Developing World Users as Lead Users: A Case Study in Engineering Reverse Innovation

This paper examines the “reverse innovation” of the leveraged freedom chair (LFC), a high-performance, low-cost, off-road wheelchair originally designed for developing countries. A needs study of 71 developed world wheelchair users was conducted through three different data collection efforts. These data were contrasted with studies of 125 developing world wheelchair users, who were shown to be lead users for their developed world counterparts. The GRIT freedom chair (GFC), the developed world version of the LFC, was designed based on results of the study. By recognizing developing country users as lead users, designers can reveal latent needs and create globally disruptive innovations.Singapore University of Technology and DesignMassachusetts Institute of Technology. Department of Mechanical EngineeringRobert N. Noyce Career Development Chair at MITGlobal Research Innovation and Technology (GRIT

Research Note

Attitudes toward and Perceptions of Workplace Diversity: The Impact of Diversity Training on HR Professionals The purpose of this research note is to identify the impact of diversity training on attitudes and perceptions of HR professionals toward workplace diversity

Stakeholder-Driven Design Evolution of the Leveraged Freedom Chair Developing World Wheelchair

The Leveraged Freedom Chair (LFC) is a low-cost, all-terrain, variable mechanical advantage, lever-propelled wheelchair designed for use in developing countries. The user effectively changes gear by shifting his hands along the levers; grasping near the ends increases torque delivered to the drive-train, while grasping near the pivots enables a larger angular displacement with every stroke, which increases angular velocity in the drivetrain and makes the chair go faster. This paper chronicles the design evolution of the LFC through three user trials in East Africa, Guatemala, and India. Feedback from test subjects was used to refine the chair between trials, resulting in a device 9.1 kg (20 lbs) lighter, 8.9 cm (3.5 in) narrower, and with a center of gravity 12.7 cm (5 in) lower than the first iteration. Survey data substantiated increases in performance after successive iterations. Quantitative biomechanical performance data were also measured during the Guatemala and India trials, which showed the LFC to be 76 percent faster and 41 percent more efficient during a common daily commute and able to produce 51 percent higher peak propulsion force compared to conventional, pushrim-propelled wheelchairs

Low Raman-noise correlated photon-pair generation in a dispersion-engineered chalcogenide As2S3 planar waveguide

We demonstrate low Raman-noise correlated photon-pair generation in a dispersion-engineered 10 mm As2S3 chalcogenide waveguide at room temperature. We show a coincidence-to-accidental ratio (CAR) of 16.8, a 250 times increase compared with previously published results in a chalcogenide waveguide, with a corresponding brightness of 3×105  pairs·s−1·nm−1 generated at the chip. Dispersion engineering of our waveguide enables photon passbands to be placed in the low spontaneous Raman scattering (SpRS) window at 7.4 THz detuning from the pump. This Letter shows the potential for As2S3 chalcogenide to be used for nonlinear quantum photonic devices.This work was supported by the Centre of Excellence, Federation Fellowship, and Discovery Early Career Researcher Award (DECRA) programs of the Australian Research Council (ARC). The Centre for Ultrahigh bandwidth Devices for Optical Systems (CUDOS) is an ARC Centre of Excellence (project number CE110001018)

Quantitative assessment of barriers to the clinical development and adoption of cellular therapies:A pilot study

There has been a large increase in basic science activity in cell therapy and a growing portfolio of cell therapy trials. However, the number of industry products available for widespread clinical use does not match this magnitude of activity. We hypothesize that the paucity of engagement with the clinical community is a key contributor to the lack of commercially successful cell therapy products. To investigate this, we launched a pilot study to survey clinicians from five specialities and to determine what they believe to be the most significant barriers to cellular therapy clinical development and adoption. Our study shows that the main concerns among this group are cost-effectiveness, efficacy, reimbursement, and regulation. Addressing these concerns can best be achieved by ensuring that future clinical trials are conducted to adequately answer the questions of both regulators and the broader clinical community

Characterization of N-acetyltransferase 1 and 2 polymorphisms and haplotype analysis for inflammatory bowel disease and sporadic colorectal carcinoma

<p>Abstract</p> <p>Background</p> <p>N-acetyltransferase 1 (NAT1) and 2 (NAT2) are polymorphic isoenzymes responsible for the metabolism of numerous drugs and carcinogens. Acetylation catalyzed by NAT1 and NAT2 are important in metabolic activation of arylamines to electrophilic intermediates that initiate carcinogenesis. Inflammatory bowel diseases (IBD) consist of Crohn's disease (CD) and ulcerative colitis (UC), both are associated with increased colorectal cancer (CRC) risk. We hypothesized that <it>NAT1 </it>and/or <it>NAT2 </it>polymorphisms contribute to the increased cancer evident in IBD.</p> <p>Methods</p> <p>A case control study was performed with 729 Caucasian participants, 123 CRC, 201 CD, 167 UC, 15 IBD dysplasia/cancer and 223 controls. <it>NAT1 </it>and <it>NAT2 </it>genotyping were performed using Taqman based techniques. Eight single nucleotide polymorphisms (SNPs) were characterized for <it>NAT1 </it>and 7 SNPs for <it>NAT2</it>. Haplotype frequencies were estimated using an Expectation-Maximization (EM) method. Disease groups were compared to a control group for the frequencies at each individual SNP separately. The same groups were compared for the frequencies of <it>NAT1 </it>and <it>NAT2 </it>haplotypes and deduced NAT2 phenotypes.</p> <p>Results</p> <p>No statistically significant differences were found for any comparison. Strong linkage disequilibrium was present among both the <it>NAT1 </it>SNPs and the <it>NAT2 </it>SNPs.</p> <p>Conclusion</p> <p>This study did not demonstrate an association between <it>NAT1 </it>and <it>NAT2 </it>polymorphisms and IBD or sporadic CRC, although power calculations indicate this study had sufficient sample size to detect differences in frequency as small as 0.05 to 0.15 depending on SNP or haplotype.</p

Tai Chi for osteopenic women: design and rationale of a pragmatic randomized controlled trial

<p>Abstract</p> <p>Background</p> <p>Post-menopausal osteopenic women are at increased risk for skeletal fractures. Current osteopenia treatment guidelines include exercise, however, optimal exercise regimens for attenuating bone mineral density (BMD) loss, or for addressing other fracture-related risk factors (e.g. poor balance, decreased muscle strength) are not well-defined. Tai Chi is an increasingly popular weight bearing mind-body exercise that has been reported to positively impact BMD dynamics and improve postural control, however, current evidence is inconclusive. This study will determine the effectiveness of Tai Chi in reducing rates of bone turnover in post-menopausal osteopenic women, compared with standard care, and will preliminarily explore biomechanical processes that might inform how Tai Chi impacts BMD and associated fracture risks.</p> <p>Methods/Design</p> <p>A total of 86 post-menopausal women, aged 45-70y, T-score of the hip and/or spine -1.0 and -2.5, have been recruited from primary care clinics of a large healthcare system based in Boston. They have been randomized to a group-based 9-month Tai Chi program plus standard care or to standard care only. A unique aspect of this trial is its pragmatic design, which allows participants randomized to Tai Chi to choose from a pre-screened list of community-based Tai Chi programs. Interviewers masked to participants' treatment group assess outcomes at baseline and 3 and 9 months after randomization. Primary outcomes are serum markers of bone resorption (C-terminal cross linking telopeptide of type I collagen), bone formation (osteocalcin), and BMD of the lumbar spine and proximal femur (dual-energy X-ray absorptiometry). Secondary outcomes include health-related quality-of-life, exercise behavior, and psychological well-being. In addition, kinetic and kinematic characterization of gait, standing, and rising from a chair are assessed in subset of participants (n = 16) to explore the feasibility of modeling skeletal mechanical loads and postural control as mediators of fracture risk.</p> <p>Discussion</p> <p>Results of this study will provide preliminary evidence regarding the value of Tai Chi as an intervention for decreasing fracture risk in osteopenic women. They will also inform the feasibility, value and potential limitations related to the use of pragmatic designs for the study of Tai Chi and related mind-body exercise. If the results are positive, this will help focus future, more in-depth, research on the most promising potential mechanisms of action identified by this study.</p> <p>Trial registration</p> <p>This trial is registered in Clinical Trials.gov, with the ID number of NCT01039012.</p

Diagnostic accuracy of a clinical diagnosis of idiopathic pulmonary fibrosis: An international case-cohort study

We conducted an international study of idiopathic pulmonary fibrosis (IPF) diagnosis among a large group of physicians and compared their diagnostic performance to a panel of IPF experts. A total of 1141 respiratory physicians and 34 IPF experts participated. Participants evaluated 60 cases of interstitial lung disease (ILD) without interdisciplinary consultation. Diagnostic agreement was measured using the weighted kappa coefficient (\u3baw). Prognostic discrimination between IPF and other ILDs was used to validate diagnostic accuracy for first-choice diagnoses of IPF and were compared using the Cindex. A total of 404 physicians completed the study. Agreement for IPF diagnosis was higher among expert physicians (\u3baw=0.65, IQR 0.53-0.72, p20 years of experience (C-index=0.72, IQR 0.0-0.73, p=0.229) and non-university hospital physicians with more than 20 years of experience, attending weekly MDT meetings (C-index=0.72, IQR 0.70-0.72, p=0.052), did not differ significantly (p=0.229 and p=0.052 respectively) from the expert panel (C-index=0.74 IQR 0.72-0.75). Experienced respiratory physicians at university-based institutions diagnose IPF with similar prognostic accuracy to IPF experts. Regular MDT meeting attendance improves the prognostic accuracy of experienced non-university practitioners to levels achieved by IPF experts