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Table 2 Key term and measure definitions in relation to this network

From: Primary health care case management through the lens of complexity: an exploratory study of naturopathic practice using complexity science principles

Term

Definition

Information this provides about the node or network

Significance in this network

Example or value in this network

Foundational

 Node

An element of a network

Identifies different components within a system

Identifies a pertinent aspect of a case presentation as determined by one or more participants

Obesity

 Link

A association (direction specific) between any pair of nodes

Identifies relationships of influence within a system

Identifies a connection between two nodes that is considered relevant to the case presentation determined by one or more of participants

Alcohol intake to Liver

 Path

A series of links connecting any pair or group of nodes

Identifies a sequence of connections between two or more elements

Identifies a sequence of relationships between two or more nodes as determined by one or more participants

Increased cortisol to sympathetic nervous system activation to social anxiety to excessive sweating

 Cluster or Community

A substructure or clique of nodes that are more closely connected to each other compared with nodes outside the subgroup

Identifies well connected cliques within the network, revealing underlying network structure

Establishes the node subgroups as identified by the participants

Green cluster (nervous system, flat mood / depression, fatigue, low motivation, antidepressant medication, headaches, low serotonin)

Node level measures

 Degree

The number of links (in or out) that a node has

Identifies nodes deemed most connected with other nodes

Establishes the nodes the practitioners deemed most interactive within the network

High degree: diet, Low degree: loose stools

 Average degree

The average number of links across all nodes

Establishes the average number of links across the nodes

Provides a mid-point from which the number of links each node has can be compared against

Average = 3.05 (with variation between one and 36)

 Distance

The number of links on the shortest path between two nodes

Detects the minimum number of steps influence needs to travel

Establishes the intermediate steps for influence to spread between two nodes, as identified by the participants

Indoor job to compromised vitamin D status to flat mood / depression to

OR alcohol intake to liver to reduced fat metabolism to oxidative stress

 Betweenness centrality

How often a node appears on the shortest path between other pairs of nodes

Measures the number of paths that pass through a particular node

Demonstrates the value of each nodes in terms of its potential to interact with others as determined by the participants

Dysbiosis is on the shortest path between:

diet & bloating with cramping; gas production & gut fermentation; toxin recycling & halitsosis

Flat mood = 2880

Obesity = 2348

Dysbiosis = 2080

Systemic inflammation = 1648

Liver = 1248

 Clustering co-efficient

The number of links a node has divided by the total number of possible links. The highest possible value is 1 (where a node is linked to all other node)

Along with the mean shortest path, the clustering co-efficient can indicate a ‘small-world’ effect, and signifies how embedded nodes are within their neighbourhood

Denotes the extent to which nodes are linked within the network

Average clustering co-efficient = 0.114

 Eigenvector centrality

Measures the value of each nodes, based on the number of links it has, and the number of links the nodes it connected to has, and so on across the network

A measure of the influence of an element within the network

Denotes the extent to which well-linked nodes are connected to other well-linked nodes

Liver (0.39), hypertension (0.41), systemic inflammation (0.48), dysbiosis (0.60), obesity (0.68), and flat mood / depression (1)

Network level measures

 Diameter

The shortest pathway between the two most distant nodes

Provides a measure of the parameters of the network

A measure of how tightly the nodes in the network are linked, as identified by the participants

Diameter = 9

 Average path length

The average of the shortest path between all pairs of nodes

The average minimum number of links between all pairs of nodes

Indication of the ease with which change can move across the system

Average path length = 3.71

 Average clustering co-efficient

The average of the clustering co-efficient for all nodes

Averaged across all nodes, the proportion of nodes with a direct link to each node, divided by the total number of nodes identified in the network

A measure of how connected the network is

Average clustering co-efficient = 0.114

 Modularity

A measure of the extent the network decomposes into subgroups or cliques

Reveals underlying layers of structure within the network

Within communities denser interactional possibilities exist, plus reveals potential sub-structures as identified by the participants

6 communities detected with between 12 to 33 elements each

Modularity score = 0.40