Working with the public sector:SME medical device innovation and pre-procurement

Healthcare providers are under ever increasing pressure to deliver more technologically advanced care without increasing costs. Innovation is essential (Darzi, 2008), and for this healthcare providers rely on innovation within commercial companies. SMEs have an important part to play in this sector (NHS Supply Chain Parliamentary Brief, 2013). Collaboration between SME suppliers and the NHS for innovation forms the focus of this paper. We examine the academic literature on interorganizational innovation including academic insights from the areas of forward commitment procurement (Environmental Innovation Advisory Group, 2003-2008), pre-commercial procurement (Bos & Corvers, 2007), innovation and SMEs. We then explore practice, first from a policy and business sector perspective. Second, we present evidence from fifteen cases of interorganizational innovation projects involving SMEs and UK healthcare providers. Our findings show much effort is being put into creating opportunities for more interorganizational innovation of medical devices. Working across organizational boundaries presents added complexity to the innovation environment and process, and the challenge of developing high-quality cross-boundary group interaction.

Beyond maternal death: improving the quality of maternal care through national studies of ‘near-miss’ maternal morbidity

Knight M, Acosta C, Brocklehurst P, Cheshire A, Fitzpatrick K, Hinton L, Jokinen M, Kemp B, Kurinczuk JJ, Lewis G, Lindquist A, Locock L, Nair M, Patel N, Quigley M, Ridge D, Rivero-Arias O, Sellers S, Shah A on behalf of the UKNeS coapplicant group. Background Studies of maternal mortality have been shown to result in important improvements to women’s health. It is now recognised that in countries such as the UK, where maternal deaths are rare, the study of near-miss severe maternal morbidity provides additional information to aid disease prevention, treatment and service provision. Objectives To (1) estimate the incidence of specific near-miss morbidities; (2) assess the contribution of existing risk factors to incidence; (3) describe different interventions and their impact on outcomes and costs; (4) identify any groups in which outcomes differ; (5) investigate factors associated with maternal death; (6) compare an external confidential enquiry or a local review approach for investigating quality of care for affected women; and (7) assess the longer-term impacts. Methods Mixed quantitative and qualitative methods including primary national observational studies, database analyses, surveys and case studies overseen by a user advisory group. Setting Maternity units in all four countries of the UK. Participants Women with near-miss maternal morbidities, their partners and comparison women without severe morbidity. Main outcome measures The incidence, risk factors, management and outcomes of uterine rupture, placenta accreta, haemolysis, elevated liver enzymes and low platelets (HELLP) syndrome, severe sepsis, amniotic fluid embolism and pregnancy at advanced maternal age (≥ 48 years at completion of pregnancy); factors associated with progression from severe morbidity to death; associations between severe maternal morbidity and ethnicity and socioeconomic status; lessons for care identified by local and external review; economic evaluation of interventions for management of postpartum haemorrhage (PPH); women’s experiences of near-miss maternal morbidity; long-term outcomes; and models of maternity care commissioned through experience-led and standard approaches. Results Women and their partners reported long-term impacts of near-miss maternal morbidities on their physical and mental health. Older maternal age and caesarean delivery are associated with severe maternal morbidity in both current and future pregnancies. Antibiotic prescription for pregnant or postpartum women with suspected infection does not necessarily prevent progression to severe sepsis, which may be rapidly progressive. Delay in delivery, of up to 48 hours, may be safely undertaken in women with HELLP syndrome in whom there is no fetal compromise. Uterine compression sutures are a cost-effective second-line therapy for PPH. Medical comorbidities are associated with a fivefold increase in the odds of maternal death from direct pregnancy complications. External reviews identified more specific clinical messages for care than local reviews. Experience-led commissioning may be used as a way to commission maternity services. Limitations This programme used observational studies, some with limited sample size, and the possibility of uncontrolled confounding cannot be excluded. Conclusions Implementation of the findings of this research could prevent both future severe pregnancy complications as well as improving the outcome of pregnancy for women. One of the clearest findings relates to the population of women with other medical and mental health problems in pregnancy and their risk of severe morbidity. Further research into models of pre-pregnancy, pregnancy and postnatal care is clearly needed.

Multi-physics modelling - A vital component of virtual manufacturing

One of the core tasks of the virtual-manufacturing environment is to characterise the transformation of the state of material during each of the unit processes. This transformation in shape, material properties, etc. can only be reliably achieved through the use of models in a simulation context. Unfortunately, many manufacturing processes involve the material being treated in both the liquid and solid state, the trans-formation of which may be achieved by heat transfer and/or electro-magnetic fields. The computational modelling of such processes, involving the interactions amongst various interacting phenomena, is a consider-able challenge. However, it must be addressed effectively if Virtual Manufacturing Environments are to become a reality! This contribution focuses upon one attempt to develop such a multi-physics computational toolkit. The approach uses a single discretisation procedure and provides for direct interaction amongst the component phenomena. The need to exploit parallel high performance hardware is addressed so that simulation elapsed times can be brought within the realms of practicality. Examples of Multiphysics modelling in relation to shape casting, and solder joint formation reinforce the motivation for this work.

Collecting banana diversity in eastern Indonesia

Major diseases, including Fusarium wilt tropical race 4, threaten banana production systems worldwide. New sources of genetic resistance are considered necessary in the fight against such diseases. The triangular region of Indonesia taking in Sulawesi, the Maluku Islands and Lesser Sunda Islands was prioritized by the Global Musa Genetic Resources Network, MusaNet for exploration and collecting. It is just east of the Wallace Line, which is recognized as a transition zone for flora in southeast Asia, and had been little explored. Bioversity International funded a team of scientists from Indonesia and Australia to make collecting missions in the triangle in October 2012 and February 2013. Suckers and seeds of 35 promising new accessions were collected. About 90% of these are either wild species or diploid cultivars of more direct use to breeding programs. These were morphologically characterized during the collecting missions and included a set of photographs recommended by Bioversitys Taxonomic Advisory Group. Cigar leaf samples were also collected and sent as fresh samples to the International Banana Genotyping Centre in the Czech Republic. Ploidy and DNA (SSR) genotyping determinations from these samples have been invaluable in quickly interpreting and better appreciating what has been discovered. The new accessions have been grown on at Solok field collection, West Sumatra and will be made available by Indonesia to the international community, including breeding programs, for evaluation and utilization. Information on wild Eumusa prompts a rethinking of the phytogeography of Musa acuminata. The variation within the Australimusa species M. lolodensis highlights the need for broader study of this Musa section. French Plantain-like edible AAs and prospects for the generation of African plantains in the region were identified. The mission indicated existence of local edible ABs in eastern Indonesia in association with balbisiana hybrids origins in the region. Further explorations in the region should add to Musa diversity knowledge.

Functional outcomes in the Cleft Care UK study - Part 3:oral health and audiology

OBJECTIVES: To compare oral health and hearing outcomes from the Clinical Standards Advisory Group (CSAG, 1998) and the Cleft Care UK (CCUK, 2013) studies. SETTING AND SAMPLE POPULATION: Two UK-based cross-sectional studies of 5-year-olds born with non-syndromic unilateral cleft lip and palate undertaken 15 years apart. CSAG children were treated in a dispersed model of care with low-volume operators. CCUK children were treated in a centralized, high volume operator system. MATERIALS AND METHODS: Oral health data were collected using a standardized proforma. Hearing was assessed using pure tone audiometry and middle ear status by otoscopy and tympanometry. ENT and hearing history were collected from medical notes and parental report. RESULTS: Oral health was assessed in 264 of 268 children (98.5%). The mean dmft was 2.3, 48% were caries free, and 44.7% had untreated caries. There was no evidence this had changed since the CSAG survey. Oral hygiene was generally good, 96% were enrolled with a dentist. Audiology was assessed in 227 of 268 children (84.7%). Forty-three per cent of children received at least one set of grommets--a 17.6% reduction compared to CSAG. Abnormal middle ear status was apparent in 50.7% of children. There was no change in hearing levels, but more children with hearing loss were managed with hearing aids. CONCLUSIONS: Outcomes for dental caries and hearing were no better in CCUK than in CSAG, although there was reduced use of grommets and increased use of hearing aids. The service specifications and recommendations should be scrutinized and implemented.

A cross-sectional survey of 5-year-old children with non-syndromic unilateral cleft lip and palate:the Cleft Care UK study. Part 1: background and methodology

OBJECTIVES: We describe the methodology for a major study investigating the impact of reconfigured cleft care in the United Kingdom (UK) 15 years after an initial survey, detailed in the Clinical Standards Advisory Group (CSAG) report in 1998, had informed government recommendations on centralization. SETTING AND SAMPLE POPULATION: This is a UK multicentre cross-sectional study of 5-year-olds born with non-syndromic unilateral cleft lip and palate. Children born between 1 April 2005 and 31 March 2007 were seen in cleft centre audit clinics. MATERIALS AND METHODS: Consent was obtained for the collection of routine clinical measures (speech recordings, hearing, photographs, models, oral health, psychosocial factors) and anthropometric measures (height, weight, head circumference). The methodology for each clinical measure followed those of the earlier survey as closely as possible. RESULTS: We identified 359 eligible children and recruited 268 (74.7%) to the study. Eleven separate records for each child were collected at the audit clinics. In total, 2666 (90.4%) were collected from a potential 2948 records. The response rates for the self-reported questionnaires, completed at home, were 52.6% for the Health and Lifestyle Questionnaire and 52.2% for the Satisfaction with Service Questionnaire. CONCLUSIONS: Response rates and measures were similar to those achieved in the previous survey. There are practical, administrative and methodological challenges in repeating cross-sectional surveys 15 years apart and producing comparable data.

Centralization of cleft care in the UK. Part 6:a tale of two studies

OBJECTIVES: We summarize and critique the methodology and outcomes from a substantial study which has investigated the impact of reconfigured cleft care in the United Kingdom (UK) 15 years after the UK government started to implement the centralization of cleft care in response to an earlier survey in 1998, the Clinical Standards Advisory Group (CSAG). SETTING AND SAMPLE POPULATION: A UK multicentre cross-sectional study of 5-year-olds born with non-syndromic unilateral cleft lip and palate. Data were collected from children born in the UK with a unilateral cleft lip and palate between 1 April 2005 and 31 March 2007. MATERIALS AND METHODS: We discuss and contextualize the outcomes from speech recordings, hearing, photographs, models, oral health and psychosocial factors in the current study. We refer to the earlier survey and other relevant studies. RESULTS: We present arguments for centralization of cleft care in healthcare systems, and we evidence this with improvements seen over a period of 15 years in the UK. We also make recommendations on how future audit and research may configure. CONCLUSIONS: Outcomes for children with a unilateral cleft lip and palate have improved after the introduction of a centralized multidisciplinary service, and other countries may benefit from this model. Predictors of early outcomes are still needed, and repeated cross-sectional studies, larger longitudinal studies and adequately powered trials are required to create a research-led evidence-based (centralized) service.

Small states and the promotion of their foreign policy agenda in the international scenario: Trinidad and Tobago and the Kyoto Protocol

Este estudio de caso busca identificar los elementos del portafolio de política exterior de Trinidad y Tobago que le permitieron promover exitosamente sus intereses en el Protocolo de Kioto. Al hacer esto, este texto analizará las limitaciones de Trinidad y Tobago en términos de vulnerabilidades de localización, burocracia y recursos. Posteriormente, una revisión del portafolio de política exterior de este Estado ilustrará el uso de estrategias de creación de capacidades y de organización como lo son el contacto con actores institucionales y no gubernamentales, la formación de coaliciones y estrategias argumentativas, entre otras. Finalmente, este artículo concluirá que dichas acciones permitieron la promoción de la agenda de política exterior de Trinidad y Tobago a través de la creación de hojas de ruta y la coordinación de la incertidumbre con el Protocolo de Kioto. Para hacer esto, este trabajo se concentrará en examinar conceptos como vulnerabilidad y priorización, asimismo contrastando diferentes artículos académicos en la materia junto con documentos oficiales de Trinidad y Tobago.

Informe de la Reunión del Grupo de Expertos Asesor del Grupo Latinoamericano en la Comisión Preparatoria de la Autoridad Internacional de los Fondos Marinos y del Tribunal Internacional del Derecho del Mar = Report of the Meeting of the Ad-hoc Advisory Expert Group of the Latin American Group in the Preparatory Commission for the International Sea-Bed Authority and for the International Tribunal for the Law of the Sea

Contiene la asistencia, organización de los trabajos y resumen de los debates de la reunión convocada con el propósito de analizar fórmulas para el fortalecimiento de la capacidad negociadora de los grupos latinoamericanos en foros internacionales relacionados con el desarrollo de los recursos marinos.

Watershed Planning Advisory Council 2015 Annual Report, December 10, 2015

The Watershed Planning Advisory Council (WPAC) was established by the Iowa Legislature (see Appendix A: Iowa Code 466B.31) to assemble a diverse group of stakeholders to make recommendations to state and federal agencies to protect water resources in Iowa. In 2015, WPAC prioritized the seven areas for recommendations outlined in 466B.31, and small work groups drafted recommendations for approval by the full membership.