Innovation and technology transfer in the health sciences: a cross-sectional perspective

This article is based on the strategic reflection and discussion that took place on occasion of the first conference on innovation and technology transfer in the health sciences organized by the REGIC-ENS-FENIN-SEMICYUC and held in Madrid in the Instituto de Salud Carlos III on May 7th, 2013, with the aim of promoting the transfer of technological innovation in medicine and health care beyond the European program "Horizon 2020". The presentations dealt with key issues such as evaluation of the use of new technologies, the need to impregnate the decisions related to adoption and innovation with the concepts of value and sustainability, and the implication of knowledge networks in the need to strengthen their influence upon the creation of a "culture of innovation" among health professionals. But above all, emphasis was placed on the latent innovation potential of hospitals, and the fact that these, being the large companies that they are, should seriously consider that much of their future sustainability may depend on proper management of their ability to generate innovation, which is not only the generation of ideas but also their transformation into products or processes that create value and economic returns.

MORE THAN MONEY: THE EXPONENTIAL IMPACT OF ACADEMIC TECHNOLOGY TRANSFER

Academic technology transfer in its current form began with the passage of the Bayh-Dole Act in 1980, which allowed universities to retain ownership of federally funded intellectual property. Since that time, a profession has evolved that has transformed how inventions arising in universities are treated, resulting in significant impact to US society. While there have been a number of articles highlighting benefits of technology transfer, now, more than at any other time since the Bayh-Dole Act was passed, the profession and the impacts of this groundbreaking legislation have come under intense scrutiny. This article serves as an examination of the many positive benefits and evolution, both financial and intrinsic, provided by academic invention and technology transfer, summarized in Table 1.

From cultural traditions to cumulative culture: parameterizing the differences between human and nonhuman culture

Diverse species exhibit cultural traditions, i.e. population-specific profiles of socially learned traits, from songbird dialects to primate tool-use behaviours. However, only humans appear to possess cumulative culture, in which cultural traits increase in complexity over successive generations. Theoretically, it is currently unclear what factors give rise to these phenomena, and consequently why cultural traditions are found in several species but cumulative culture in only one. Here, we address this by constructing and analysing cultural evolutionary models of both phenomena that replicate empirically attestable levels of cultural variation and complexity in chimpanzees and humans. In our model of cultural traditions (Model 1), we find that realistic cultural variation between populations can be maintained even when individuals in different populations invent the same traits and migration between populations is frequent, and under a range of levels of social learning accuracy. This lends support to claims that putative cultural traditions are indeed cultural (rather than genetic) in origin, and suggests that cultural traditions should be widespread in species capable of social learning. Our model of cumulative culture (Model 2) indicates that both the accuracy of social learning and the number of cultural demonstrators interact to determine the complexity of a trait that can be maintained in a population. Combining these models (Model 3) creates two qualitatively distinct regimes in which there are either a few, simple traits, or many, complex traits. We suggest that these regimes correspond to nonhuman and human cultures, respectively. The rarity of cumulative culture in nature may result from this interaction between social learning accuracy and number of demonstrators.

The use of real-time feedback via wireless technology to improve hand hygiene compliance

BACKGROUND

Hand hygiene (HH) is widely regarded as the most effective preventive measure for health care-associated infection. However, there is little robust evidence on the best interventions to improve HH compliance or whether a sustained increase in compliance can reduce rates of health care-associated infection.

METHODS

To evaluate the effectiveness of a real-time feedback to improve HH compliance in the inpatient setting, we used a quasiexperimental study comparing the effect of real-time feedback using wireless technology on compliance with HH. The study was conducted in two 20-bed step-down units at a private tertiary care hospital. Phase 1 was a 3-month baseline period in which HH counts were performed by electronic handwash counters. After a 1-month washout period, a 7-month intervention was performed in one step-down unit while the other unit served as a control.

RESULTS

HH, as measured by dispensing episodes, was significantly higher in the intervention unit (90.1 vs 73.1 dispensing episodes/patient-day, respectively, P = .001). When the intervention unit was compared with itself before and after implementation of the wireless technology, there was also a significant increase in HH after implementation (74.5 vs 90.1 episodes/patient-day, respectively, P = .01). There was also an increase in mean alcohol-based handrub consumption between the 2 phases (68.9 vs 103.1 mL/patient-day, respectively, P = .04) in the intervention unit.

CONCLUSION

We demonstrated an improvement in alcohol gel usage via implementation of real-time feedback via wireless technology.

From technological acceptability to appropriation by users: methodological steps for device assessment in road safety

This article presents the methodology developed within the framework of the research project SARI (Automated Road Surveillance for Driver and Administrator Information). This methodology is based on the logic of action research. The article presents the different stages in the development of technological innovation addressing vehicle control loss when driving on a curve. The results observed in speed reduction illustrate that no matter how optimal an innovation may be technologically speaking, it is only as effective as it is acceptable from a user standpoint. This acceptability can only be obtained if the technology is developed by engineers in liaison with social science specialists.

State Investments in Psychiatric Innovation: Investigating Unmeasured State Factors

We apply three separate panel data estimation methods to examine the diffusion of technologies at the state-level. These methods include the Hausman-Taylor random effects model, the fixed effects vector decomposition (FEVD), and generalized estimating equations (GEE). We discuss the assumptions required of each and assess the stability of our policy results across the three models for a longitudinal study of the diffusion of newer psychotropic technologies. We find a reasonable level of consistency among marginal effects for time varying independent variables between our three estimation methods but some discrepancy in the estimated measure of precision in our empirical application. We find a number of policy conclusions are quite stable across estimation methods and may be of interest to state-level mental health policy decision makers.

Gamification: The Intersection between Behavior Analysis and Game Design Technologies

Deterding et al. (Proceedings of the 15th International Academic MindTrek Conference: Envisioning Future Media Environments, USA 15: 9-15, 2011) report a recent rise in popularity of video game inspired software designed to address issues in a variety of areas, including health, energy conservation, education, and business. These applications have been based on the concept of gamification, which involves a process by which nongame activities are designed to be more like a game. We provide examples of how gamification has been used to increase health-related behavior, energy consumption, academic performance, and other socially-significant behavior. We argue that behavior analytic research and practice stands to benefit from incorporating successful elements of game design. Lastly, we provide suggestions for behavior analysts regarding applied and basic research related to gamification.

Special funding schemes for innovative medical devices in French hospitals: the pros and cons of two different approaches

Financing innovative medical devices is an important challenge for national health policy makers, and a crucial issue for hospitals. However, when innovative medical devices are launched on the European market there is generally little clinical evidence regarding both efficacy and safety, both because of the flaws in the European system for regulating such devices, and because they are at an early stage of development. To manage the uncertainty surrounding the reimbursement of innovation, several European countries have set up temporary funding schemes to generate evidence about the effectiveness of devices. This article explores two different French approaches to funding innovative in-hospital devices and collecting supplementary data: the coverage with evidence development (CED) scheme introduced under Article L. 165-1-1 of the French Social Security Code; and national programs for hospital-based research. We discuss pros and cons of both approaches in the light of CED policies in Germany and the UK. The CED policies for devices share common limitations. Thus, transparency of CED processes should be enhanced and decisions need to be made in a timely way. Finally, we think that closer collaboration between manufacturers, health authorities and hospitals is essential to make CED policies more operational.

Innovation in pediatric surgery: the surgical innovation continuum and the ETHICAL model

Innovations are indispensable to the practice and advancement of pediatric surgery. Children represent a special type of vulnerable population and must be protected since they do not have legal capacity to consent, and their parent's judgment may be compromised in circumstances when the child is very ill or no adequate therapy exists. In an effort to protect patients, legislators could pass and enforce laws that prohibit or curtail surgical innovations and thus stifle noble advancement of the practice. The goals of this paper are, 1) To clearly define the characteristics of surgical innovation types so interventions may be classified into 1 of 3 distinct categories along a continuum: Practice Variation, Transition Zone, and Experimental Research, and 2) To propose a practical systematic method to guide surgeon decision-making when approaching interventions that fall into the "Transition Zone" category on the Surgical Intervention Continuum. The ETHICAL model allows those that know the intricacies and nuances of pediatric surgery best, the pediatric surgeons and professional pediatric surgical societies, to participate in self-regulation of innovation in a manner that safeguards patients without stifling creativity or unduly hampering surgical progress.

Research and development in drug innovation: reflections from the 2013 bioeconomy conference in China, lessons learned and future perspectives

The enormous progress biotechnology, bioinformatics and nanotechnology made in recent years provides opportunities and scientific framework for development of biomedicine and constitutes a paradigm shift in pharmaceutical R&D and drug innovation. By analyzing the data and related information at R&D level over the past decades, developmental tendency and R&D patterns were summarized. We found that a growing number of biologics in the pipeline of pharma companies with successful products already in the market though, small molecular entities have primarily dominated drug innovation. Additionally, small/medium size companies will continue to play a key role in the development of small molecule drugs and biologics in a multi-channel integrated process. More importantly, modern and effective R&D strategies in biomedicine development to predict and evaluate efficacy and/or safety of 21st century therapeutics are urgently needed. To face new challenges, developmental strategies were proposed, in terms of molecular targeted medicine, generic drugs, new drug delivery system and protein-based drugs. Under the current circumstances, interdisciplinary cooperation mode and policy related to drug innovation in China were deeply discussed as well.

The impact of pharmaceutical innovation on longevity and medical expenditure in France, 2000-2009

Longitudinal, disease-level data are used to analyze the impact of pharmaceutical innovation on longevity (mean age at death) and medical expenditure in France during the period 2000-2009. The estimates imply that pharmaceutical innovation increased mean age at death by 0.29 years (3.43 months) during this period-about one-fifth of the total increase in longevity. This estimate is smaller than those obtained in previous studies of Germany and the U.S., but the rate of adoption of new drugs was lower in France. Longevity is much more strongly related to the number of drugs than it is to the number of drug classes. Pharmaceutical innovation during 2000-2009 is estimated to have increased per capita pharmaceutical expenditure by $125 (26%) in 2009, but most (87%) of this increase was offset by a reduction in hospital expenditure. The baseline estimate of the cost per life-year gained from pharmaceutical innovation in France during 2000-2009 is about $8100. This estimate is fairly close to the mean of estimates obtained ($10,800) from U.S., German, and Australian studies.

[Strengths and future of the Revista Médica del Instituto Mexicano del Seguro Social]

The journals of medicine arose as a communication tool more than 200 years ago. At the beginning, their nature was local; later, their aim was to spread medical information along the nation; and, finally, they sought to reach the world distribution. The Revista Médica del Instituto Mexicano del Seguro Social was published for the first time 52 years ago, and it has walked its way from local to international distribution. This journal has 23 000 subscribers, it is included in Medline and it reached a 0.112 SCImago Journal Rank in 2012. Its website receives around 200 000 visits monthly and 45 % are foreign visits. In the future, the peer review system is going to be strengthened, and the journal is going to offer audio, video, and applications to reinforce interactive participation between authors, readers in order to reach modernity and draw young new attention.

Greening, new frontiers for research and employment in the agro-food sector

The "greening" of the European Union's (EU) Common Agricultural Policy (CAP) is meant to protect and enhance biodiversity as well as to make food production more sustainable by encouraging, for example, the responsible use of natural resources. The "greening" process seems to be driven by, first of all, the policy push through various policy and regulatory measures. Farmers have to invest time and resources in maintaining permanent grasslands, practice crop diversification and manage ecological focus areas for which they will receive compensation from the EU. "Greening" is also driven by the consumer or market pull generated by preferences for more sustainably produced food and sustainability initiatives along the agro-food chain. EU investments in research and development activities are required for the successful implementation of greening practices. Professionals from different disciplines are called upon to provide, in the next few years, solutions for all the new requirements in order to realize a sustainable and socially and economically healthy agricultural system. Besides this, farmers need support to implement and manage greening measures, but also to reap the benefits of their investments by networking and engaging with stakeholders higher in the agro-food chain, such as retailers and supermarkets. This is not only to assure sustainability at processing, packaging and storage, but also to increase visibility of farmers' practices to consumers through communication that may help influencing consumers' choices. These factors are currently not given the importance they need by the EU, but are crucial for a successful "greening".

Competitiveness measurement system in the advertising sector

In this paper a new approach to find indicators that can be used to measure companies’ competitiveness and performance in an efficient and reliable way is presented.

The aim is to assist managers of companies within a specific industrial sector by providing information about their relative position in the market so as to define better action plans that may improve the company’s performance.

The approach combines the use of the Analytic Network Process, a multicriteria decision method, with the Balanced Scorecard. It allows the definition of a number of competitiveness indicators based on the performance and setting of the advertising sector. In this way it is possible to obtain a Competitiveness Index that allows a company to know its relative position with respect to other companies in the sector, and establish a ranking of the companies ordered by their competitiveness level.

A case study in the advertising industry of Venezuela is provided. Results show that improvement plans for the agencies analyzed should promote creativity, innovation and the use of new technologies, as a particular form of innovation. These factors were considered to be the most relevant indicators in the advertising sector.

The participating experts agreed that the methodology is useful and an improvement over current competitiveness assessment methods.

Cumulative cultural evolution: the role of teaching

In humans, cultural transmission occurs usually by cumulative inheritance, generating complex adaptive behavioral features. Cumulative culture requires key psychological processes (fundamentally imitation and teaching) that are absent or impoverished in non-human primates. In this paper we analyze the role that teaching has played in human cumulative cultural evolution. We assume that a system of cumulative culture generates increasingly adaptive behaviors, that are also more complex and difficult to imitate. Our thesis is that, as cultural traits become more complex, cumulative cultural transmission requires teaching to ensure accurate transmission from one generation to the next. In an increasingly complex cultural environment, we consider that individuals commit errors in imitation. We develop a model of cumulative cultural evolution in a changing environment and show that these errors hamper the process of cultural accumulation. We also show that a system of teaching between parents and offspring that increases the fidelity of imitation unblocks the accumulation and becomes adaptive whenever the gain in fitness compensates the cost of teaching.

Designing interactivity on consumer health websites: PARAFORUM for spinal cord injury

OBJECTIVE

This paper addresses the issue of interactivity on health consumer websites powered by health organizations, by presenting the design of PARAFORUM, an interactive website in the field of spinal cord injury (SCI).

METHODS

The design of PARAFORUM is based on different streams of research in online health communication, web-based communities, open innovation communities and formative evaluation with stakeholders.

RESULTS

PARAFORUM implements a model of diversified interactivity based on individuals with SCI and their families, health professionals, and researchers sharing their expertise in SCI. In addition to traditional health professional/researcher-to-consumer and peer-to-peer interactions, through PARAFORUM consumers, health professionals and researchers can co-design ideas for the enhancement of practice and research on SCI.

CONCLUSION

There is the need to reflect on the conceptualization and operationalization of interactivity on consumer health websites. Interactions between different users can make these websites important platforms for promoting self-management of chronic conditions, organizational innovation, and participatory research.

PRACTICE IMPLICATIONS

Interactivity on consumer health websites is a main resource for health communication. Health organizations are invited to build interactive websites, by considering, however, that the exploitation of interactivity require users' collaboration, processes and standards for managing content, creating and translating knowledge, and conducting internet-based studies.

Enabling ICH Q10 Implementation--Part 1. Striving for Excellence by Embracing ICH Q8 and ICH Q9

This article is the first in a series of articles that will focus on understanding the implementation essentials necessary to deliver operational excellence through a International Conference on Harmonisation of Technical Requirements for Registration of Pharmaceuticals for Human Use (ICH) Q10-based pharmaceutical quality system (PQS). The authors examine why, despite the fact that the ICH Q10 guideline has been with us since 2008, the transformation of the traditional Quality Management Systems QMS in use within the pharmaceutical industry is a work in progress for only a few forward-thinking organisations. Unfortunately, this transformation remains a mere aspiration for the majority of organisations. We explore the apparent lack of progress by the pharmaceutical sector in adopting six sigma and related quality management techniques to ensure the availability of high-quality medicines worldwide. The authors propose that the desired progress can be delivered through two key shifts in our current practices; by embodying the principles of operational excellence in every aspect of our business and by learning how to unlock the scientific and tacit knowledge within our organisations.

LAY ABSTRACT

It has been ten years since The Wall Street Journal revealed the pharmaceutical industry's "little secret" comparing the perceived level of manufacturing expertise in the industry as lagging far behind those of potato-chip and laundry-soap makers. Would you consider the quality and manufacturing strategies in place today in your organisation to be more efficient and scientifically based than those of 2003? If so, what evidence exists for you to draw any conclusion regarding enhanced performance? Do your current practices drive innovation and facilitate continual improvement and if so, how? Ultimately, can you confidently affirm that patient-related risks associated with the product(s) manufactured by your organisation have been reduced due to the quality assurance program now applied within your organisation? This article asks you to question if you have truly embraced Q8(R2), Q9, and Q10, and in doing so can you demonstrate that you have made the necessary changes that would warrant reduced regulatory oversight?

Rapid tests for diagnosis of leptospirosis: current tools and emerging technologies

Leptospirosis is an emerging zoonosis with a worldwide distribution but is more commonly found in impoverished populations in developing countries and tropical regions with frequent flooding. The rapid detection of leptospirosis is a critical step to effectively manage the disease and to control outbreaks in both human and animal populations. Therefore, there is a need for accurate and rapid diagnostic tests and appropriate surveillance and alert systems to identify outbreaks. This review describes current in-house methods and commercialized tests for the rapid diagnosis of acute leptospirosis. It focuses on diagnostic tests that can be performed with minimal training and limited equipment in less-developed and newly industrialized countries, particularly in resource-limited settings and with results in minutes to less than 4 hours. We also describe recent technological advances in the field of diagnostic tests that could allow for the development of innovative rapid tests in the near future.

Combining analytical frameworks to assess livelihood vulnerability to climate change and analyse adaptation options

Experts working on behalf of international development organisations need better tools to assist land managers in developing countries maintain their livelihoods, as climate change puts pressure on the ecosystem services that they depend upon. However, current understanding of livelihood vulnerability to climate change is based on a fractured and disparate set of theories and methods. This review therefore combines theoretical insights from sustainable livelihoods analysis with other analytical frameworks (including the ecosystem services framework, diffusion theory, social learning, adaptive management and transitions management) to assess the vulnerability of rural livelihoods to climate change. This integrated analytical framework helps diagnose vulnerability to climate change, whilst identifying and comparing adaptation options that could reduce vulnerability, following four broad steps: i) determine likely level of exposure to climate change, and how climate change might interact with existing stresses and other future drivers of change; ii) determine the sensitivity of stocks of capital assets and flows of ecosystem services to climate change; iii) identify factors influencing decisions to develop and/or adopt different adaptation strategies, based on innovation or the use/substitution of existing assets; and iv) identify and evaluate potential trade-offs between adaptation options. The paper concludes by identifying interdisciplinary research needs for assessing the vulnerability of livelihoods to climate change.

Patient-reported outcome measures: an on-line system empowering patient choice

An innovative web-based system was developed to allow patient-reported outcome measures (PROMs) to be easily administered. Stakeholders guided the design and implementation. The software gives patients access to their current and previous scores. This pilot study focused on patients undergoing arthroscopic subacromial decompression, evaluated using the Oxford shoulder score (OSS). Patients showing good improvement in their OSS were offered the choice to return for routine follow-up clinic appointments, or continue rehabilitation, reassured by their improved score. Thirty-six of 117 patients were eligible. Thirty of these (83%) were opted to avoid further clinics. PROMs 2.0 can be used for any medical intervention with a validated PROM. Evolution and refinement is ongoing. Funding has been granted for 12 primary and secondary healthcare trusts to implement PROMs 2.0. Further work is needed to assess economic impact, patient views and satisfaction with the process.

[Toward a conditional price for medicine?]

For the first time, and as an exceptional option, the 2012 LEEM-CEPS framework agreement introduces the notion of conditional prices in conventional practice. The contractualization of drug price according to changes in its value that could occur in "real world" enables the Payer and the Company to settle, in a predictable manner, the "bet" represented by first registration price setting. Its systematization is based on the ability to standardize the implementation and assessment of observational studies, whereas the analysis and sharing of the risk of value changes (depreciation, appreciation) are structuring elements of the contractualization. Ethical from both the payer's and patient's point of view, drug price conditionality on its value is impeded by compliance with legal and economic constraints for the company, that should be taken into account by legalising this latter's ability to influence it through observance or therapeutic education and by guaranteeing a sufficiently long period of revenues for the company.

[Innovative medicines and market access agreements]

Market Access Agreements (MAA) for drugs have emerged in response to the need to control health expenditures, as well as to the uncertainty about the true benefit of a drug. It is possible to group MAA in two types of agreements: financial agreements and outcome-based agreements. MAA is a growing trend and is shifting towards conditional access. However, the willingness to use these contracts and their implementation differ across countries, and some are still resistant to put them in place. The MAA challenges to overcome encompass the complexity of the schemes, the administrative burden and the difficulty of evaluating MAA. It is likely that these agreements might experience further evolution in the future to become a faster pathway for therapeutic innovations, at a fair price.