Innovation Systems, Innovation Ecologies: Innovation Policy and The World of Restless Capitalism

Our purpose in this paper is to provide a different perspective on the by now widely discussed idea of innovation systems. This perspective is designed to cohere with the problems faced by innovation policy makers as they seek to pursue the challenge of creating wealth from knowledge and to reflect the salient aspects of a modern capitalist economy. Two main themes, are at the centre of our approach, the nature of the connection between wealth and knowledge in capitalism and, secondly, the nature of innovation policy making. A systems perspective allows a distinction to be made between ‘innovation ecologies’ on which much of our discussion now depends. Included in innovation ecologies are the primary organisations such as universities and firms that generate and store knowledge as well as those intermediary organisations that serve as brokers between the primary agencies. Innovation systems are parts of the ecology that are connected and focused upon the solution of particular innovation problems. They are constructed for this purpose and depend upon various mechanisms to ensure the necessary connectivity and flows of information between the constituent members. The general thrust of this paper is to propose that an innovation systems policy is the proper domain of attempts to enhance the rate of innovation. We argue in terms of a double policy domain, on the one hand, concerned with the availability of the components of innovation systems and, on the other hand, with the potential for their self assembly into localized innovation systems that are focused on emerging problem sequences. The evolutionary economic approach to innovative competition, embedded in co evolving instituted frames of market and non-market arrangements provides the necessary understanding that innovation policy makers require to deal with restless capitalism and the ignorance economy

Limited visibility and uptake of the clopidogrel pharmacogenomic guidelines among cardiologists

Abstract Background Clopidogrel is an antiplatelet agent widely utilised in the treatment of acute coronary syndromes and following coronary interventions. Clopidogrel is a prodrug activated in the liver, mostly by cytochrome P450 2C19 that is encoded by a gene (CYP2C19). Variability in CYPC2C19 affects enzymatic activity and leads to variability in the activation and efficacy of clopidogrel. In 2011, the Clinical Pharmacogenetics Implementation Consortium (CPIC) produced the first set of detailed guidelines on the use of genetic testing to guide the clinical utilization of clopidogrel. Updates on these guidelines were published in 2013 and 2022. However, pre-prescription genetic testing is seldom performed. Purpose To establish whether these pharmacogenomics guidelines have visibility within the cardiovascular (CVD)community and have been incorporated into CVD guidelines. Methods (i) We examine the impact of the CPIC Clopidogrel guidelines released in 2013 and 2022 by looking at the citation patterns in CVD journals indexed in PubMed. (ii) We reviewed the guidelines released by the European Society of Cardiology and the American College of Cardiology on the management of coronary interventions and coronary artery disease over the last 15 years to establish whether CPIC guidelines are making any impact on practice. Results The CPIC 2022 guidelines were cited by 88 articles (49 journals) of which 13 citations (14.7%) appear in CVD journals. None of these citations are in the five major journals in which CVD guideline statements are most frequently published (Nature Review Cardiology, European Heart Journal, Circulation, Journal of the American College of Cardiology, and Journal of the American Medical Association - Cardiology). The 2013 guideline received 366 citations (183 PubMed journals). Of these, 47 were in cardiology journals (12.8%), but only 4 citations were in one of the same five major cardiology journals (2 in Nature Review Cardiology, 1 in Circulation and 1 in JAMA Cardiology). Of the 14 guidelines published by the ESC and ACC over the last 14 years, none cited the CPIC clopidogrel guidelines. Only 6 out of the 14 guidelines mentioned that the efficacy of clopidogrel was modulated by genetic factors but none of them included details or practical implications. Conclusion(s) Whilst sufficient time has not yet elapsed for the 2022 CPIC guidelines to have an impact on the specialist literature, the 2013 guidelines have had limited visibility within the CVD community. Undoubtedly, given the potential contribution of PGx, discussions on its uptakes are ongoing thus far, without resolution. Some considerations of clopidogrel genetics are diffusing into the specialty; however, from the citation evidence, it appears that CPIC clopidogrel guidelines of any vintage have had limited impact in terms of adoption and/or endorsement by cardiologists. </jats:sec

A systematic review of floating and beach landing records of Sargassum beyond the Sargasso Sea

Sargassum algal blooms on ocean surfaces and landings of huge Sargassum mats on beaches is an emerging global environmental challenge with wide socio-economic and environmental implications. Literature on Sargassum growth cycles, travel patterns, species and morphotypes, and quantified impacts have tended to focus on a geographic region, or a specific event. Few, if any, publications document long term continuous monitoring of Sargassum blooms in large areas such as the Pacific, or the tropical Atlantic. To address this gap, this paper systematically reviews the global evidence of Sargassum bloom monitoring beyond the Sargasso Sea, and identifies gaps in the evidence base of floating and landing influxes. This systematic review uses combinations of two key terms relating to Sargassum and monitoring, and utilises the resources in ISI Web of Knowledge, Scopus and Google Scholar. The analysis moves us past a classic literature review, and produces an unbiased assessment of empirical research on Sargassum monitoring from 1960 to 2019. We find a significant research focus on open-ocean blooms and floating mats whereas research on beach landings and their associated impacts is comparatively limited. Research is focused within specific countries or water bodies (notably, the Gulf of Mexico, the Caribbean and North Atlantic Ocean) and tends not to comprehensively assess neighbouring or regional shorelines, for example, West Africa and Central America. There was a lack of consistency in the application of methods for quantifying Sargassum biomass volume (including dry/wet weight, unit of measurement, and spatial extent of calculations). Further, in many publications Sargassum species identification was omitted. Given current attempts to understand the drivers and impacts of the exponential growth in Sargassum in some parts of the world, a consistent and replicable research approach to monitoring Sargassum could support creation of a Sargassum evidence database. To move this agenda forwards, we propose a definition for a Sargassum 'event': a continuous bloom of any Sargassum in open oceans, or, an aggregation of landed Sargassum, with the potential to disrupt social, economic or ecosystem functioning, or to impact human health. This review highlights the importance of standardising Sargassum monitoring methods to facilitate improved documentation of temporal and spatial patterns of Sargassum blooms and beach landings

Evaluation of prognostic risk models for postoperative pulmonary complications in adult patients undergoing major abdominal surgery: a systematic review and international external validation cohort study

Background Stratifying risk of postoperative pulmonary complications after major abdominal surgery allows clinicians to modify risk through targeted interventions and enhanced monitoring. In this study, we aimed to identify and validate prognostic models against a new consensus definition of postoperative pulmonary complications. Methods We did a systematic review and international external validation cohort study. The systematic review was done in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We searched MEDLINE and Embase on March 1, 2020, for articles published in English that reported on risk prediction models for postoperative pulmonary complications following abdominal surgery. External validation of existing models was done within a prospective international cohort study of adult patients (≥18 years) undergoing major abdominal surgery. Data were collected between Jan 1, 2019, and April 30, 2019, in the UK, Ireland, and Australia. Discriminative ability and prognostic accuracy summary statistics were compared between models for the 30-day postoperative pulmonary complication rate as defined by the Standardised Endpoints in Perioperative Medicine Core Outcome Measures in Perioperative and Anaesthetic Care (StEP-COMPAC). Model performance was compared using the area under the receiver operating characteristic curve (AUROCC). Findings In total, we identified 2903 records from our literature search; of which, 2514 (86·6%) unique records were screened, 121 (4·8%) of 2514 full texts were assessed for eligibility, and 29 unique prognostic models were identified. Nine (31·0%) of 29 models had score development reported only, 19 (65·5%) had undergone internal validation, and only four (13·8%) had been externally validated. Data to validate six eligible models were collected in the international external validation cohort study. Data from 11 591 patients were available, with an overall postoperative pulmonary complication rate of 7·8% (n=903). None of the six models showed good discrimination (defined as AUROCC ≥0·70) for identifying postoperative pulmonary complications, with the Assess Respiratory Risk in Surgical Patients in Catalonia score showing the best discrimination (AUROCC 0·700 [95% CI 0·683–0·717]). Interpretation In the pre-COVID-19 pandemic data, variability in the risk of pulmonary complications (StEP-COMPAC definition) following major abdominal surgery was poorly described by existing prognostication tools. To improve surgical safety during the COVID-19 pandemic recovery and beyond, novel risk stratification tools are required. Funding British Journal of Surgery Society

Dynamics of collaborative research in medicine: the case of glaucoma

This paper inquires into the organizational and spatial dynamics of scientific research by focussing on the evolution of epistemic networks in a specific area of medical practice, glaucoma. As researchers and practitioners struggle to come to grips with this elusive disease, the medical scientific community exhibits a great degree of variety in the ecology of organisations and the associated scientific pathways. Data on scientific publications over a thirty-year period affords a clearer understanding of the changing configurations of a clinical-scientific community, and speaks to the adaptive nature of problem-solving in medicine. © 2013 Springer Science+Business Media New York.DC acknowledges financial support from the European Community (FP7-PEOPLE-IEF-2008-235278).Peer Reviewe