Design for emergence – Enabling stakeholder liminal transitions and innovation value pivoting through complex systemic transformations

How might we emerge sustainable innovation value within complex systemic transformations? Researchers observe that “innovation occurs through the combination and recombination of information and knowledge that are old and new” where “innovation is thus an emergent process” (Cooke, 2013). However, emerging innovation in a sustainable manner – whether within markets, communities or organizations – is increasingly viewed as being related to the processes of learning (Harkema, 2003) within complex–adaptive systems (Carlisle & McMillan, 2006), collaboration within multi–stakeholder environments (Sørensen & Torfing, 2011), and value co–creation (Romero & Molina, 2011). And yet, the innovation initiatives entrusted with emerging sustainable innovation value frequently experience challenges in cross–industry settings – including lack of adoption by the key stakeholders in the natural resource management practices (Shiferaw, Okello, & Reddy, 2009), healthcare organizations (Cresswell & Sheikh, 2013), and policy environments (Douthwaite, Keatinge, & Park, 2001). Innovation is posited to be further complexified by the team climate and performance (González-Romá, Fortes-Ferreira, & Peiró, 2009), and the multi– dimensional aspects of enabling adoption (Pichlak, 2016). To respond to the outlined concerns around the feasibility of emerging new value through innovation processes, we introduce Design for Emergence – a practical, applied design methodology intended for multidisciplinary teams and practitioners – to enable flourishing futures and increased resilience across systemic scales (Bergström & Dekker, 2014), human psychosocial contexts (Matin & Taylor, 2015) and social support systems (Sippel et al., 2015; Almedom, 2015). We introduce tools and methods for building social coherence (Antonovsky, 1987; Keyes 1998) across systemic scales and levels of analysis (Marr, 1982), with the goal of easing the stressors within ‘liminal spaces’ (Van Gennep, 1906; Turner, 1987) to impact desirable future outcomes and enable individual and organizational transformational journeys. The Design for Emergence is positioned as a meta–design modality comprised of three core components: 1) Design for Adoption, 2) Design for Resilience, and 3) Design for Transience. Each component is a general purpose meta–design modality with specific canvasses, intended to simplify practical use of theoretical concepts within diverse, complex innovation environments requiring multi–stakeholder collaboration and delivery of broad cross–scale impacts. Recognizing that the intrinsic and continued participation of key stakeholders is essential for the success of innovation initiatives, as exemplified in co–innovation (Lee, Olson, & Trimi, 2012), the Design for Adoption eases this process by leveraging motivational theory to support both initial and ongoing stakeholder engagements (Pink, 2009). To maintain energy throughout the implementation phase of an innovation initiative, the Design for Resilience leverages methods for managing liminal journeys (Van Gennep, 1906; Turner, 1987), and uses the ‘Sense of Coherence’ (SoC) mechanism (Antonovsky, 1987; Keyes 1998) to enhance resilience of the communities, organizations and stakeholders involved. As an innovation initiative nears completion, researchers observe that a change in the underlying value perceptions acts as a stressor (Cullen, Edwards, Casper, & Gue, 2014). To re–imagine the value propositions within the enclosing ecosystem and re–orient stakeholder value–perceptions, the Design for Transience maps how value perceptions change through the levels of analysis (Marr & Poggio, 1982), and leverages the ‘three horizons’ foresight method (Curry & Hodgson, 2008) for exploring the evolution of value perceptions from the experienced present to a perceived future. A key objective is to be able to leverage practical tools to pivot value perceptions within market changes and complex ecosystemic transformations – to articulate value–propositions that enhance collaborative potential and create alignment with the key stakeholders, customers and communities in a way capable of enabling emergent innovation

Collaboration for Complexity – Team Competencies for Engaging Complex Social Challenges

This Major Research Paper (MRP) thesis paper explores the notions of collaboration within the context of complex societal issues – that exist at the intersection of the so–called ‘wicked problems’, ‘problematiques’, ‘social messes’, ‘super–wicked problems’ and the more recently postulated, ‘post–modern complexity’. The argument put forward is that these categories of issue complexity belong to a larger unified typology, termed 'complex social challenges' – one characterized by specific cognitive, contextual and cooperative ambiguities. Experiences of the key stakeholders are considered from the liminal, salutogenic and sense-of-coherence perspectives, in order to improve both the ecosystemic sustainability and the stakeholder resilience through the enacted collaborative processes. A specific type of collaboration is proposed for effectively engaging complex challenges, posited as a 'collaboration for complexity' – that calls for specific team competencies and a particular kind of team, entitled the 'complexity–oriented team' (COT). An example use-case of a stakeholder population in the midst of a real–life complex social challenge in investigated

Proteomic analysis of morphologically changed tissues after prolonged dexamethasone treatment

Prolonged dexamethasone (Dex) administration leads to serious adverse and decrease brain and heart size, muscular atrophy, hemorrhagic liver, and presence of kidney cysts. Herein, we used an untargeted proteomic approach using liquid chromatography-tandem mass spectrometry (LC-MS/MS) for simultaneous identification of changes in proteomes of the major organs in Sprague-Dawley (SD rats post Dex treatment. The comparative and quantitative proteomic analysis of the brain, heart, muscle, liver, and kidney tissues revealed differential expression of proteins (n = 190, 193, 39, 230, and 53, respectively) between Dex-treated and control rats. Functional network analysis using ingenuity pathway analysis (IPA revealed significant differences in regulation of metabolic pathways within the morphologically changed organs that related to: (i) brain-cell morphology, nervous system development, and function and neurological disease; (ii) heart-cellular development, cellular function and maintenance, connective tissue development and function; (iii) skeletal muscle-nucleic acid metabolism, and small molecule biochemical pathways; (iv) liver-lipid metabolism, small molecular biochemistry, and nucleic acid metabolism; and (v) kidney-drug metabolism, organism injury and abnormalities, and renal damage. Our study provides a comprehensive description of the organ-specific proteomic profilesand differentially altered biochemical pathways, after prolonged Dex treatement to understand the molecular basis for development of side effects

Elective cancer surgery in COVID-19-free surgical pathways during the SARS-CoV-2 pandemic: An international, multicenter, comparative cohort study

PURPOSE As cancer surgery restarts after the first COVID-19 wave, health care providers urgently require data to determine where elective surgery is best performed. This study aimed to determine whether COVID-19–free surgical pathways were associated with lower postoperative pulmonary complication rates compared with hospitals with no defined pathway. PATIENTS AND METHODS This international, multicenter cohort study included patients who underwent elective surgery for 10 solid cancer types without preoperative suspicion of SARS-CoV-2. Participating hospitals included patients from local emergence of SARS-CoV-2 until April 19, 2020. At the time of surgery, hospitals were defined as having a COVID-19–free surgical pathway (complete segregation of the operating theater, critical care, and inpatient ward areas) or no defined pathway (incomplete or no segregation, areas shared with patients with COVID-19). The primary outcome was 30-day postoperative pulmonary complications (pneumonia, acute respiratory distress syndrome, unexpected ventilation). RESULTS Of 9,171 patients from 447 hospitals in 55 countries, 2,481 were operated on in COVID-19–free surgical pathways. Patients who underwent surgery within COVID-19–free surgical pathways were younger with fewer comorbidities than those in hospitals with no defined pathway but with similar proportions of major surgery. After adjustment, pulmonary complication rates were lower with COVID-19–free surgical pathways (2.2% v 4.9%; adjusted odds ratio [aOR], 0.62; 95% CI, 0.44 to 0.86). This was consistent in sensitivity analyses for low-risk patients (American Society of Anesthesiologists grade 1/2), propensity score–matched models, and patients with negative SARS-CoV-2 preoperative tests. The postoperative SARS-CoV-2 infection rate was also lower in COVID-19–free surgical pathways (2.1% v 3.6%; aOR, 0.53; 95% CI, 0.36 to 0.76). CONCLUSION Within available resources, dedicated COVID-19–free surgical pathways should be established to provide safe elective cancer surgery during current and before future SARS-CoV-2 outbreaks

Elective Cancer Surgery in COVID-19-Free Surgical Pathways During the SARS-CoV-2 Pandemic: An International, Multicenter, Comparative Cohort Study.

PURPOSE: As cancer surgery restarts after the first COVID-19 wave, health care providers urgently require data to determine where elective surgery is best performed. This study aimed to determine whether COVID-19-free surgical pathways were associated with lower postoperative pulmonary complication rates compared with hospitals with no defined pathway. PATIENTS AND METHODS: This international, multicenter cohort study included patients who underwent elective surgery for 10 solid cancer types without preoperative suspicion of SARS-CoV-2. Participating hospitals included patients from local emergence of SARS-CoV-2 until April 19, 2020. At the time of surgery, hospitals were defined as having a COVID-19-free surgical pathway (complete segregation of the operating theater, critical care, and inpatient ward areas) or no defined pathway (incomplete or no segregation, areas shared with patients with COVID-19). The primary outcome was 30-day postoperative pulmonary complications (pneumonia, acute respiratory distress syndrome, unexpected ventilation). RESULTS: Of 9,171 patients from 447 hospitals in 55 countries, 2,481 were operated on in COVID-19-free surgical pathways. Patients who underwent surgery within COVID-19-free surgical pathways were younger with fewer comorbidities than those in hospitals with no defined pathway but with similar proportions of major surgery. After adjustment, pulmonary complication rates were lower with COVID-19-free surgical pathways (2.2% v 4.9%; adjusted odds ratio [aOR], 0.62; 95% CI, 0.44 to 0.86). This was consistent in sensitivity analyses for low-risk patients (American Society of Anesthesiologists grade 1/2), propensity score-matched models, and patients with negative SARS-CoV-2 preoperative tests. The postoperative SARS-CoV-2 infection rate was also lower in COVID-19-free surgical pathways (2.1% v 3.6%; aOR, 0.53; 95% CI, 0.36 to 0.76). CONCLUSION: Within available resources, dedicated COVID-19-free surgical pathways should be established to provide safe elective cancer surgery during current and before future SARS-CoV-2 outbreaks

Effect of remote ischaemic conditioning on clinical outcomes in patients with acute myocardial infarction (CONDI-2/ERIC-PPCI): a single-blind randomised controlled trial.

BACKGROUND: Remote ischaemic conditioning with transient ischaemia and reperfusion applied to the arm has been shown to reduce myocardial infarct size in patients with ST-elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PPCI). We investigated whether remote ischaemic conditioning could reduce the incidence of cardiac death and hospitalisation for heart failure at 12 months. METHODS: We did an international investigator-initiated, prospective, single-blind, randomised controlled trial (CONDI-2/ERIC-PPCI) at 33 centres across the UK, Denmark, Spain, and Serbia. Patients (age >18 years) with suspected STEMI and who were eligible for PPCI were randomly allocated (1:1, stratified by centre with a permuted block method) to receive standard treatment (including a sham simulated remote ischaemic conditioning intervention at UK sites only) or remote ischaemic conditioning treatment (intermittent ischaemia and reperfusion applied to the arm through four cycles of 5-min inflation and 5-min deflation of an automated cuff device) before PPCI. Investigators responsible for data collection and outcome assessment were masked to treatment allocation. The primary combined endpoint was cardiac death or hospitalisation for heart failure at 12 months in the intention-to-treat population. This trial is registered with ClinicalTrials.gov (NCT02342522) and is completed. FINDINGS: Between Nov 6, 2013, and March 31, 2018, 5401 patients were randomly allocated to either the control group (n=2701) or the remote ischaemic conditioning group (n=2700). After exclusion of patients upon hospital arrival or loss to follow-up, 2569 patients in the control group and 2546 in the intervention group were included in the intention-to-treat analysis. At 12 months post-PPCI, the Kaplan-Meier-estimated frequencies of cardiac death or hospitalisation for heart failure (the primary endpoint) were 220 (8·6%) patients in the control group and 239 (9·4%) in the remote ischaemic conditioning group (hazard ratio 1·10 [95% CI 0·91-1·32], p=0·32 for intervention versus control). No important unexpected adverse events or side effects of remote ischaemic conditioning were observed. INTERPRETATION: Remote ischaemic conditioning does not improve clinical outcomes (cardiac death or hospitalisation for heart failure) at 12 months in patients with STEMI undergoing PPCI. FUNDING: British Heart Foundation, University College London Hospitals/University College London Biomedical Research Centre, Danish Innovation Foundation, Novo Nordisk Foundation, TrygFonden

The Other Side of Design: Tension manifolds and collective action

Systemic issues feature dynamic complexity that challenges cognitive, contextual, spatial, and temporal perceptions within ‘social messes’ (Ackoff, 1974) and ‘super-wicked problem’ (Levin et al., 2012) environments. Systemic designers thus find themselves working with tensions endemic to paradoxes, breaks in scale, value (or goal) conflicts and heterogeneous contexts. These differences may yield opportunities for design exploration when considered as spaces of praxis. Tensions within such spaces often make collaboration and collective action challenging – yet can also be considered as a type of design medium. This paper proposes the concept of ‘tension manifolds’ – and explores the potential for enabling design within systemic issues, with the goal of reframing tensions as a type of design affordance that enables collaboration and collective action in multi-stakeholder environments

Intelligent Multicast Internet Radio

As the internet continues to mature static content will continue to give way to dynamic, interactive multimedia content. This content will enrich all online media while at the same time imposing heavy bandwidth usage on the underlying network infrastructure. Multicast networking will undoubtedly increase in popularity to relieve the congested networks. Even as the scaling power of multicast networking approaches, users are burdened by the amount of multimedia and have to spend countless hours searching for the appropriate content. Recommender systems are a key way to personalize this content. This thesis is aimed at developing a scalable streaming application over the current IP multicast infrastructure and then using personalization for recommending and customizing dynamic multimedia content. The system uses a web based personalization system as the basis for user interaction and data collection. The multimedia streams are delivered through either Multicast or Unicast depending on each user\u27s capabilities. In short it is a completely scalable, intelligent, audio streaming application

Challenges in performance evaluation system of prosecutors = Desafios no sistema de avaliação de desempenho de procuradores

Pondera sobre como as reformas judiciais têm refletido diferentes pontos de vista, principalmente com relação à necessidade de gerenciamento ou não dos promotores. Aborda dois documentos estratégicos (período de 2006-2011 e período de 2006-2011) indicando que ambos definem um conjunto de medidas e indicadores para melhorar a eficiência e a competência do sistema de justiça no conjunto e a eficiência e competência dos juízes e procuradores como detentores de funções judiciais