Frugal innovation for healthcare: strategies and tools for the identification and evaluation of frugal and reverse innovations in healthcare

Global healthcare systems are united by their desire to widen patient access to safe and effective clinical services in the face of increasing demand and financial constraints. In low- and middle-income countries (LMICs), a variety of ingenious product and process solutions, termed frugal innovations, have been able to deliver services at a fraction of the cost. It is the broad proposition of this work that such ideas could be applicable to high-income countries (HICs), a concept labeled reverse innovation. Using a conceptual model of innovation scouting derived from the causal mechanism of critical realism, this work examined the development and testing of a tool to deductively identify frugal innovations in healthcare (FIH-ID tool) and then evaluated methodology to assess the reversibility of potential of frugal innovations. The FIH-ID tool demonstrated consistently acceptable inter-rater reliability scores using different methods of application and different raters, moreover, construct validity was shown by its ability to identify well-known frugal innovations. With respect to the assessment of the reversibility potential, the results of the present study highlighted the challenges of undertaking such a complex evaluation process using a simple scoring system. Raters achieved poor levels of inter-rater reliability and only 2 innovations were thought likely to reverse to a HIC. This study presents the first application of a critical realist approach to innovation scouting. It has identified a cohort of 76 potential frugal innovations in healthcare suggesting that the FIH-ID tool is likely to be a valuable asset for similar studies in the future. It has highlighted the challenges of assessing the reversibility potential of innovations from LMICs. It has documented the emergence of the global innovation curator, entities that seek to identify, curate and promote innovations from LMICs, and it proposes a conceptual model for the role of global innovation curators in the diffusion of innovation.Open Acces

Non-Contact Evaluation of Residual Stress in Metals with Laser-Generated Surface Acoustic Waves and a Point-Like Fiber-Optic Sagnac Detector

Stress can remain in a material after the original load is removed. It can be purposely introduced to improve the properties of structural components, but can also be undesired, shortening a component’s lifetime, changing its original geometry or even leading to failure. There is a large spectrum of problems where residual stress must be evaluated. An acousto-elastic approach is non-destructive and uses stress-dependent alterations in ultrasound (US) speed of bulk or surface modes [1]. However, these alterations are incredibly small (10-3 ÷ 10-5) and, thus, accurate measurement of both the US wave speed and propagation distance is required. Thickness measurement is not required for surface acoustic waves (SW) as compared to bulk acoustic modes. However, it requires a well determined distance between source and detector and very accurate time-of-flight measurement. Here we show that an approach based on laser-generated SW can solve this problem when a highly sensitive, point-like optical detector [2, 3] is used on receive. Using a laser beam focused to a narrow strip about 100 μm wide as a wave source and a modified Sagnac interferometer [2, 3] with an 8 μm diameter beam on receive, it is possible to use a short propagation path (5-10 mm) to obtain the required accuracy of time-of-flight measurements. For instance, the relative wave speed was estimated with an error of approx. 0.025% (i.e. 2.5*10-4) when only 20 signal averages were applied. The in-plane distribution of relative deviations of SW speed (proportional to stress) can be obtained with 2D scanning over a sample [4]. An example of relative SW speed deviations in one cross-section is shown in Fig.1 for a stainless steel sample

High Frequency, High Accuracy Pointing onboard Nanosats using Neuromorphic Event Sensing and Piezoelectric Actuation

As satellites become smaller, the ability to maintain stable pointing decreases as external forces acting on the satellite come into play. At the same time, reaction wheels used in the attitude determination and control system (ADCS) introduce high frequency jitter which can disrupt pointing stability. For space domain awareness (SDA) tasks that track objects tens of thousands of kilometres away, the pointing accuracy offered by current nanosats, typically in the range of 10 to 100 arcseconds, is not sufficient. In this work, we develop a novel payload that utilises a neuromorphic event sensor (for high frequency and highly accurate relative attitude estimation) paired in a closed loop with a piezoelectric stage (for active attitude corrections) to provide highly stable sensor-specific pointing. Event sensors are especially suited for space applications due to their desirable characteristics of low power consumption, asynchronous operation, and high dynamic range. We use the event sensor to first estimate a reference background star field from which instantaneous relative attitude is estimated at high frequency. The piezoelectric stage works in a closed control loop with the event sensor to perform attitude corrections based on the discrepancy between the current and desired attitude. Results in a controlled setting show that we can achieve a pointing accuracy in the range of 1-5 arcseconds using our novel payload at an operating frequency of up to 50Hz using a prototype built from commercial-off-the-shelf components. Further details can be found at https://ylatif.github.io/ultrafinestabilisatio

Nanomechanical detection of antibiotic-mucopeptide binding in a model for superbug drug resistance

The alarming growth of the antibiotic-resistant superbugs methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant Enterococcus (VRE) is driving the development of new technologies to investigate antibiotics and their modes of action. We report the label-free detection of vancomycin binding to bacterial cell wall precursor analogues (mucopeptides) on cantilever arrays, with 10 nM sensitivity and at clinically relevant concentrations in blood serum. Differential measurements quantified binding constants for vancomycin-sensitive and vancomycin-resistant mucopeptide analogues. Moreover, by systematically modifying the mucopeptide density we gain new insights into the origin of surface stress. We propose that stress is a product of a local chemical binding factor and a geometrical factor describing the mechanical connectivity of regions affected by local binding in terms of a percolation process. Our findings place BioMEMS devices in a new class of percolative systems. The percolation concept will underpin the design of devices and coatings to significantly lower the drug detection limit and may also impact on our understanding of antibiotic drug action in bacteria.Comment: Comments: This paper consists of the main article (6 pages, 5 figures) plus Supplemental Material (6 pages, 3 figures). More details are available at http://www.london-nano.co

Stakeholder perspectives on shale gas fracking: A Q-method study of environmental discourses

The rapid expansion of shale gas exploration worldwide is a significant source of environmental controversy. Successful shale gas policymaking is dependent upon a clear understanding of the dynamics of competing stakeholder perspectives on these issues, and so methods are needed to delineate the areas of agreement and conflict that emerge. This empirical study, based in the United Kingdom, examines emergent perspectives on a range of environmental, health and socio-economic impacts associated with shale gas fracking using Q- methodology: a combined qualitative-quantitative approach. The analysis reveals three typologies of perspectives amongst key industry, civil society and non-affiliated citizen stakeholders; subsequently contextualised in relation to Dryzek’s typology of environmental discourses. These are labelled A) “Don’t trust the fossil fuels industry: campaign for renewables” (mediating between sustainable development and democratic pragmatism discourses); B) “Shale gas is a bridge fuel: economic growth and environmental scepticism” (mediating between economic rationalism and ecological modernisation discourses); and C) “Take place protective action and legislate in the public interest” (reflecting a discourse of administrative rationalism). The implications of these competing discourses for nascent shale gas policy in the UK are discussed in light of recent Government public consultation on changes to national planning policy

The Florey Adelaide Male Ageing Study (FAMAS): Design, procedures & participants

<p>Abstract</p> <p>Background</p> <p>The Florey Adelaide Male Ageing Study (FAMAS) examines the reproductive, physical and psychological health, and health service utilisation of the ageing male in Australia. We describe the rationale for the study, the methods used participant response rates, representativeness and attrition to date.</p> <p>Methods</p> <p>FAMAS is a longitudinal study involving approximately 1200 randomly selected men, aged 35–80 years and living in the north – west regions of Adelaide. Respondents were excluded at screening if they were considered incapable of participating because of immobility, language, or an inability to undertake the study procedures. Following a telephone call to randomly selected households, eligible participants were invited to attend a baseline clinic measuring a variety of biomedical and socio-demographic factors. Beginning in 2002, these clinics are scheduled to reoccur every five years. Follow-up questionnaires are completed annually. Participants are also invited to participate in sub-studies with selected collaborators.</p> <p>Results</p> <p>Of those eligible to participate, 45.1% ultimately attended a clinic. Non-responders were more likely to live alone, be current smokers, have a higheevalence of self-reported diabetes and stroke, and lower levels of hypercholesterolemia. Comparisons with the Census 2001 data showed that participants matched the population for most key demographics, although younger groups and never married men were under-represented and elderly participants were over-represented. To date, there has been an annual loss to follow-up of just over 1%.</p> <p>Conclusion</p> <p>FAMAS allows a detailed investigation into the effects of bio-psychosocial and behavioural factors on the health and ageing of a largely representative group of Australian men.</p

Do International Health Partnerships contribute to reverse innovation? a mixed methods study of THET-supported partnerships in the UK

Background International health partnerships (IHPs) are changing, with an increased emphasis on mutual accountability and joint agenda setting for both the high- and the low- or middle-income country (LMIC) partners. There is now an important focus on the bi-directionality of learning however for the UK partners, this typically focuses on learning at the individual level, through personal and professional development. We sought to evaluate whether this learning also takes the shape of ‘Reverse Innovation’ –when an idea conceived in a low-income country is subsequently adopted in a higher-income country. Methods This mixed methods study used an initial scoping survey of all the UK-leads of the Tropical Health Education Trust (THET)-supported International Health Partnerships (n = 114) to ascertain the extent to which the IHPs are or have been vehicles for Reverse Innovation. The survey formed the sampling frame for further deep-dive interviews to focus on volunteers’ experiences and attitudes to learning from LMICs. Interviews of IHP leads (n = 12) were audio-recorded and transcribed verbatim. Survey data was analysed descriptively. Interview transcripts were coded thematically, using an inductive approach. Results Survey response rate was 27% (n = 34). The majority (70%) strongly agreed that supporting LMIC partners best described the mission of the partnership but only 13% of respondents strongly agreed that learning about new innovations and models was a primary mission of their partnership. Although more than half of respondents reported having observed innovative practice in the LMIC, only one IHP respondent indicated that this has led to Reverse Innovation. Interviews with a sample of survey respondents revealed themes primarily around how learning is conceptualised, but also a central power imbalance between the UK and LMIC partners. Paternalistic notions of knowledge could be traced to partnership power dynamics and latent attitudes to LMICs. Conclusions Given the global flow of innovation, if High-income countries (HICs) are to benefit from LMIC practices, it is paramount to keep an open mind about where such learning can come from. Making the potential for learning more explicit and facilitating innovation dissemination upon return will ultimately underpin the success of adoption

Adjunctive rifampicin for Staphylococcus aureus bacteraemia (ARREST): a multicentre, randomised, double-blind, placebo-controlled trial.

BACKGROUND: Staphylococcus aureus bacteraemia is a common cause of severe community-acquired and hospital-acquired infection worldwide. We tested the hypothesis that adjunctive rifampicin would reduce bacteriologically confirmed treatment failure or disease recurrence, or death, by enhancing early S aureus killing, sterilising infected foci and blood faster, and reducing risks of dissemination and metastatic infection. METHODS: In this multicentre, randomised, double-blind, placebo-controlled trial, adults (≥18 years) with S aureus bacteraemia who had received ≤96 h of active antibiotic therapy were recruited from 29 UK hospitals. Patients were randomly assigned (1:1) via a computer-generated sequential randomisation list to receive 2 weeks of adjunctive rifampicin (600 mg or 900 mg per day according to weight, oral or intravenous) versus identical placebo, together with standard antibiotic therapy. Randomisation was stratified by centre. Patients, investigators, and those caring for the patients were masked to group allocation. The primary outcome was time to bacteriologically confirmed treatment failure or disease recurrence, or death (all-cause), from randomisation to 12 weeks, adjudicated by an independent review committee masked to the treatment. Analysis was intention to treat. This trial was registered, number ISRCTN37666216, and is closed to new participants. FINDINGS: Between Dec 10, 2012, and Oct 25, 2016, 758 eligible participants were randomly assigned: 370 to rifampicin and 388 to placebo. 485 (64%) participants had community-acquired S aureus infections, and 132 (17%) had nosocomial S aureus infections. 47 (6%) had meticillin-resistant infections. 301 (40%) participants had an initial deep infection focus. Standard antibiotics were given for 29 (IQR 18-45) days; 619 (82%) participants received flucloxacillin. By week 12, 62 (17%) of participants who received rifampicin versus 71 (18%) who received placebo experienced treatment failure or disease recurrence, or died (absolute risk difference -1·4%, 95% CI -7·0 to 4·3; hazard ratio 0·96, 0·68-1·35, p=0·81). From randomisation to 12 weeks, no evidence of differences in serious (p=0·17) or grade 3-4 (p=0·36) adverse events were observed; however, 63 (17%) participants in the rifampicin group versus 39 (10%) in the placebo group had antibiotic or trial drug-modifying adverse events (p=0·004), and 24 (6%) versus six (2%) had drug interactions (p=0·0005). INTERPRETATION: Adjunctive rifampicin provided no overall benefit over standard antibiotic therapy in adults with S aureus bacteraemia. FUNDING: UK National Institute for Health Research Health Technology Assessment

Shale gas policy in the United Kingdom: An argumentative discourse analysis

Shale gas has become an energy policy priority in the United Kingdom in light of profitable extraction activities in the United States. Since 2012 the Coalition Government has created key economic drivers to encourage shale exploration, whilst growing activism in affected site communities has stirred significant media and academic commentary. This study examines the growing national debate as a matter of discourse, adopting an argumentative discourse analytic approach to assess data collected from stakeholder interviews (n=21) and key policy actor statements quoted in broadsheet newspapers. We explore three dominant "storylines" emerging in relation to shale gas policy: (1) "cleanliness and dirt" concerns the relative framing of the environmental benefits and harms of shale gas; (2) "energy transitions - pathways and diversions" concerns geographic metaphors of transitions to carbon intensive and low-carbon energy systems; and (3) "geographies of environmental justice" concerns divisions of economic benefit distribution, environmental impact and procedural fairness. We find that central government policy rhetoric emphasises economic development, regulatory oversight and distribution of benefits to site communities, whilst minimising discussion of the implications of shale gas for anthropogenic climate change. The role of these discourses in influencing shale gas policy is discussed