Static Future Technologies, Dynamic Professionalism : Co-creating Future Scenarios in Medical Imaging Practices

New magnetic resonance imaging (MRI) techniques that offer faster scanning and potential artificial intelligence-assisted interpretation and diagnosis can significantly impact existing workflows in radiology. In a qualitative study embedded within a responsible research and innovation design, we investigate the development and potential implementation of quantitative MRI. We aim to investigate postdigital MRI futures, covered by scenarios of potential workflows, as well as the resulting implications for professions and related education involved in the MRI process. Furthermore, we examine the related and changing responsibilities, more specifically reflecting on ‘forward-looking responsibilities’. Through expert interviews (n = 20) and a focus group, stakeholder perspectives on the future of quantitative imaging techniques were explored. During a subsequent co-creation workshop and another focus group, stakeholders reflected on future scenarios in quantitative MRI. Our study shows that a proactive and future-oriented investigation of the influence of emerging technologies on potential workflows and subsequent changes in expertise and roles help in gaining or increasing awareness about the wider impact of a technology developed to contribute to faster and quantitative MRI exams. We argue that anticipating postdigital worlds by reflecting on future responsibilities through the co-creation of imaginaries can help making uncertain futures tangible in other ways

Artificial intelligence-assisted decision-making in long-term care: a qualitative study on opportunities and prerequisites for responsible innovation (Preprint)

Background: While use of artificial intelligence (AI)-based technologies such as decision-support systems (AI-DSSs) could help sustaining and improving the quality and efficiency of care, their deployment also creates ethical and social challenges. In recent years, there has been a growing prevalence of high-level guidelines and frameworks to provide guidance on responsible AI innovation. However, few studies specify how AI-based technologies such as AI-DSSs can be responsibly embedded in specific contexts such as the nursing process in the long-term care (LTC) for older adults. Objective: Opportunities and prerequisites for responsible AI-assisted decision-making in the nursing process were explored from the perspectives of nurses and other professional stakeholders in LTC. Methods: Semi-structured interviews were conducted with 24 care professionals in Dutch LTC, including nurses, care coordinators, data specialists and care centralists. Two imaginary scenarios about the future use of AI-DSSs were developed beforehand and used to enable participants to articulate their expectations regarding the opportunities and risks of AI-assisted decision-making. After first openly discussing opportunities and possible risks associated with both scenarios, six high-level principles for responsible AI were used as probing themes to evoke further consideration on risks of using AI-DSSs in LTC. Further, participants were asked to brainstorm about possible strategies and actions in the design, implementation and use of AI-DSSs to address or mitigate the mentioned risks. A thematic analysis was carried out to identify opportunities and prerequisites for responsible innovation in this area. Results: Professionals’ stance towards the use of AI-DSSs is not a matter of purely positive or negative expectations, but rather a nuanced interplay of positive and negative elements that lead to a weighed perception of opportunities and prerequisites for responsible AI-assisted decision-making. Both opportunities and risks were identified in relation to early identification of care needs, guidance in devising care strategies, shared decision-making, and caregivers’ workload and work experience. To optimally balance opportunities and risks of AI-assisted decision-making, seven categories of prerequisites for responsible AI-assisted decision-making in the nursing process were identified: (1) regular deliberation on data collection, (2) a balanced proactive nature of AI-DSSs, (3) incremental advancements aligned with trust and experience, (4) customization for all user groups including clients and caregivers, (5) measures to counteract bias and narrow perspectives, (6) human-centric learning loops, and (7) routinization of using AI-DSSs. Conclusions: Opportunities of AI-assisted decision-making in the nursing process could turn into drawbacks, depending on the specific shaping of the design and the deployment of AI-DSSs. Therefore, we recommend viewing the responsible use of AI-DSSs as a balancing act. Moreover, given the interrelatedness of the identified prerequisites, we call for various actors, including developers and users of AI-DSSs, to cohesively address different factors important to the responsible embedding of AI-DSSs in practice

The impact of anti-malarial markets on artemisinin resistance: perspectives from Burkina Faso

Background: Widespread artemisinin resistance in Africa could be catastrophic when drawing parallels with the failure of chloroquine in the 1970s and 1980s. This article explores the role of anti-malarial market characteristics in the emergence and spread of arteminisin resistance in African countries, drawing on perspectives from Burkina Faso. Methods: Data were collected through in-depth interviews and focus group discussions. A representative sample of national policy makers, regulators, public and private sector wholesalers, retailers, clinicians, nurses, and community members were purposively sampled. Additional information was also sought via review of policy publications and grey literature on anti-malarial policies and deployment practices in Burkina Faso. Results: Thirty seven in-depth interviews and 6 focus group discussions were conducted. The study reveals that the current operational mode of anti-malarial drug markets in Burkina Faso promotes arteminisin resistance emergence and spread. The factors are mainly related to the artemisinin-based combination therapy (ACT) supply chain, to ACT quality, ACT prescription monitoring and to ACT access and misuse by patients. Conclusion: Study findings highlight the urgent requirement to reform current characteristics of the anti-malarial drug market in order to delay the emergence and spread of artemisinin resistance in Burkina Faso. Four recommendations for public policy emerged during data analysis: (1) Address the suboptimal prescription of anti-malarial drugs, (2) Apply laws that prohibit the sale of anti-malarials without prescription, (3) Restrict the availability of street drugs, (4) Sensitize the population on the value of compliance regarding correct acquisition and intake of anti-malarials. Funding systems for anti-malarial drugs in terms of availability and accessibility must also be stabilized

The impact of patient advocacy: the case of innovative breast cancer drug reimbursement

Current research into patient advocacy focuses on attempts of patient groups to mobilise resources and to influence researchers, pharmaceutical companies and policy-makers. This paper adopts a ‘framing political opportunities’ approach to draw attention to other kinds of advocacy strategies. In a case study of breast cancer patient advocacy of Herceptin reimbursement, it is shown how patient groups tried to gain access to policy-making by means of three different opportunity-framing strategies. Articulation aims at creating awareness through public-agenda building. Negotiation aims at frame alignment between interdependent stakeholders by arranging meetings. Politicisation is a strategy to influence the agendas of political arenas. Patient organisations succeeded in creating awareness and support, which had a considerable impact on other stakeholders. These impacts in turn aided the politicisation of the issue. However, the final impact on reimbursement procedures was only partially achieved due to depoliticising counterstrategies based on persistent ideas buttressing a particular division of responsibilities in the organisation of healthcare. According to these ideas cost control in healthcare is a medical responsibility, not a political one

Collective institutional work : the case of Airbnb in Amsterdam, London and New York

Given that online platforms disrupt established industries and challenge existing institutions, they can only be successful if their innovation becomes both legal and legitimate. This requires ‘institutional work’ that changes perceptions and regulations within society. Rather than only focussing on the online platform as the sole agent engaging in institutional work, our study analyses institutional work as a collective process. We investigate the case of home-sharing platform Airbnb and the process of institutional change its introduction prompted regarding short-term rental in Amsterdam, London and New York. We find, contrary to the popular view of online platforms as disruptive entrepreneurs, that the platform mainly focusses on creating new institutions rather than disrupting existing ones, and that users and non-users undertake most of the institutional work activities. We also show that different types of actors carry out different types of institutional work suggesting that the process of institutional work is highly distributed

Knowledge co-production in protective spaces : case studies of two climate adaptation projects

Knowledge co-production, a mode of research including contributions both from academic and non-academic actors, is a promising approach for climate adaptation research in order to produce knowledge that supports the development of local and regional adaptation policies. However, such a local and practical focus may be ill-aligned with the global ambitions of academic participants. The differences between performance criteria of academic and non-academic partners make knowledge co-production unlikely to emerge and survive without protection. This paper aims to understand how different participants in knowledge co-production for climate adaptation can be protected from the norms, values, and performance criteria of their own respective organizations and communities. We found that combinations of shielding (moderating pressures from the selection environment), nurturing (supporting knowledge development), and empowerment (increasing influence over the contexts) activities lead to more successful knowledge co-production. Moreover, our analysis shows that there is no silver bullet for the protection of knowledge co-production. An effective protection strategy should be tailored to the research problem and the social network of a given program

Conceptualizing market formation for transformative policy

Transitions are hardly conceivable without understanding how new markets are formed. However, there is still an incipient conceptualization of market formation in the context of transformation and transformative policy. Drawing on existing perspectives of market formation in economics of innovation, sociology of markets and marketing studies literature, this paper develops a framework for characterizing, differentiating and analyzing new market formation processes. We use three case studies to demonstrate how the framework is able to capture the dynamic and interconnected nature of market formation. The market formation framework serves to diagnose potential misalignments, bottlenecks and failures, to identify entry points for policy to intervene in market formation and support transformative innovation

Innovation pathways in additive manufacturing: Methods for tracing emerging and branching paths from rapid prototyping to alternative applications

In recent years, the Forecasting Innovation Pathway approach (FIP) has shown to be a promising set of tools to capture potential developments in emerging fields through capturing indications of endogenous futures. However, the FIP approach is reliant on a clear demarcated area to study, a challenge for emerging technology fields where uncertainty and rhetoric abound. This paper presents an addition to the FIP toolbox that helps characterise and demarcate boundaries of emerging fields to allow for deeper analysis through other FIP methods. We illustrate this approach through an exercise for 3D printing technology (also known as Additive Manufacturing). We show that 3D printing can be represented by a dominant design: a tri-partite configuration of printer, material and digital design software. In the past decade we have seen significant branching from applications in rapid-prototyping to medical, fashion, aeronautics and supply chain management with a variety of elements coming together in tri-partite configurations. The paper adds to the current FTA literature an approach building on evolutionary theories of technical change to help with such situations – emerging, evolving and branching ‘innovation pathways’. Moreover, we developed a methodology to construct these innovation paths

The study of institutional entrepreneurship and its implications for transition studies

Innovations accompanying transitions often prompt institutional change if they do not match with existing institutions. Transition studies started to incorporate institutional dynamics into their research, but efforts hitherto remain underdeveloped. In this paper, we systematically review the institutional entrepreneurship literature. Based on a reading of 153 empirical cases, we identify trends and biases in the literature and we distil a number of insights for transition studies to engage with

Market formation in the context of transitions : a comment on the transitions agenda

Transition studies has recently underscored the need to focus on upscaling and diffusion of innovations. A key question is how these innovations, already existing in niche markets, can become diffused and embedded in broader markets. As a first step, we offer ideas about the design and formation of what one might call ‘markets for transitions’. We argue that less attention has been paid to legitimized perceptions of market boundaries, the roles of actors, the interplay between markets, and the process character of market formation