The research strategy for this study is quantitative. 300 questionnaires were distributed to established project-based organizations to collect data. Statistical software for social science research, SPSS, and PLS, was used to analyze the data. The findings show that democratic leaders have a positive impact on project success. Innovative work behavior can help to boost project success in a complex situation within an organization.

The Application of SLAM in Life and Scientific Research

This article mainly focuses on the application of SLAM in technology and provides a literature review on the following aspects: 1) The application of SLAM in automatic parking of automobiles. This includes using AVP-SLAM for high-precision automatic parking in outdoor parking lots using convolutional neural networks, and using MOFISLM for high-precision automatic parking when indoor GPS signals are poor. 2) The application of SLAM in robotics. It includes three aspects. The first is using the GMapping algorithm to construct and locate maps with high accuracy, low computational complexity, and high robustness, enabling robots to plan the shortest path in unknown environments. The second is to use ORB-SLAM2, which can handle more complex situations, to navigate medical institution robots to improve hospital efficiency and reduce disease transmission rates. The third is for robots that perform tasks in complex and unknown terrains. The improved version of LAMP1.0, LAMP2.0, which is suitable for complex underground environments, can achieve multi robot collaborative cooperation with high accuracy and robustness. 3) Application of SLAM in the field of unmanned aerial vehicles. This article mainly elaborates on four aspects. The first is to use visual SLAM to achieve collaborative work between ground robots and drones, and to utilize the high camera advantage of drones to quickly build maps for ground robots, improve accuracy, and save time. The second is to utilize the application of VSLAM on unmanned aerial vehicles to contribute to agriculture. The third is ORB-SLAM3 to provide rapid and high-precision landing on deck for unmanned aerial vehicles in maritime missions. The fourth is using SLAM to assist unmanned aerial vehicles in landing in emergency or position situations (such, when GPS signals are lost).

РОЛЬ ЧАСТОТНО- РЕЗОНАНСНОГО АНАЛИЗА В ИССЛЕДОВАНИИ ДЕНТАЛЬНЫХ ИМПЛАНТАТОВ, УСТАНОВЛЕННЫХ В РЕКОНСТРУИРОВАННЫЕ АЛЬВЕОЛЯРНЫЕ ОТРОСТКИ С НЕБОЛЬШИМ ОБЪЕМОМ КОСТИ ЧЕЛЮСТЕЙ

The use of dental implants being the intraosseous artificial fixtures is often required for orthopedic rehabilitation of completely edentulous patients; for their placement, adequate amount of bone tissue is needed, which in many cases is insufficient due to physiological bone loss, long-term wearing of full dentures, the duration of edentulism and complex clinical situations caused by maxillofacial injuries or general somatic diseases. Implant placement in the above situations requires timely preparation of deficient alveolar ridge by means of osteoplastic surgery. In its turn, the newly formed regenerated bone by its histological, physicomechanical and structural-functional properties can only approach the recipient bone tissue; therefore, the issue of implant osseointegration and its functional loading in regenerated bone remains debatable. This research uses the method of frequency-resonance analysis showing implant stability coefficient numerically equal to the ISQ (Implant stability Quotient) values and reflecting the percentage of the osseointegration area of the intraosseous part of the implant. The results of research obtained by means of frequency-resonance analysis have proved that with the timely start of implant usage and adequate functional loading, ISQ values increase, that is, increases the osseointegration area along the interface of the intraosseous part of the implant placed in regenerated bone. Comparative results of research reflecting ISQ values in 12 months after implant placement in bone augmented using various forms of autogenous bonegrafts, have been presented; therefore, a conclusion can be made that there is a direct relationship between osseointegration under conditions of functional chewing load and the shape and size of autogenous bonegrafts.

Visuo-motor response of students living in areas of military threat

Background and Study Aim. In the modern fast-changing world, university students face a range of complex situations and challenges that require quick and accurate decision-making. In this context, the motor responses of students are crucial for successful adaptation to contemporary challenges. This is particularly important when students live in areas of military conflict. Therefore, the aim of this study is to assess the choice reaction and reaction time to visual stimuli through an online simulation test in university students. Material and Methods. The study involved students from three Ukrainian universities (physical culture faculties). A total of 86 students participated (men – n=38; women – n=48). An online simulation test was used to assess the visuo-motor reaction to visual stimuli. Information about the participants was collected through Google Form. For statistical analysis, the PyCharm CE development environment and various Python programming language libraries were used. Results. Differences in average visuo-motor reaction metrics were established among students from three universities. According to the test results, 9 men (27 clicks in 30 seconds) and 12 women (about 25 clicks in 30 seconds) were assigned to the first quartile. The best result was shown by students from university 2 (0.737 ± 0.19 ms). The best results by universities: men – university 3 (0.73 ± 0.106 ms); women – university 2 (0.785 ± 0.208 ms). It was determined that variations in time intervals between clicks decrease towards the end of the test. Conclusions. The impact of the conflict in Ukraine goes beyond direct physical threats, infiltrating the everyday existence of those in the impacted regions, encompassing college students. In such scenarios, prompt physical responses are vital for effectively adjusting to current challenges.

Психологические ресурсы личности при проживании жизненных ситуаций разной степени неопределенности

<p style="text-align: justify;"><strong>Objective.</strong> The study of the psychological resources’ specifics of persons experiencing life challenges with varying degrees of uncertainty. <br><strong>Context and relevance.</strong> Uncertainty is a fundamental characteristic of the modern world. Any life situation has a certain degree of uncertainty and contributes to the activation of psychological resources of the individual, on which the success of coping depends. <br><strong>Research Design.</strong> The paper analyzes the types of life challenges, identifies groups of people who differently assess the degree of life challenges’ uncertainty and studies the specifics of the severity of psychological resources (emotional, motivational, instrumental, sustainability resources) depending on the degree of life challenges’ uncertainty. <br><strong>Participants. </strong>The study involved 1248 people aged 18 to 76 years (31,09 <em>± </em>12,59), including 297 (23,8%) men, 175 (14,0%) persons with disabilities. <br><strong>Methods</strong>. A socio-biographic questionnaire with an open question about an actual difficult life situation (TS), which needed to be evaluated on a 10-point Likert scale: 1) the level of its complexity; 2) the intensity of the emotions accompanying it. "Subjective assessment of a difficult life situation" (E.V. Bityutskaya, A.A. Korneev); Resilience test (E.N. Osin, E.I. Rasskazova); Self-activation technique (M.A. Odintsova, N.P. Radchikova); COPE technique (E.I. Rasskazova, T.O. Gordeeva, E.N. Osin). <br><strong>Results</strong>. Seven types of challenges are experienced as life situations with varying degrees of uncertainty. Respondents more often attribute the global challenge as a very complex and complex situations of uncertainty; the challenge of loss – as a complex situations. The challenge of illness, the challenge of relationships, the challenge of material difficulties in about forty percent of cases are assessed as very difficult situations of uncertainty and about a third – as complex or simple. The challenge to self-design and the challenge of professional activity are more often assessed either as very complex situations of uncertainty, or as simple. Very complex and complex situations of uncertainty are assessed as less controllable, complex ones as the most intractable. <br><strong>Conclusions</strong>. Psychological resources in situations of varying degrees of uncertainty are emotional experiences, resilience, self-activation and various coping styles. The lower the degree of uncertainty of the life situation, the more pronounced are the resources of resilience and self-activation.</p>

Sources of resilience in adolescent female Rohingya survivors stranded in Aceh

In 2015 to 2016 when the Rohingya were stranded in Kuala Langsa Harbor, Aceh. The research was conducted when the Rohingya survivors had been living in Aceh for six months. For most people, entering puberty is not easy. Adolescence is a stormy and stressful time because it is a time of emotional turmoil and imbalance. For Rohingya adolescents who experienced this runaway tragedy, of course, the adolescent phase they went through adds color, uniqueness, difficulties, and pressures that are different from ordinary adolescents who did not go through a tragedy in their lives. These conditions make Rohingya adolescents have to survive and find their ways to get through this tragedy. This research aims to discover the sources of resilience owned by adolescent girls who are Rohingya survivors. It is known from previous research that adolescent girls are not as resilient as adolescent boys and tend to be more sensitive and stressed when facing complex and stressful situations. This study uses a qualitative method with a phenomenological approach. The subject was taken by purposive sampling and amounted to only one person who was 16 years old. Resilient sources obtained by Rohingya adolescent survivors stranded in Aceh are obtained from internal sources, namely, I Am and I Can. External sources, namely, I have external support and sources in increasing resilience that are received from social support and trades.

Comparison of nonparametric estimators of the expected number of recurrent events.

We compare the performance of nonparametric estimators for the mean number of recurrent events and provide a systematic overview for different recurrent event settings. The mean number of recurrent events is an easily interpreted marginal feature often used for treatment comparisons in clinical trials. Incomplete observations, dependencies between successive events, terminating events acting as competing risk, or gaps between at risk periods complicate the estimation. We use survival multistate models to represent different complex recurrent event situations, profiting from recent advances in nonparametric estimation for non-Markov multistate models, and explain several estimators by using multistate intensity processes, including the common Nelson-Aalen-type estimators with and without competing mortality. In addition to building on estimation of state occupation probabilities in non-Markov models, we consider a simple extension of the Nelson-Aalen estimator by allowing for dependence on the number of prior recurrent events. We pay particular attention to the assumptions required for the censoring mechanism, one issue being that some settings require the censoring process to be entirely unrelated while others allow for state-dependent or event-driven censoring. We conducted extensive simulation studies to compare the estimators in various complex situations with recurrent events. Our practical example deals with recurrent chronic obstructive pulmonary disease exacerbations in a clinical study, which will also be used to illustrate two-sample-inference using resampling.

“Nothing about us, without us”. Practical elaboration of experience experts in primary care

The health care sector sensed already for several years a shift in primary care to more complex situations and support questions. Tackling these challenges requires an integrated collaboration between health, wellbeing and social care. There was an urge to bring in a different approach of care. In order to fulfill that need Flanders was defined into 60 geographical areas in 2020: ‘The primary care zones’. Capturing local needs and working bottom-up became the foundation of the organization. The focus on goal-oriented, customized and integrated care made it possible to fill out the gap created by more complex situations.
 Representatives from health providers, welfare workers, local authorities and the person in need of care are brought together. The primary care zone promotes collaboration between these different partners. This extensive network ensures that primary care regions can as well pick up and unroll local needs as charges unrolled by the government.
 Person-centered care is the key to success of this new approach. Care and support goals from the people itself, depending on their quality of life, are the starting point. This in combination with more recognition for informal care, makes sure that socially vulnerable people are able to take control of their own life and the necessary care to sustain this. In order to realize a care policy in function of person-centered care, we need to listen to the people who live in our primary care zone. There’s continually increased attention and effort to cocreate and build our organization with socially vulnerable people. Self-determination and autonomy are ever highly valuated. As organization there’s the expectation of building bridges between professionals, but also between the professional and the client.
 The focus in the relationship between clients and professionals shifted the past years. There’s more attention for participation and democratic decision making and for the perspective of the people itself. Clients are not to be seen as passive recipients anymore. They say: ‘nothing about us, without us.’ and who are we to protest?
 In order to do so we established a group of 15 experts. From October 22 until November 23 we will meet up monthly to exchange ideas. The group has experience in different domains: informal care, chronic illnesses, poverty, addiction, psychic vulnerability, elderly care and disabilities. The experts hope to dive deeper into our participation process to show and explain to you how to co-design a care journey that responds to people’s needs. 
 Taking their experience in account, will help our board to pick up local needs and to adjust primary care to them. Focus on strength and possibilities of the people in the group are hereby necessary to accomplish our goal. Together with the group we strive to share the ownership on our plan of action We want them to have an impact on the policy and to cocreate an organization not only for them, but with them.

The extended care team for people with multimorbidity as a complex adaptive system: How to raise the adaptability of your own team.

1.Short summary: Rapid changes in healthcare structure and demands require continuous adaptability of healthcare teams. This workshop will describe a case vignette of a patient with multimorbidity to start a theoretically underpinned reflection on how teams can be supported to adapt to changing contexts.
 2.Why: Traditionally healthcare delivery has been structured based on disease-specific guidelines, procedures and teams in which effectiveness and quality of interventions is often measured by means of disease specific clinical outcome indicators defined in disease-specific randomized clinical trials. However, for people with a combination of disorders or with a complex context, outcomes are often a lot more uncertain. In addition, patients with multimorbidity are often followed by different professionals in different healthcare and welfare services, each with their own perspective and priorities. Therefore, interprofessional healthcare teams often operate in complex situations. Moreover, they tend to operate in fragmented order throughout different primary and secondary healthcare and welfare services. Complexity science has been introduced in healthcare as a theoretical framework to better understand complex situations. Interdisciplinary healthcare teams can be viewed as Complex Adaptive Systems (CAS) by focusing more on the team members' interactions than on the characteristics of individual team members. Viewing teams in this way can provide us with insights into the origins of team behavior. Insights that can be supportive to improved team functioning and improved integrated care.
 3.Audience: Clinicians, teamleaders, managers
 
 Structure (90')
 
 Introduction (10') on changes in population needs (e.g. multimorbidity) and healthcare delivery (e.g. interprofessional collaboration) including the related challenges. The need for optimizing the adaptability of clinical teams towards this changing working context will be emphasized as focus of the workshop. Theoretical background on complexity science as a lens to better understand working in VUCA (volatile, uncertain, complex, ambiguous) conditions
 Group work (30') A case vignette will be provided of a patient with multimorbidity taken care of by a multiprofessional team. Based on the case vignette participants will fill in the CAL questionnaire (Complex Adaptive Leadership Organisational Capability Questionnaire). Group discussion on the meaning of the scores will be guided by the moderators
 Theory (10')The constructs of the Questionnaire will be explained and the use of the questionnaire as a monitoring tool during team transitions will be discussed
 Group work (10') discuss/brainstorm about strategies to influence the topics defined in the different questions of the questionnaire.
 Reporting back (20') small groups will report back about the strategies they have defined for each question.
 Wrap up and key messages (10') Two minutes of repetition of the theoretical principles of complexity science in healthcare by the moderators. Group formulation of preferred strategies defined during the workshop to optimize the adaptability of clinical teams in working with complex patients
 5.How to engage
 Small group discussions – plenary discussions
 Case vignette – clinical reflection – brainstorm
 Dscussion on transferability of ideas to real world situation
 6.Take home messages?
 Partly by moderators, partly by participants
 One pager with theoretical underpinning + further reading suggestions will be provided