Responsible innovation as a driver of regional policies and innovation and entrepreneurial practices: The context of digitalisation of healthcare and welfare services

This thesis explores the concept of responsible innovation (RI) and its implications for regional policies, innovation, and entrepreneurship policies and practices in the context of healthcare and welfare services. RI is a concept that emerged in the wake of widening grand societal challenges and is developing and spreading quickly to govern research and innovation on society’s needs, values, and expectations. RI emphasises the reflection of purpose, process, and outcomes of innovation and entrepreneurship policies and practices such that they contribute to addressing grand societal challenges and create a broader societal impact. There is a growing belief that RI dimensions of inclusion, anticipation, reflexivity, and responsiveness can offer a valuable tool. Thus, RI practices could enable policymakers, firms, and stakeholders within the regional innovation ecosystem to interact to address grand societal challenges. However, RI has stalled at articulating a governance process with a strongly normative loading without clear, practical guidelines for implementation strategies and mainly concentrated on publicly funded research projects. RI scholars argued that RI and its aspiration could only be achieved if integrated into policies and practices. Furthermore, because firms and the private sector are the primary drivers of innovation, they need to acknowledge the significance of RI practices in innovation and business practices. However, most firms and policymakers are either unaware of RI or find implementing RI in research, innovation, and entrepreneurship policies and practices challenging. Furthermore, RI emphasises the inclusion of micro, meso, and macro levels of stakeholders in the innovation ecosystem for desirable, sustainable, and responsible innovative outcomes and broader impact. However, existing theoretical frameworks do not fully account for whether, how, and why firms adapt and practice RI in innovation and entrepreneurship. Thus, given that firms are embedded in the regional context, there is a need to understand RI and its role in shaping the purpose, process, and outcomes of innovation and entrepreneurial policies and activities to achieve overall regional goals. This thesis addresses these problems in the context of healthcare and welfare services, which are under immense pressure to ensure accessible, equitable, and sustainable services, primarily due to demographic and ecological changes. The emerging digitalisation and innovation in digital technology bring several potentials to address societal challenges, including healthcare and welfare service challenges. However, digital innovation might also raise privacy, safety, and security issues. RI can play a vital role in addressing these issues and drive research and innovation to benefit society. The empirical setting is the context of digital innovation in healthcare and welfare services, particularly in the Western region of Norway. This region established the Norwegian Smart Care Cluster (NSCC) in 2013 to promote digital healthcare and welfare provisions to citizens and contribute to regional and national economic growth. The cluster comprises approximately 290 organizations, including 194 private firms working on digital innovations in healthcare and welfare services. This thesis employs a qualitative approach with two different research designs between Paper I and Papers II, III, and IV. It utilizes empirical data collected from the nine firms belonging to the NSCC and the diverse set of stakeholders, including the cluster administration, university researchers, municipality representatives responsible for procurement and implementation of health and welfare services, healthcare professionals, and regional politicians. Paper I is a systematic literature review based on peer-reviewed journals. Papers II, III, and IV are case studies conducted using semi-structured interviews and secondary data gathered from various sources. The case studies and data gathered in this thesis take an exploratory approach. The approach is split between multiple case studies in Papers II and III and a single case study in Paper IV. The four research papers together answer the overarching research inquiry, ‘How does the RI approach facilitate regional policies and innovation and entrepreneurship practices in firms toward increased societal impact?’ The individual research papers apply different theoretical perspectives together with RI. In so doing, the thesis contributes to theory, practice, and policy in RI, innovation, and entrepreneurship

Responsible innovation in venture creation and firm development: the case of digital innovation in healthcare and welfare services

The increasing adaptation of digitalisation has engendered numerous venture ideas and entrepreneurial opportunities. Many of these ideas bear the potential to address grand societal challenges. However, perceived opportunities can be elusive, especially in the context of complex problems. Opportunity confidence (OC) can be essential to venture creation and firm development. OC depends on evaluating socioeconomic, socio-ethical, and socioecological factors, which are not straightforward. Responsible innovation (RI) can be a viable approach to building OC. However, whether or how firms and entrepreneurs pursue RI to build OC needs to be clarified. Accordingly, we explore these issues through a case study of nine for-profit firms in digital healthcare and welfare services. The findings reveal that although the firms do not integrate RI principles in innovation and entrepreneurial activities per se, they practice them to varying degrees. This helps them to build OC. The study contributes to theory, practice, and policy.publishedVersio

Validation of a Preoperative Scoring System to Predict Difficult Laparoscopic Cholecystectomy: A Nepalese Perspective

Introduction: Preoperative prediction of the factors leading to difficulty or conversion in cholecystectomy could help plan the surgical strategies and possible outcomes beforehand. The present study aimed to predict and analyze risk factors using a scoring system deemed responsible for surgical difficulties in patients undergoing cholecystectomy for symptomatic cholelithiasis. Methods: This hospital based prospective study was conducted at Department of Surgery, Lumbini Medical College and Teaching Hospital, Nepal. Various factors considered preoperatively were gender, age, previous history of hospitalization, impacted stone, obesity, gall bladder wall thickness, pericholecystic collection, previous abdominal scar and palpable gall bladder. Results: Among 177 cases operated, the mean age ±SD of the patients was 47.72±17.54 years. Conversion rate was 7.9 %. At preoperative score of 5; sensitivity, specificity, positive predictive value and negative predictive value were 89.40% (CI: 83.36%-93.82%), 69.23% (CI: 48.21 %-85.67%), 94.41%(CI: 90.44%-96.79%) and 52.94% (CI: 39.85%-65.64%) respectively{Area under curve– 0.74, p=0.0001, CI (0.637-0.846)}. Multivariate analysis showed abdominal scar {p=0.02, OR (CI): 5.2 (1.2-21.8)}, previous hospitalization {p=0.001, OR(CI): 6.8(2.2-20.8)} and thickened gall bladder wall {p= 0.03, OR(CI): 3.6(1.1-11.5)} to be statistically significant risk factors. Conclusion: With possible prediction beforehand, high risk group of patients can be identified and dealt accordingly to generate good surgical outcome avoiding complications

Axial Torsion and Meckel’s Diverticulitis: A Diagnostic Conundrum

Introduction: Meckel’s diverticulum is one the most common congenital anomalies of gastrointestinal tract that mimics acute appendicitis, gastroenteritis, peptic ulcer disease. Complications related to it can be haemorrhage, intestinal obstruction, perforation while axial torsion is one of the rarest complications. So, this paper objectifies a rare clinical scenario that we encountered in our practice and highlights on the possible management strategies. Case : An 11 year boy presented with a history of pain at peri-umbilical region for four days with 2-3 episodes of vomiting. Abdominal examination revealed tenderness at suprapubic area with a mass around 5x3 cm along hypogastrium. Ultrasonography abdomen revealed an avascular structure in central area with clumping of bowel and omentum over the lesion while computed tomography scan of abdomen revealed blind ended gas filled structure at hypogastrium with thickened enhancing irregular wall associated with adjacent mesenteric fat plane stranding and prominent adjacent axial vessels supplying inflammatory lesion. Exploratory laparotomy showed axial twisting of diverticulum about 10x5 cm arising from anti-mesenteric border around 50 cm proximal to ileo-caecal junction with a fibrous band attached to the fundus and ileum leading to gangrenous diverticulum with clumping of bowel loops along with omental covering. De-twisting and adhesiolysis along with excision of the diverticulum was done with two layered closure of the defect. Conclusion: Axial torsion is the rarest of the complication of MD and should be managed with utmost caution. Excision of the twisted diverticulum with or without wedge resection of the involved ileum is the procedure of choice

Metabolic Syndrome and Benign Prostatic Hyperplasia: A Nepalese Perspective

Introduction: Metabolic syndrome is defined as the presence of at least 3 of the following parameters: (1) waist circumference ≥ 90 cm, (2) triglycerides > 150 mg/dl or treatment for hypertriglyceridemia, (3) HDL-cholesterol < 40 mg/dl or treatment for reduced HDL-cholesterol, (4) blood pressure ≥ 130/85 mmHg or current use of antihypertensive medications, (5) fasting blood glucose ≥ 110 mg/dl or previous diagnosis of type-2 diabetes mellitus. It is closely associated with many diseases and recent studies have also shown its association with benign prostatic hyperplasia and lower urinary tract symptoms. Our study aimed to investigate association between metabolic syndrome and its components with benign prostatic hyperplasia among patients managed surgically in a tertiary centre in Western Nepal. Methods: One hundred and four patients above 50 years with benign prostatic hyperplasia managed in the department of Surgery over one year were included in the study. Results: Twenty-seven patients had metabolic syndrome (25.96%). There was association between metabolic syndrome and mean prostate size and among components of metabolic syndrome, high serum triglyceride and low HDL Cholesterol were found to be associated. There was increase in mean prostate size with increase in number of metabolic syndrome components which was statistically significant. Conclusion: Metabolic syndrome along with its two components, serum triglyceride and HDL Cholesterol were associated with increase in mean prostate size

Development of a collagen-based scaffold for sequential delivery of antimicrobial agents and pdgf genes to chronic wounds

Chronic wounds are a global health burden affecting more than 5 million people in the United States alone. The complex wound microenvironment causes variable therapeutic outcomes following treatment with commercially available products. Wound infection is one of the major barriers in healing of wounds and localized delivery of antimicrobials is necessary for treatment. Furthermore, growth factors play a vital role in orchestrating the wound healing process through enhancement of cell proliferation, migration, and extracellular matrix remodeling. Accordingly, we have developed a collagen-based scaffold modified with combination of vancomycin-loaded liposomes and platelet derived growth factor (PDGF)-loaded DNA polyplexes. Both the liposomes and polyplexes were anchored to collagen using collagen mimetic peptides (CMPs). Our aim was to use CMP tethering to control the sequential release of vancomycin and PDGF polyplexes to immediately suppress infection and subsequently transfect wound bed fibroblasts with PDGF to assist the wound healing process. Vancomycin-loaded liposomes were prepared using dipalmitoylphosphatidylcholine (DPPC), cholesterol, and 1,2-distearoyl-sn-glycero-3-phosphoethanolamine-N-[amino(polyethylene glycol)-2000] (DSPE-PEG). The liposomes were 160.7±2.1 nm in diameter based on dynamic light scattering (DLS) analyses, and the loading capacity of vancomycin was 51.5±0.7% in the liposomes. PDGF polyplexes (115.2±1.2 nm in diameter) were prepared by self-assembly of polyethyleneimine and PDGF plasmid DNA (N/P = 8) in 20 mM HEPES buffer (pH = 6.0), and successful PDGF gene loading was confirmed by agarose gel electrophoresis. Co-gels were prepared with collagen (4 mg/mL), fibrinogen (1.25 mg/mL), and thrombin (0.156 IU/mL) combinations that could successfully encapsulate both the vancomycin-loaded liposomes and PDGF polyplexes. Drug release studies confirmed that ~80% of the vancomycin was released during the 48 h study period, whereas PDGF polyplexes were retained longer (\u3e 5 days) in the gel because their release requires collagen degradation mediated by matrix metalloproteinases present in the wound bed. The ability of the PDGF polyplexes to transfect fibroblasts was confirmed by in vitro cell transfection studies using green fluorescent protein (GFP) as a model gene. Furthermore, polyplex-mediated PDGF transfection was evaluated in fibroblasts cultured in an in vitro culture wound model, which showed that PDGF transfection enhanced migration rates of fibroblasts by ~2.4 fold as compared to controls in which culture wounds were allowed to heal in the absence of polyplexes. These results showcase the capacity for sequential delivery of vancomycin and PDGF gene in vitro, using collagen-based scaffolds, for potential applications in in vivo chronic wound treatments

Predictive Factors for Post-Operative Bleeding in Percutaneous Nephrolithotomy.

Introduction: Post-operative bleeding is a serious complication necessitating prompt attention inPercutaneous Nephrolithotomy (PCNL). A number of factors dictate the severity of post-PCNL bleeding.Identification of these risk factors helps prevent bleeding complications. Methods: In this observationalcross-sectional study, a total of 126 patients with renal stones >10mm or stag-horn stones underwent PCNL.All the relevant pre- and intra-operative factors were noted and analyzed. Hemoglobin differences betweenpre- and post-operative levels were considered for the evaluation of blood loss. Univariate and multivariablelogistic regression analysis was done. The strength of association was examined using Odds Ratio and95% confidence intervals derived from the logistic regression. A p value <0.05 was considered statisticallysignificant. Results: The mean age of the patients was 31.9 ±4.47 years. The mean drop in hemoglobinwas 1.83 ±0.98 gm/dl. Age, stone size, number of tracts, size of Amplatz sheath and number of stonessignificantly affected the blood loss in univariate analysis. Among the variables mentioned above only, thenumber of stones could maintain the significance in multivariable analysis (p<0.05). The number of stonesincrease the risk of bleeding post PCNL by 4.4 times. Conclusion: Stone size, number of tracts, size ofAmplatz sheath and the number of stones significantly affect the blood loss post PCNL. Identification ofthese risk factors should be considered for minimizing bleeding in PCNL

Impact of artificial roughness variation on heat transfer and friction characteristics of solar air heating system

The present study describes the optimization of the spacer length parameter of perforated delta-shaped winglets (PDWs) imposed on the absorber plate of the solar air heater (SAH). An experimental set up is designed to analyze the influence of artificial roughness (AR) variation on the thermo-hydraulic performance of SAH. The variable parameter of the PDWs is the spacer length which varies from0 mm to 300 mm in steps of 100 mm. The impact of variation of on Nusselt number , friction factor and thermo-hydraulic performance is investigated. The fixed parameters of the PDWs are relative roughness height of perforated delta-shaped winglets = 0.8, relative longitudinal length of the perforated delta-shaped winglet = 2, relative transversal length of the perforated delta-shaped winglet = 0.66 and angle of incidence = 90°. The and of SAH provided with artificial roughened in the form of PDWs were improved by 5.17 and 4.52 times in comparison to SAH having smooth absorber plate. At the optimum value of spacer length = 0 mm and Re of 12000, attains a maximum value of 3.14 (>1). The study reveals the effectiveness of perforated delta winglets in the heat transfer augmentation of SAH

Morphological Changes in Carotid Arteries in Stroke Cases

Introduction: Majority of stroke is due to ischemic infarction and occurs in carotid artery territory. The  extra cranial parts of carotid arteries are the common sites for the atherosclerotic plaque formation. Ultrasonography is the first line of investigation for screening of the carotid artery diseases to localize and characterize the plaques. Objective was to study the morphological changes in extra cranial part of carotid arteries in cases of ischemic infarction using Ultrasonography. Methods: It was an institution based prospective study and convenience sampling method was used. Computed Tomography proven ischemic infarct, lacunar infarction and transient ischemic infarction cases were included in the study. Results: Fifty four cases were included in the study. Mean of Intimo-medial Complex Thickness was 0.89 mm and 0.88 mm in right and left side respectively. Sixty five percent cases had plaque in extra cranial part of carotid artery. Ninety three percent of plaque was found in and adjacent to the carotid bulb region. Ipsilateral plaque was found in 76% and 65% cases on right and left side respectively. Fifty three percent of cases had soft plaque. Majority of cases had less than 50% narrowing of the lumen diameter in term of cross-sectional area due to plaque. Thirteen (24%) cases had plaque in internal carotid artery. Conclusions: Carotid ultrasound can be used for screening of the asymptomatic but high-risk cases and following up of the symptomatic cases to plan for necessary management as required. Keywords: carotid artery, carotid ultrasonography, ischemic infarction, plaque