Chapter 5 Technological accretion in diagnostics

This book brings together a collection of empirical case studies featuring a wide spectrum of medical innovation. While there is no unique pathway to successful medical innovation, recurring and distinctive features can be observed across different areas of clinical practice. This book examines why medical practice develops so unevenly across and within areas of disease, and how this relates to the underlying conditions of innovation across areas of practice. The contributions contained in this volume adopt a dynamic perspective on medical innovation based on the notion that scientific understanding, technology and clinical practice co-evolve along the co-ordinated search for solutions to medical problems. The chapters follow an historical approach to emphasise that the advancement of medical know-how is a contested, nuanced process, and that it involves a variety of knowledge bases whose evolutionary paths are rooted in the contexts in which they emerge. This book will be of interest to researchers and practitioners concerned with medical innovation, management studies and the economics of innovation. Chapter 5 of this book is freely available as a downloadable Open Access PDF under a Creative Commons Attribution-Non Commercial-No Derivatives 3.0 license. https://s3-us-west-2.amazonaws.com/tandfbis/rt-files/docs/Open+Access+Chapters/9781138860346_oachapter5.pd

The emergence of molecular biology in the diagnosis of cervical cancer: A network perspective

Trabajo presentado a la Atlanta Conference on Science and Innovation Policy, celebrada en Atlanta (US) del 17 al 19 de septiembre de 2015.Cytology-base technologies have been extensively used for decades to diagnose cervical cancer in women despite the large number of false negative cases those may report. The rise of molecular biology, since mid-1980s, has spurred the emergence of novel diagnostic technologies, which have significantly changed both the research landscape and clinical practices around cervical cancer. Within this context, the present paper examines how different institutional groups of actors (research and higher education, governmental, hospital and care, industrial, and non-governmental organisations) have contributed to the emergence of molecular biology from an inter-organisational network lens (co-authorship data of publications). To do so, we analyse the patterns of network interactions among different institutional groups involved in the emerge process. We specifically examine the formation of ties (dyads) within and between groups as well as the extent to which organisational actors operate in di↵erent brokerage positions (triads) over the emergence process. The analysis is based on a sample of scientific articles published over more than 30 years in the diagnosis domain of cervical cancer research. Findings provide evidence that the process of tie formation as well as the brokerage activity follow different patterns according to the considered institutional group. The process of tie formation and brokerage activity also evolve over emergence.N

Are there three main subgroups within the patellofemoral pain population? A detailed characterisation study of 127 patients to help develop targeted Intervention (TIPPs)

• Background Current multimodal approaches for the management of non-specific patellofemoral pain are not optimal, however, targeted intervention for subgroups could improve patient outcomes. This study explores whether subgrouping of non-specific patellofemoral pain patients, using a series of low cost simple clinical tests, is possible. • Method The exclusivity and clinical importance of potential subgroups was assessed by applying à priori test thresholds (1 SD) from seven clinical tests in a sample of adult patients with non-specific patellofemoral pain. Hierarchical clustering and latent profile analysis, were used to gain additional insights into subgroups using data from the same clinical tests. • Results One hundred and thirty participants were recruited, 127 had complete data: 84 (66%) female, mean age 26 years (SD 5.7) and mean BMI 25.4 (SD 5.83), median (IQR) time between onset of pain and assessment was 24 (7-60) months. Potential subgroups defined by the à priori test thresholds were not mutually exclusive and patients frequently fell into multiple subgroups. Using hierarchical clustering and latent profile analysis three subgroups were identified using 6 of the 7 clinical tests. These subgroups were given the following nomenclature: (i) ‘strong’, (ii) ‘weak and tighter’, and (iii) ‘weak and pronated foot’. • Conclusions We conclude that three subgroups of patellofemoral patients may exist based on the results of six clinical tests which are feasible to perform in routine clinical practice. Further research is needed to validate these findings in other datasets and, if supported by external validation, to see if targeted interventions for these subgroups improve patient outcomes

Towards Visualization of Time-Series Ecological Momentary Assessment (EMA) Data on Standalone Voice-First Virtual Assistants.

Population aging is an increasingly important consideration for health care in the 21th century, and continuing to have access and interact with digital health information is a key challenge for aging populations. Voice-based Intelligent Virtual Assistants (IVAs) are promising to improve the Quality of Life (QoL) of older adults, and coupled with Ecological Momentary Assessments (EMA) they can be effective to collect important health information from older adults, especially when it comes to repeated time-based events. However, this same EMA data is hard to access for the older adult: although the newest IVAs are equipped with a display, the effectiveness of visualizing time-series based EMA data on standalone IVAs has not been explored. To investigate the potential opportunities for visualizing time-series based EMA data on standalone IVAs, we designed a prototype system, where older adults are able to query and examine the time-series EMA data on Amazon Echo Show - a widely used commercially available standalone screen-based IVA. We conducted a preliminary semi-structured interview with a geriatrician and an older adult, and identified three findings that should be carefully considered when designing such visualizations

How do Older Adults Set Up Voice Assistants? Lessons Learned from a Deployment Experience for Older Adults to Set Up Standalone Voice Assistants.

While standalone Voice Assistants (VAs) are promising to support older adults daily routine and wellbeing management, onboarding and setting up these devices can be challenging. Although some older adults choose to seek assistance from technicians and adult children, easy set up processes that facilitate independent use are still critical, especially for those who do not have access to external resources. We aim to understand the older adults experience while setting up commercially available voice-only and voice-first screen-based VAs. Rooted in participants observations and semi-structured interviews, we designed a within-subject study with 10 older adults using Amazon Echo Dot and Echo Show. We identified the values of the built-in touchscreen and the instruction documents, as well as the impact of form factors, and outline important directions to support older adult independence with VAs

Screen or No Screen? Lessons Learnt from a Real-World Deployment Study of Using Voice Assistants With and Without Touchscreen for Older Adults

While voice user interfaces offer increased accessibility due to hands-free and eyes-free interactions, older adults often have challenges such as constructing structured requests and perceiving how such devices operate. Voice-first user interfaces have the potential to address these challenges by enabling multimodal interactions. Standalone voice + touchscreen Voice Assistants (VAs), such as Echo Show, are specific types of devices that adopt such interfaces and are gaining popularity. However, the affordances of the additional touchscreen for older adults are unknown. Through a 40-day real-world deployment with older adults living independently, we present a within-subjects study (N = 16; age M = 82.5, SD = 7.77, min. = 70, max. = 97) to understand how a built-in touchscreen might benefit older adults during device setup, conducting self-report diary survey, and general uses. We found that while participants appreciated the visual outputs, they still preferred to respond via speech instead of touch. We identified six design implications that can inform future innovations of senior-friendly VAs for managing healthcare and improving quality of life

How do Older Adults Set Up Voice Assistants? Lessons Learned from a Deployment Experience for Older Adults to Set Up Standalone Voice Assistants

While standalone Voice Assistants (VAs) are promising to support older adults' daily routine and wellbeing management, onboarding and setting up these devices can be challenging. Although some older adults choose to seek assistance from technicians and adult children, easy set up processes that facilitate independent use are still critical, especially for those who do not have access to external resources. We aim to understand the older adults' experience while setting up commercially available voice-only and voice-first screen-based VAs. Rooted in participants observations and semi-structured interviews, we designed a within-subject study with 10 older adults using Amazon Echo Dot and Echo Show. We identified the values of the built-in touchscreen and the instruction documents, as well as the impact of form factors, and outline important directions to support older adult independence with VAs