The role of the marginalized and unusual suspects in the production of digital innovations: Models of innovation in an African context

The rapid proliferation of innovation concepts addressing experiences in the Global South raises crucial questions about the relevance of this phenomenon for development. In an effort to bring conceptual clarity, this paper reviews several related understandings of innovation and related approaches to, firstly, map overlaps and differences, and secondly, understand how they are situated within the development discourse. This study uses a literature review and applies thematic analysis in identifying the various innovation concepts, and the extent to which they include the marginalized in their framing and operationalization. In particular, this study evaluates whether these innovation concepts are framing innovation as something developed outside of poor communities but on behalf of them, whether innovation is designed alongside poor communities, or whether it is designed by and within poor communities. The findings of this study revealed that in most cases, these concepts are pro-poor, with very few exceptions of innovations done in collaboration with the poor, in a per-poor process

Search for the standard model Higgs boson in the decay channel H to ZZ to 4 leptons in pp collisions at sqrt(s) = 7 TeV

A search for a Higgs boson in the four-lepton decay channel H to ZZ, with each Z boson decaying to an electron or muon pair, is reported. The search covers Higgs boson mass hypotheses in the range 110 < mH < 600 GeV. The analysis uses data corresponding to an integrated luminosity of 4.7 inverse femtobarns recorded by the CMS detector in pp collisions at sqrt(s) = 7 TeV from the LHC. Seventy-two events are observed with four-lepton invariant mass m[4 leptons] > 100 GeV (with thirteen below 160 GeV), while 67.1 +/- 6.0 (9.5 +/-1.3) events are expected from background. The four-lepton mass distribution is consistent with the expectation of standard model background production of ZZ pairs. Upper limits at 95% confidence level exclude the standard model Higgs boson in the ranges 134-158 GeV, 180-305 GeV, and 340 -465 GeV. Small excesses of events are observed around masses of 119, 126, and 320 GeV, making the observed limits weaker than expected in the absence of a signal.Comment: Submitted to Physical Review Letter

Impact of primary kidney disease on the effects of empagliflozin in patients with chronic kidney disease: secondary analyses of the EMPA-KIDNEY trial

Background: The EMPA KIDNEY trial showed that empagliflozin reduced the risk of the primary composite outcome of kidney disease progression or cardiovascular death in patients with chronic kidney disease mainly through slowing progression. We aimed to assess how effects of empagliflozin might differ by primary kidney disease across its broad population. Methods: EMPA-KIDNEY, a randomised, controlled, phase 3 trial, was conducted at 241 centres in eight countries (Canada, China, Germany, Italy, Japan, Malaysia, the UK, and the USA). Patients were eligible if their estimated glomerular filtration rate (eGFR) was 20 to less than 45 mL/min per 1·73 m2, or 45 to less than 90 mL/min per 1·73 m2 with a urinary albumin-to-creatinine ratio (uACR) of 200 mg/g or higher at screening. They were randomly assigned (1:1) to 10 mg oral empagliflozin once daily or matching placebo. Effects on kidney disease progression (defined as a sustained ≥40% eGFR decline from randomisation, end-stage kidney disease, a sustained eGFR below 10 mL/min per 1·73 m2, or death from kidney failure) were assessed using prespecified Cox models, and eGFR slope analyses used shared parameter models. Subgroup comparisons were performed by including relevant interaction terms in models. EMPA-KIDNEY is registered with ClinicalTrials.gov, NCT03594110. Findings: Between May 15, 2019, and April 16, 2021, 6609 participants were randomly assigned and followed up for a median of 2·0 years (IQR 1·5–2·4). Prespecified subgroupings by primary kidney disease included 2057 (31·1%) participants with diabetic kidney disease, 1669 (25·3%) with glomerular disease, 1445 (21·9%) with hypertensive or renovascular disease, and 1438 (21·8%) with other or unknown causes. Kidney disease progression occurred in 384 (11·6%) of 3304 patients in the empagliflozin group and 504 (15·2%) of 3305 patients in the placebo group (hazard ratio 0·71 [95% CI 0·62–0·81]), with no evidence that the relative effect size varied significantly by primary kidney disease (pheterogeneity=0·62). The between-group difference in chronic eGFR slopes (ie, from 2 months to final follow-up) was 1·37 mL/min per 1·73 m2 per year (95% CI 1·16–1·59), representing a 50% (42–58) reduction in the rate of chronic eGFR decline. This relative effect of empagliflozin on chronic eGFR slope was similar in analyses by different primary kidney diseases, including in explorations by type of glomerular disease and diabetes (p values for heterogeneity all &gt;0·1). Interpretation: In a broad range of patients with chronic kidney disease at risk of progression, including a wide range of non-diabetic causes of chronic kidney disease, empagliflozin reduced risk of kidney disease progression. Relative effect sizes were broadly similar irrespective of the cause of primary kidney disease, suggesting that SGLT2 inhibitors should be part of a standard of care to minimise risk of kidney failure in chronic kidney disease. Funding: Boehringer Ingelheim, Eli Lilly, and UK Medical Research Council

Severity of Baseline Alcohol Use as a Moderator of Brief Interventions in the Emergency Department

Aims: This study examines whether the severity of baseline alcohol consumption/consequences moderates the effect of an alcohol brief intervention (BI) in the emergency department (ED). Methods: Injured patients (N = 494) were recruited from an ED, randomly assigned to receive brief advice or not and completed a 12-month follow-up interview. Results: A significant interaction was found between severity of baseline alcohol consumption (i.e. average weekly, binge drinking) and receipt of a BI on alcohol consumption at 12 months. The form of this interaction indicates that the BI group tended to report lower alcohol consumption at follow-up than the untreated group especially in those who had reported high baseline consumption. Severity of alcohol consequences at baseline did not significantly impact the effect of the BI on 12-month outcomes. Conclusion: ED patients with higher alcohol consumption benefit from BI. In some cases, the BI's effects may be enhanced for patients who are heavier drinkers, perhaps due to a greater opportunity to develop a discrepancy between current behavior and future goals