Designing the future: strategy, design and the 4th Revolution: an introduction

This is an introduction to the special issue of California Management Review on Design Thinking (DT). This special issue joins the growing body of work exploring the idea of DT and whether DT makes a difference in terms enhancing or augmenting the impact of technology—and, as a result, innovation—in a positive way. We have chosen an interesting, relevant, and useful array of papers that provide different approaches, views, and interpretations of applied design thinking. These articles provide both management and scholarly readers with insights in how DT is used, as well as its impact and usefulness in a variety of contexts

Bronchoscopic radioisotope injection for sentinel lymph-node mapping in potentially resectable non-small-cell lung cancer

Objective: Prospective study to evaluate the feasibility of a preoperative bronchoscopic radioisotope application, followed by conventional sentinel lymph-node (SLN) identification and to investigate the occurrence and distribution of micrometastases in relation to SLN activity. Methods: Twenty patients with a mean age of 63 years and proven clinical stage T1-3 N0-1 non-small-cell lung cancer (NSCLC) were included. A dosage of 80 MBq radiolabeled technetium-99m nanocolloid was endoscopically administrated on intubated patients in the operation theatre. At thoracotomy, scintigraphic readings of both the primary tumor and hilar and mediastinal lymph-node stations were obtained with a hand-held gamma-counter. Patients underwent lung resection and mediastinal lymphadenectomy. Radiolabeled nodes were also examined separately on back-table. SLNs were defined as the hottest nodes or nodes with at least one-tenth of the radioactivity of the hottest nodes. SLNs pathologic assessment included standard examination using hematoxylin and eosin staining on step sections and immunohistochemistry (ICH) for cytokeratins. Results: Identification of SLNs was possible in 19/20 (95%) patients after bronchoscopic radioisotope application. In 7/19 (37%) patients, a unique SLN was identified, whereas in 12/19 (63%) patients, nodes from two different stations could be classified as SLNs. Metastatic nodal disease was found in 9/19 (47%) patients. ICH revealed micrometastases in 2/12 (17%) patients, initially classified nodal negative. Pathologic negative SLNs were a predictor for absence of metastatic nodal disease after mediastinal lymphadenectomy. No complication related to the procedure was observed. Conclusion: Our preliminary results suggest that preoperative bronchoscopic radioisotope injection for SLN identification is a safe and simple method, improving accuracy of SLN detection in comparison to intraoperative technique. The absence of metastases in the SLNs seems to predict a negative nodal status accuratel

Microbial vitamin production mediates dietary effects on diabetic risk

Adequate levels of essential vitamins are important for the prevention of diabetes. While the main efforts to address this are currently focused on the intake of vitamin supplements, improving and maintaining intrinsic vitamin production capacity, which is determined by gut microbes, has received insufficient attention. In this study, we systematically investigated the relationship between gut microbial vitamin production and factors related to diabetes and cardiometabolic health in a deeply phenotyped cohort, Lifelines-DEEP (N = 1,135). We found that blood glucose–related factors, lipids, circulating inflammation, and fecal short-chain fatty acids are associated with gut microbial vitamin production. Use of laxatives and metformin are associated with increased levels of vitamin B1/B6 biosynthesis pathways. We further reveal a mediatory role for microbial vitamin B1/B2 production on the influence of fruit intake on diabetes risk. This study provides preliminary evidence for microbiome-targeted vitamin metabolism interventions to promote health

Quasi-linearly polarized hybrid modes in tapered and metal-coated tips with circular apertures: understanding the functionality of aperture tips

In this study, we investigate analytically and experimentally the roles of quasi-linearly polarized (LP), hybrid, plasmonic and photonic modes in optical detection and excitation with aperture tips in scanning near-field optical microscopy. Aperture tips are tapered and metal-coated optical fibers where small circular apertures are made at the apex. In aperture tips, there exist plasmonic modes that are bound at the interface of the metal cladding to the inner dielectric fiber and photonic modes that are guided in the area of the increased index in the dielectric fiber core. The fundamental photonic mode, although excited by the free-space Gaussian beam, experiences cutoff and turns into an evanescent mode. The photonic mode also becomes lossier than the plasmonic mode toward the tip aperture, and its power decay due to absorption and reflection is expected to be at least 10−9. In contrast, the fundamental plasmonic mode has no cutoff and thus reaches all the way to the tip aperture. Due to the non-adiabaticity of both modes' propagations through the taper below a core radius of 600 nm, there occurs coupling between the modes. The transmission efficiency of the plasmonic mode, including the coupling efficiency and the propagation loss, is expected to be about 10−6 that is at least 3 orders of magnitude larger than that of the photonic mode. Toward the tip aperture, the longitudinal field of the photonic mode becomes stronger than the transverse ones while the transverse fields always dominate for the plasmonic mode. Experimentally, we obtain polarization resolved images of the near-field at the tip aperture and compare with the x- and y-components of the fundamental quasi-LP plasmonic and photonic modes. The results show that not only the pattern but also the intensity ratios of the x- and y-components of the aperture near-field match with that of the fundamental plasmonic mode. Consequently, we conclude that only the plasmonic mode reaches the tip aperture and thus governs the near-field interaction outside the tip aperture. Our conclusion remains valid for all aperture tips regardless of the cladding metal type that mainly influences the total transmission efficiency of the aperture tip

Treatment with human growth hormone in patients with Prader-Labhart-Willi syndrome reduces body fat and increases muscle mass and physical performance

Twelve children with documented Prader-Labhart-Willi syndrome were treated with human growth hormone (24 U/m2/week) during 1 year. The children were divided into three groups: group 1: overweight and prepubertal (n = 6, age 3.8-7.0 years); group 2: underweight and prepubertal (n = 3, age 0.6-4.1 years); group 3: pubertal (n = 3, age 9.2-14.6 years). In group 1, height increased from -1.7 SD to -0.6 SD, while weight decreased from 1.1 SD to 0.4 SD, with a dramatic drop in weight for height from 3.8 SD to 1.2 SD. Hand length increased from -1.5 SD to -0.4 SD and foot length from -2.5 SD to -1.4 SD. Body fat, measured by dual X-ray energy absorptiometry, dropped by a third, whereas muscle mass increased by a fourth. Physical capability (Wingate test) improved considerably. The children were reported to be much more active and capable. In group 2, similar changes were seen, but weight for height increased, probably because muscle mass increase exceeded fat mass decrease. Changes in group 3 were similar as in group 1, even though far less distinct. Conclusion: Growth hormone treatment in Prader-Labhart-Willi syndrome led to dramatic changes: distinct increase in growth velocity, height and muscle mass, as well as an improvement in physical performance. Fat mass and weight for height decreased in the initially overweight children, and weight for height increased in underweight childre