Innovations in Health Care: Design Theory and Realist Evaluation Combined

Innovations in health care are often characterized by complexity and fuzzy boundaries, involving both the elements of the innovation and the organizational structure required for a full implementation. Evaluation in health care is traditionally based on the collection and dissemination of evidence-based knowledge stating the randomized controlled trial, and the quasi-experimental study design as the most rigorous and ideal approaches. These evaluation approaches capture neither the complexity of innovations in health care, nor the characteristics of the organizational structure of the innovation. As a result, the reasons for innovations in health care not being disseminated are not fully explained. The aim of the paper is to present a design-evaluation framework for complex innovations in health care in order to understand what works for whom under what circumstances combining design theory and realist evaluation. The framework is based on research findings of a case study of a complex innovation, a health care quality register, in order to understand underlying assumptions behind the design of the innovation, as well as the characteristics of the implementation process. The design-evaluation cycle is hypothesized to improve the design and implementation of complex innovation by using program/kernel theories to develop design principles, which are evaluated by realistic evaluation, resulting in further refinement of program/kernel theories. The goal of the design-evaluation cycle is to provide support to implementers and practitioners designing and implementing complex innovations in health care, for improving dissemination of complex innovations

A Novel Laser Vaccine Adjuvant Increases the Motility of Antigen Presenting Cells

Background Development of a potent vaccine adjuvant without introduction of any side effects remains an unmet challenge in the field of the vaccine research. Methodology/Principal Findings We found that laser at a specific setting increased the motility of antigen presenting cells (APCs) and immune responses, with few local or systemic side effects. This laser vaccine adjuvant (LVA) effect was induced by brief illumination of a small area of the skin or muscle with a nondestructive, 532 nm green laser prior to intradermal (i.d.) or intramuscular (i.m.) administration of vaccines at the site of laser illumination. The pre-illumination accelerated the motility of APCs as shown by intravital confocal microscopy, leading to sufficient antigen (Ag)-uptake at the site of vaccine injection and transportation of the Ag-captured APCs to the draining lymph nodes. As a result, the number of Ag+ dendritic cells (DCs) in draining lymph nodes was significantly higher in both the 1° and 2° draining lymph nodes in the presence than in the absence of LVA. Laser-mediated increases in the motility and lymphatic transportation of APCs augmented significantly humoral immune responses directed against a model vaccine ovalbumin (OVA) or influenza vaccine i.d. injected in both primary and booster vaccinations as compared to the vaccine itself. Strikingly, when the laser was delivered by a hair-like diffusing optical fiber into muscle, laser illumination greatly boosted not only humoral but also cell-mediated immune responses provoked by i.m. immunization with OVA relative to OVA alone. Conclusion/Significance The results demonstrate the ability of this safe LVA to augment both humoral and cell-mediated immune responses. In comparison with all current vaccine adjuvants that are either chemical compounds or biological agents, LVA is novel in both its form and mechanism; it is risk-free and has distinct advantages over traditional vaccine adjuvants.National Institutes of Health (U.S.) (grant AI070785)National Institutes of Health (U.S.) (grant RC1 DA028378)Bill & Melinda Gates Foundation (Grand Challenges Explorations grant # 53273)Boston BioCom (Firm) (Sponsored Research agreement grant #2008A25652

ZBED6, a Novel Transcription Factor Derived from a Domesticated DNA Transposon Regulates IGF2 Expression and Muscle Growth

This study identifies a previously uncharacterized protein, encoded by a domesticated DNA transposon, called ZBED6 that regulates the expression of the insulin-like growth factor 2 (IGF2) gene, and possibly numerous others, in all placental mammals including human

Designing for Complex Innovations in Health Care : Design Theory and Realist Evaluation Combined

Innovations in health care are often characterized by complexity and fuzzy boundaries, involving both the elements of the innovation and the organizational structure required for a full implementation. Evaluation in health care is traditionally based on the collection and dissemination of evidence-based knowledge stating the randomized controlled trial, and the quasi-experimental study design as the most rigorous and ideal approaches. These evaluation approaches capture neither the complexity of innovations in health care, nor the characteristics of the organizational structure of the innovation. As a result, the reasons for innovations in health care not being disseminated are not fully explained. The aim of the paper is to present a design – evaluation framework for complex innovations in health care in order to understand what works for whom under what circumstances by combining design theory and realist evaluation. The framework is based on research findings of a case study of a complex innovation, a health care quality register, in order to understand underlying assumptions behind the design of the innovation, as well as the characteristics of the implementation process. The design - evaluation cycle is hypothesized to improve the design and implementation of complex innovation by using program/kernel theories to develop design propositions, which are evaluated by realistic evaluation, resulting in further refinement of program/kernel theories. The goal of the design – evaluation cycle is to provide support to implementers and practitioners in designing and implementing complex innovations in health care. As a result, the design – evaluation cycle could provide opportunities of improving dissemination of complex innovations in health care

Development of a Cooled Radial Flameholder for the F404/RM12 Afterburner: Part III Afterburner Rumble Prediction and Suppression

One-dimensional methods used for solving acoustic instabilities are of doubtful value in the design of afterburner systems. In this paper a three-dimensional method developed and used at Volvo Aero Corporation is described. The method deals with the mean flow and the perturbation flow separately. The perturbation part is based on the linearized Euler equations (time domain) for compressible multi-species flow together with a spectrum trans-formation and Arnoldis method for eigenmode extraction

Development of a Cooled Radial Flameholder for the F404/RM12 Afterburner: Part III Afterburner Rumble Prediction and Suppression

One-dimensional methods used for solving acoustic instabilities are of doubtful value in the design of afterburner systems. In this paper a three-dimensional method developed and used at Volvo Aero Corporation is described. The method deals with the mean flow and the perturbation flow separately. The perturbation part is based on the linearized Euler equations (time domain) for compressible multi-species flow together with a spectrum trans-formation and Arnoldis method for eigenmode extraction