Negotiating boundaries: Framing and sense-making in a design thinking project with an elderly community

In recent years Design Thinking has established itself as a popular methodology for unlocking the creative potential that drives innovation, and scholars have begun to apply it in the health sector. However, as a conceptual framework, the approach has been criticised for lacking coherence and empirical validation. Although few have explicitly highlighted the central role of frame management in Design Thinking, we propose that much of the innovative potential, as outlined in its founding principles, stems from a concern with mental processes that contextualise new information to give it meaning and significance. Here we sought to address this gap by studying the framing process in two design teams tasked with developing solutions to assist an elderly population with compliance with medication schedules. Findings from a qualitative analysis indicate that although Design Thinking has clear merit as a methodology for helping designers shift beyond their immediate field of expertise, feedback and observations gathered during engagement with stakeholders inevitably appear to make their way through a filtering process where specific interpretations and meanings become censored and constrained by dominant discourses. Especially in the health sector, where information is sensitive, critical attention to the underlying value systems and prevailing discourses that influence designers’ implicit frames of reference is needed if Design Thinking is to gain credibility as a scientifically robust method for innovation. design thinking, framing, health innovation, medication adherenc

Development of an assessment instrument for student engagement in design thinking projects for health innovation

Student engagement is a dynamic and multifaceted concept encompassing physical, emotional, and cognitive components. Various instruments to assess student engagement exist; however, these are not intended to assess how students engage with one another and with community stakeholders in participatory health projects. Although instruments exist to assess participation and power-sharing in participatory health research projects, none of the available tools are suitable for assessing student engagement in such projects. Accordingly, this study set out to develop an assessment instrument for student engagement in design thinking projects for health innovation. An adapted form of the survey development guide for medical education research was applied. The development process included triangulation of data, which included collating student input from an initial literature informed instrument, an analysis of written reflective reports and a focus group discussion with students enrolled in a master’s level course called Health Innovation & Design (HID), and design thinking practitioner validation. A final assessment instrument for student engagement in design thinking projects is presented. Note that our instrument incorporates the design thinking phases according to the Innovation Design Engineering Organization (IDEO) design thinking approach, an educational definition of student engagement, and recommendations by students, course lecturers and facilitators of the HID course. The instrument can assess engagement in academic and non-academic settings when design thinking is applied for health innovation

Measurement of Skin Induration Size Using Smartphone Images and Photogrammetric Reconstruction: Pilot Study

Background: The tuberculin skin test (TST) is the most common method for detecting latent tuberculosis infection (LTBI). The test requires that a patient return to the health facility or be visited by a health care worker 48 to 72 hours after the intradermal placement of tuberculin so that the size of the resulting skin induration, if any, can be measured. Objective: This study aimed to propose and evaluate an image-based method for measuring induration size from images captured using a smartphone camera. Methods: We imaged simulated skin indurations, ranging from 4.0 to 19 mm, in 10 subjects using a handheld smartphone, and performed three-dimensional reconstruction of the induration sites using photogrammetry software. An experienced TST reader measured the size of each induration using the standard clinical method. The experienced reader and an inexperienced observer both measured the size of each induration using the software. The agreement between measurements generated by the standard clinical and image-based methods was assessed using the intraclass correlation coefficient (ICC). Inter- and intraobserver agreement for the image-based method was similarly evaluated. Results: Results showed excellent agreement between the standard and image-based measurements performed by the experienced reader with an ICC value of .965. Inter- and intraobserver agreements were also excellent, indicating that experience in reading TSTs is not required with our proposed method. Conclusions: We conclude that the proposed smartphone image-based method is a potential alternative to standard induration size measurement and would enable remote data collection for LTBI screening

Ischiofemoral impingement: the evolutionary cost of pelvic obstetric adaptation.

Funder: Flemmish research foundationThe risk for ischiofemoral impingement has been mainly related to a reduced ischiofemoral distance and morphological variance of the femur. From an evolutionary perspective, however, there are strong arguments that the condition may also be related to sexual dimorphism of the pelvis. We, therefore, investigated the impact of gender-specific differences in anatomy of the ischiofemoral space on the ischiofemoral clearance, during static and dynamic conditions. A random sampling Monte-Carlo experiment was performed to investigate ischiofemoral clearance during stance and gait in a large (n = 40 000) virtual study population, while using gender-specific kinematics. Subsequently, a validated gender-specific geometric morphometric analysis of the hip was performed and correlations between overall hip morphology (statistical shape analysis) and standard discrete measures (conventional metric approach) with the ischiofemoral distance were evaluated. The available ischiofemoral space is indeed highly sexually dimorphic and related primarily to differences in the pelvic anatomy. The mean ischiofemoral distance was 22.2 ± 4.3 mm in the females and 29.1 ± 4.1 mm in the males and this difference was statistically significant (P < 0.001). Additionally, the ischiofemoral distance was observed to be a dynamic measure, and smallest during femoral extension, and this in turn explains the clinical sign of pain in extension during long stride walking. In conclusion, the presence of a reduced ischiofemroal distance and related risk to develop a clinical syndrome of ischiofemoral impingement is strongly dominated by evolutionary effects in sexual dimorphism of the pelvis. This should be considered when female patients present with posterior thigh/buttock pain, particularly if worsened by extension. Controlled laboratory study

Climate variability and change or multiple stressors? Farmer perceptions regarding threats to livelihoods in Zimbabwe and Zambia

Climate variability is set to increase, characterised by extreme conditions in Africa. Southern Africa will likely get drier and experience more extreme weather conditions, particularly droughts and floods. However, while climate risks are acknowledged to be a serious threat to smallholder farmers’ livelihoods, these risks do not exist in isolation, but rather, compound a multiplicity of stressors. It was important for this study to understand farmer perceptions regarding the role of climate risks within a complex and multifarious set of risks to farmers’ livelihoods. This study used both qualitative and quantitative methods to investigate farmers’ perceptions regarding threats to livelihoods in southern Zambia and south-western Zimbabwe. While farmers report changes in local climatic conditions consistent with climate variability, there is a problem in assigning contribution of climate variability and other factors to observed negative impacts on the agricultural and socio-economic system. Furthermore, while there is a multiplicity of stressors that confront farmers, climate variability remains the most critical and exacerbate livelihood insecurity for those farmers with higher levels of vulnerability to these stressor

Quality education

This book investigates the intersections between education, social justice, gendered violence and human rights in South African schools and universities. The rich and multifarious tapestry of scholarship and literature emanating from South African classrooms provides a fascinating lens through which we can understand the complex consequences of the economies of education, social justice imperatives, gendered violence on the lives of women and children, and marginalised communities. The scholarship in the book challenges readers to imagine alternative futures predicated on the transformational capacity of a democratic South Africa. Contributors to this volume examine the many ways in which social justice and gendered violence mirrors, expresses, projects and articulates the larger phenomenon of human rights violations in Africa and how, in turn, the discourse of human rights informs the ways in which we articulate, interrogate, conceptualise, enact and interpret quality education. The book also wrestles with the linguistic contradictions and ambiguities in the articulation of quality education in public and private spaces. This book is essential reading for scholars seeking solid grounding in exploring quality education, the instances of epistemic disobedience, the political implications of place and power, and human rights in theory and practice

Quality education

This book investigates the intersections between education, social justice, gendered violence and human rights in South African schools and universities. The rich and multifarious tapestry of scholarship and literature emanating from South African classrooms provides a fascinating lens through which we can understand the complex consequences of the economies of education, social justice imperatives, gendered violence on the lives of women and children, and marginalised communities. The scholarship in the book challenges readers to imagine alternative futures predicated on the transformational capacity of a democratic South Africa. Contributors to this volume examine the many ways in which social justice and gendered violence mirrors, expresses, projects and articulates the larger phenomenon of human rights violations in Africa and how, in turn, the discourse of human rights informs the ways in which we articulate, interrogate, conceptualise, enact and interpret quality education. The book also wrestles with the linguistic contradictions and ambiguities in the articulation of quality education in public and private spaces. This book is essential reading for scholars seeking solid grounding in exploring quality education, the instances of epistemic disobedience, the political implications of place and power, and human rights in theory and practice

GAMEC – a new intensive protocol for untreated poor prognosis and relapsed or refractory germ cell tumours

There is no consensus as to the management of untreated poor prognosis or relapsed/refractory germ cell tumours. We have studied an intensive cisplatin-based regimen that incorporates high-dose methotrexate (HD MTX) and actinomycin-D and etoposide every 14 days (GAMEC). Sixty-two patients were enrolled in a phase 2 study including 27 who were untreated (IGCCCG, poor prognosis) and 35 with progression despite conventional platinum based chemotherapy. The pharmacokinetics of the drugs were correlated with standard outcome measures. Twenty of the untreated patients were progression free following GAMEC and appropriate surgery, as were 18 individuals in the pretreated group. None of the established prognostic factors for therapy for pretreated patients could identify a poor-prognosis group. Five out of nine late relapses to prior chemotherapy were progression free following GAMEC and appropriate surgery. All patients had at least one episode of febrile neutropenia and there were five (8%) treatment-related deaths. PK values were not predictive of efficacy or toxicity, although the dose intensity in the pretreated group of patients, especially of HD MTX, was significantly correlated with progression-free survival (PFS). GAMEC is a novel intensive regimen for this group of patients producing encouraging responses, although with significant toxicity. For those in whom it fails, further therapy is still possible with durable responses being seen