Understanding audiences from industry sectors in knowledge exchange

This essay discusses the concept of Knowledge Exchange between industry and academia. In particular it focuses on ways in which academic organisations can learn about different industry sectors in order to identify potential Knowledge Exchange partners and how they operate. Three case studies of scoping approaches taken in the understanding of these audiences are presented followed by a discussion of their different strengths and weaknesses. This essay concludes with presentation of an initial framework for scoping and suggestions for where this work can be developed in the future

Well Connected Blood Donation

This collaboration between the Experience Labs and the Scottish National Blood Transfusion Service (SNBTS) aimed to identify routes by which the SNBTS User Experience could be enhanced by introducing new ways of interaction for its staff and blood donors. A People-Centred Design Innovation approach was used to facilitate processes of co-enquiry and produce a proposed idea. The project involved three Labs with SNBTS staff during 2016, as well as design team synthesis sessions. Labs were designed around the design innovation process: problem identification; the development of user journeys; and prototyping practices; in order to define and develop elements of the desired user experience. The starting point was the desire to improve the staff resource, known as “The Browser”, which is primarily used to determine a donor’s eligibility to donate. Working closely with the SNBTS Blood Donation Teams helped the Experience Lab team to identify key issues in the blood donation system; to create an in-depth understanding of the pain points; and to understand the different ways staff use the existing digital system, its shortcomings, and how it ties into other parts of the blood donation process and SNBTS. This process created the required thinking space to generate and develop new ideas and solutions towards the creation of a “Well-Connected Blood Donation Experience” and an enhanced donation model for staff and donors. Consideration of the resulting design opportunities led to a development strategy that proposed the SNBTS tackle the identified issues on two fronts. Firstly, immediate alterations that could be made to the existing digital system to address issues raised by staff in the short term. Secondly, that the SNBTS could extend the Donor Portal under development to an integrated solution for staff and donors centred around three core concepts: Digital Donor ID, Interactive Maps and a Responsive DSR (Donor Session Record) to create a seamless donor and staff experience

Digital Diabetes Dudes

The Dudes project explored young people’s experiences of living with diabetes and how they would like to be supported in self-management using digital resources. In the early stages of development, Dudes is an interactive online education site for young people living with type 1 diabetes, situated within My Diabetes My Way. Dudes aims to support young people aged 17-25 years to understand selfmanagement for their lifestyle, and has been developed by a collaborative team from Edinburgh Napier University, NHS Lothian and the University of Dundee. It was accepted by the Digital Health & Care Institute as part of an integrated ‘Digital Diabetes’ programme of projects seeking to develop digital resources to support self-management. The Dudes Experience Lab took place in November 2016, following Pre- and General Labs exploring themes and questions that cut across the projects in the Digital Diabetes programme (commenced November 2015). This report describes the Experience Lab activity for the Dudes project and a detailed set of findings. It begins by providing project background and aims, and summarises the relevant findings of the Preand General Labs (described in full in previous reports). The findings are mapped onto the objectives of the Dudes project, presenting a detailed discussion of the current experiences of young people, in terms of the insights, attitudes and actions that relate to self-management. Feedback on existing resources for young people are presented, and information gaps and opportunities are identified. Finally, the report presents design requirements, concepts and scenarios of use for the enriched young person’s zone, and the conclusions of the Experience Lab Team

Digital Diabetes

The Digital Diabetes programme is a portfolio of seven promising innovation projects funded by the Digital Health & Care Institute (DHI) aiming to support engagement in self-management of diabetes.  Experience Labs were developed by the Institute of Design Innovation at The Glasgow School of Art, aiming to offer a safe and creative environment where researchers, businesses, civic partners and service users can collaborate on innovative solutions to the health and care challenges facing our society.  The aim of the Digital Diabetes Experience Labs was to bring together people living with diabetes, carers, clinicians and representatives from the voluntary sector to understand how people would like to be supported to engage in self-management. Three Experience Labs were designed and facilitated by the Experience Lab Team, involving: people living with diabetes in rural locations (Lab 1: Inverness), people living with diabetes in urban locations and carers (Lab 2: Glasgow), and health professionals and representatives from the third sector who support people living with diabetes (Lab 3: Perth).  The Lab findings are presented as a model of diabetes self-management, describing the key factors that determine how well someone will engage in self-management, and the people and things that support them.  Factors include the person’s attitude towards diabetes and the relative importance it has in their life and access to personal insight about their condition. Opportunities for new digital tools to support personal insight and positive attitudes towards diabetes were identified. Insightful and motivating conversations with trusted health professionals and their community (including peers and support organisations) were seen as key to supporting engagement in self-management. Further findings relate to the differences between type 1 and type 2 diabetes, in particular the need for short term insight to improve control of type 1, in contrast with the need for insight to relate short term decisions to longer term consequences for people living with type 2.  Three key opportunities for design innovation to support diabetes self-management were identified: i) tools to generate personal insight including visual presentation of data; ii) tools to support insightful and motivational conversations; and iii) tools to give feedback on progress

Digital Diabetes IDDEAS and GDS

The IDDEAS and GDS projects seek to develop innovative new resources for My Diabetes My Way* (MDMW) to support people living with diabetes to gain insight from health and lifestyle data to improve self-management. The IDDEAS and GDS projects were proposed by the Clinical and Technical Leads from the MDMW team, both based at the University of Dundee. The projects were accepted by the Digital Health & Care Institute as part of an integrated ‘Digital Diabetes’ programme of seven projects seeking to develop digital resources to support selfmanagement. The IDDEAS project aims to enable communication and data transfer between NHS Scotland diabetes platforms (MDMW and SCI-Diabetes) and third party and commercial products. This would give patients choice in terms of the application(s) they use to meet their needs. The GDS project aims to develop automated algorithms to analyse data obtained from home blood glucose monitoring and trigger automated clinical decision alerts and feedback for healthcare professionals and patients (via SMS) based on patterns in glucose readings. The technical aspects of the IDDEAS and GDS projects are being developed within DHI Factory projects. The Experience Lab Team were tasked with working with the intended end users to understand how they would like to collect, share, see and use their health and lifestyle data within MDMW, and understand the acceptability of the proposed innovations and how they could best support self-management. Experience Lab activity for these projects began with Pre-Labs in late 2015, and developed through General Labs in 2016, culminating in a dedicated Niche Lab in early 2017

Digital Diabetes Dashboard

The Digital Dashboard Experience Lab project explored what information is meaningful to share in a virtual consultation between a health professional and a person living with diabetes, and developed ideas for digital tools to support this experience. The project was proposed by partners at the University of the Highlands and Islands and NHS Highland, who are trialling video conferencing (VC) technology within virtual diabetes clinics to overcome increasing demand on the service and reduce travel burdens. The concept for the Dashboard emerged in response to challenges experienced in collaboratively discussing diabetes data during the virtual consultation. The project proposal was accepted by the Digital Health & Care Institute as part of an integrated ‘Digital Diabetes’ programme of projects seeking to develop digital resources to support self-management. The Digital Dashboard Experience Lab took place in December 2016, following Pre- and General Labs, which explored themes and questions that cut across the projects in the Digital Diabetes programme (commenced November 2015). This report describes the Experience Lab activity for the Digital Dashboard project and presents a detailed set of findings. It begins by providing project background and aims, and summarises the relevant findings of the Pre- and General Labs (described in full in previous reports). Three overarching themes emerged: Empowerment and Readiness, Equity and Collaboration, and Timeliness of Information and Insight; offering insight into the current consultation from the perspectives of both people living with diabetes and health professionals. These insights and ideas are mapped onto the Before, During and After stages of a virtual consultation, offering recommendations for the design of digital tools and content to support meaningful and personcentred consultations. The report sets out a concept for the ideal Digital Dashboard and explains its use throughout the virtual consultation. Finally, conclusions are presented, and next steps for the development of the Digital Dashboard are discussed

Defining the scope for altering rice leaf anatomy to improve photosynthesis: a modelling approach.

Leaf structure plays an important role in photosynthesis. However, the causal relationship and the quantitative importance of any single structural parameter to the overall photosynthetic performance of a leaf remains open to debate. In this paper, we report on a mechanistic model, eLeaf, which successfully captures rice leaf photosynthetic performance under varying environmental conditions of light and CO2. We developed a 3D reaction-diffusion model for leaf photosynthesis parameterised using a range of imaging data and biochemical measurements from plants grown under ambient and elevated CO2 and then interrogated the model to quantify the importance of these elements. The model successfully captured leaf-level photosynthetic performance in rice. Photosynthetic metabolism underpinned the majority of the increased carbon assimilation rate observed under elevated CO2 levels, with a range of structural elements making positive and negative contributions. Mesophyll porosity could be varied without any major outcome on photosynthetic performance, providing a theoretical underpinning for experimental data. eLeaf allows quantitative analysis of the influence of morphological and biochemical properties on leaf photosynthesis. The analysis highlights a degree of leaf structural plasticity with respect to photosynthesis of significance in the context of attempts to improve crop photosynthesis

Antimicrobial resistance among migrants in Europe: a systematic review and meta-analysis

BACKGROUND: Rates of antimicrobial resistance (AMR) are rising globally and there is concern that increased migration is contributing to the burden of antibiotic resistance in Europe. However, the effect of migration on the burden of AMR in Europe has not yet been comprehensively examined. Therefore, we did a systematic review and meta-analysis to identify and synthesise data for AMR carriage or infection in migrants to Europe to examine differences in patterns of AMR across migrant groups and in different settings. METHODS: For this systematic review and meta-analysis, we searched MEDLINE, Embase, PubMed, and Scopus with no language restrictions from Jan 1, 2000, to Jan 18, 2017, for primary data from observational studies reporting antibacterial resistance in common bacterial pathogens among migrants to 21 European Union-15 and European Economic Area countries. To be eligible for inclusion, studies had to report data on carriage or infection with laboratory-confirmed antibiotic-resistant organisms in migrant populations. We extracted data from eligible studies and assessed quality using piloted, standardised forms. We did not examine drug resistance in tuberculosis and excluded articles solely reporting on this parameter. We also excluded articles in which migrant status was determined by ethnicity, country of birth of participants' parents, or was not defined, and articles in which data were not disaggregated by migrant status. Outcomes were carriage of or infection with antibiotic-resistant organisms. We used random-effects models to calculate the pooled prevalence of each outcome. The study protocol is registered with PROSPERO, number CRD42016043681. FINDINGS: We identified 2274 articles, of which 23 observational studies reporting on antibiotic resistance in 2319 migrants were included. The pooled prevalence of any AMR carriage or AMR infection in migrants was 25·4% (95% CI 19·1-31·8; I2 =98%), including meticillin-resistant Staphylococcus aureus (7·8%, 4·8-10·7; I2 =92%) and antibiotic-resistant Gram-negative bacteria (27·2%, 17·6-36·8; I2 =94%). The pooled prevalence of any AMR carriage or infection was higher in refugees and asylum seekers (33·0%, 18·3-47·6; I2 =98%) than in other migrant groups (6·6%, 1·8-11·3; I2 =92%). The pooled prevalence of antibiotic-resistant organisms was slightly higher in high-migrant community settings (33·1%, 11·1-55·1; I2 =96%) than in migrants in hospitals (24·3%, 16·1-32·6; I2 =98%). We did not find evidence of high rates of transmission of AMR from migrant to host populations. INTERPRETATION: Migrants are exposed to conditions favouring the emergence of drug resistance during transit and in host countries in Europe. Increased antibiotic resistance among refugees and asylum seekers and in high-migrant community settings (such as refugee camps and detention facilities) highlights the need for improved living conditions, access to health care, and initiatives to facilitate detection of and appropriate high-quality treatment for antibiotic-resistant infections during transit and in host countries. Protocols for the prevention and control of infection and for antibiotic surveillance need to be integrated in all aspects of health care, which should be accessible for all migrant groups, and should target determinants of AMR before, during, and after migration. FUNDING: UK National Institute for Health Research Imperial Biomedical Research Centre, Imperial College Healthcare Charity, the Wellcome Trust, and UK National Institute for Health Research Health Protection Research Unit in Healthcare-associated Infections and Antimictobial Resistance at Imperial College London

Functional annotation of human long noncoding RNAs via molecular phenotyping

Long noncoding RNAs (lncRNAs) constitute the majority of transcripts in the mammalian genomes, and yet, their functions remain largely unknown. As part of the FANTOM6 project, we systematically knocked down the expression of 285 lncRNAs in human dermal fibroblasts and quantified cellular growth, morphological changes, and transcriptomic responses using Capped Analysis of Gene Expression (CAGE). Antisense oligonucleotides targeting the same lncRNAs exhibited global concordance, and the molecular phenotype, measured by CAGE, recapitulated the observed cellular phenotypes while providing additional insights on the affected genes and pathways. Here, we disseminate the largest-todate lncRNA knockdown data set with molecular phenotyping (over 1000 CAGE deep-sequencing libraries) for further exploration and highlight functional roles for ZNF213-AS1 and lnc-KHDC3L-2.Peer reviewe

Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study

Background: Surgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world. Methods: This international, prospective, multicentre cohort study included consecutive patients undergoing elective or emergency gastrointestinal resection within 2-week time periods at any health-care facility in any country. Countries with participating centres were stratified into high-income, middle-income, and low-income groups according to the UN's Human Development Index (HDI). Data variables from the GlobalSurg 1 study and other studies that have been found to affect the likelihood of SSI were entered into risk adjustment models. The primary outcome measure was the 30-day SSI incidence (defined by US Centers for Disease Control and Prevention criteria for superficial and deep incisional SSI). Relationships with explanatory variables were examined using Bayesian multilevel logistic regression models. This trial is registered with ClinicalTrials.gov, number NCT02662231. Findings: Between Jan 4, 2016, and July 31, 2016, 13 265 records were submitted for analysis. 12 539 patients from 343 hospitals in 66 countries were included. 7339 (58·5%) patient were from high-HDI countries (193 hospitals in 30 countries), 3918 (31·2%) patients were from middle-HDI countries (82 hospitals in 18 countries), and 1282 (10·2%) patients were from low-HDI countries (68 hospitals in 18 countries). In total, 1538 (12·3%) patients had SSI within 30 days of surgery. The incidence of SSI varied between countries with high (691 [9·4%] of 7339 patients), middle (549 [14·0%] of 3918 patients), and low (298 [23·2%] of 1282) HDI (p < 0·001). The highest SSI incidence in each HDI group was after dirty surgery (102 [17·8%] of 574 patients in high-HDI countries; 74 [31·4%] of 236 patients in middle-HDI countries; 72 [39·8%] of 181 patients in low-HDI countries). Following risk factor adjustment, patients in low-HDI countries were at greatest risk of SSI (adjusted odds ratio 1·60, 95% credible interval 1·05–2·37; p=0·030). 132 (21·6%) of 610 patients with an SSI and a microbiology culture result had an infection that was resistant to the prophylactic antibiotic used. Resistant infections were detected in 49 (16·6%) of 295 patients in high-HDI countries, in 37 (19·8%) of 187 patients in middle-HDI countries, and in 46 (35·9%) of 128 patients in low-HDI countries (p < 0·001). Interpretation: Countries with a low HDI carry a disproportionately greater burden of SSI than countries with a middle or high HDI and might have higher rates of antibiotic resistance. In view of WHO recommendations on SSI prevention that highlight the absence of high-quality interventional research, urgent, pragmatic, randomised trials based in LMICs are needed to assess measures aiming to reduce this preventable complication