Mesodynamics

In social networks, an “inward gravitation” leading to a structure within which everyone is connected to one another does not occur. Instead, the network in question evolves into structural groups that are tightly connected within but with scarce ties between. An analogous situation is observed in all “complex” systems even if they are not social. We see a similar pattern in microbiological (concerning the interaction of molecular structures within the chemical system of the cell), macrobiological (regarding the interaction of species within an ecological system), and socio-economic (supply mechanisms and specialization of firms within a sector, organization of individuals in an office) systems. The factor underlying this pattern is the “specialization” of small systems through evolutionary processes. Owing to these relations, micro dynamics take place within the group while meso dynamics take place between groups. This chapter explores these groups and groupings.

Influence of Office Systems on Pediatric Vaccination Rates

This study seeks to better understand the impact of practice-level factors on up-to-date (UTD) rates in children. We compared practice-level vaccination rates for 54 practices to survey data regarding office practices for staffing, vaccine delivery, reminder-recall, and quality improvement. Vaccination rates at 24 and 35 months were analyzed using t tests, analysis of variance, and linear regression. Private practices and those using standing orders had higher UTD rates at 24 months ( P = .01; P = .03), but not at 35 months. Having a pediatrician in the office was associated with higher UTD rates at both 24 and 35 months ( P < .01). Participating in a network and taking walk-in patients were associated with lower UTD rates ( P = .03; P = .03). As the percentage of publicly insured patients decreases, the UTD rate rises at 24 and 35 months ( r = −0.43, P = .001; r = −0.037, P = .007). Reported use of reminder recall-systems, night/evening hours, and taking walk-in patients were not associated with increased UTD rates.