Early Innovation Research Articles

Skill-mix and service transfer to primary care settings

British Nursing Index, CINAHL, Cochrane Database of Systematic Reviews, DARE (Database of Abstracts of Reviews of Effects), EMBASE, Medline, PsycINFO and the reference lists of eligible papers were searched. Studies that focused on practitioners with special interests (PwSIs) or roles clearly created/defined to be practising with special interests, detailing innovative ways of working with a special interest with evidence of formal evaluation of changing role of location of service from systematic reviews or interventions were included. Surveys of views on changing skill-mix or location of services, studies that did not concern dental or medical professionals, dental care or nursing professionals were excluded. Only studies in English and with a UK focus were included. All titles and abstracts identified were screened for relevance. Two authors assessed quality and extracted data, queries were reviewed by a third author and a narrative synthesis was presented. Twenty-six papers met the criteria with a strong bias towards the medical literature. Five categories emerged:(i) specialist outreach; (ii) general practitioners with a special interest; (iii) nurse practitioners with a special interest; (iv) dental care professionals; (v) out-of-hospital services. Evidence showed specialist outreach clinics to be effective in relation to access and patient satisfaction with some having a higher quality of care but higher cost. However there may be cost-benefits associated with this care, particularly when part of a multifaceted intervention. There is controversy and a limited evidence as to whether the services provided by medical PwSIs are effective, and whether the benefits outweigh the risk and the cost. From the evidence obtained through early innovation, it appears that these services can increase access and are more satisfying for patients, and that these roles have the potential to bring more work satisfaction to the practitioners. Overall, the findings do support the view that moving specialist care into the primary care setting via appropriately trained nurse practitioners is an effective use of resources, but with the caveat that nurse practitioners in primary care are not necessarily cost-effective. There is evidence that professionals complementary to dentistry (PCDs) are able to diagnose a range of conditions and, with appropriate training, complete a wide range of dental procedures as well as dentists, but much of the evidence for other aspects of substitution was of lower quality, weak or insufficient. There was limited evidence of the cost-effectiveness and health outcomes associated with changes in setting and skill-mix. However, there was evidence of improved access, patient and professional satisfaction. There is an overwhelming need for well-designed interventions with robust evaluation to examine cost-effectiveness and benefits to patients and the health workforce.

Active management of the early innovation phases in steel application research for the construction sector

AbstractThis article reports on how the steel industry in Germany can systematically improve the early phases of its cooperative pre‐competitive application research in the construction sector. The aim of this work is to increase innovation success through a targeted lead‐in to the innovation processes. It makes use of various models from industrial innovation management, experience in research management for a current project on the sustainability of steel in the construction sector and the results from a survey of the research institutes participating in the project. As a result, a model for the systematic management of the early innovation phases in steel application research for the construction industry is presented. The model supports the participants from industry and the academic sector in finding, formulating and implementing new innovation ideas.

Introduction to the 2011 Symposium Issue of JRI on Microinsurance

Individuals, households, and businesses in developed countries take for granted access to the wide variety of products and services offered by modern banking and insurance industries. Unfortunately, the ability of world's urban and rural poor to access these same services has historically been limited. As a result, low-income households often have inadequate opportunity to finance a business, few formal options to save money, and insurance is often unavailable that leaves them with no alternative but to sell productive assets or to radically reduce consumption to finance loss shocks. Research has shown this inability to save, borrow, and insure leads to a cycle of poverty that is difficult to leave and even more difficult to leave permanently. A little over 30 years ago the Grameen Bank launched an experiment designed to see if loan products could be targeted to the poorest households in Bangladesh. The group lending innovation Grameen introduced proved successful, and a new sustainable business model was created such that microcredit could be offered to the poor on reasonable terms with high customer take-up rates. The microfinance industry was born and today represents opportunity for poor households to tap their entrepreneurial spirit and build toward a better life. Although access to credit proved to be an important innovation, all too often development and microfinance professionals heard stories of households that had invested year after year to build a small business only to have that progress eliminated by a single loss event. Perhaps this is not surprising as researchers have long noted the vulnerability of the poor to loss shocks (both in terms of likelihood and severity as these events are often large relative to household income), and their ability to informally manage these shocks is inefficient at best (Murdoch, 1999). Even worse, although covariant risks are difficult for any community to manage efficiently, research has also shown the informal risk-sharing mechanisms used by the poor are inefficient even for idiosyncratic, diversifiable risks (see, e.g., Jalan and Ravallion, 1999). Given the recognition that poor households have limited options to efficiently manage and that this inability is a significant determinant of remaining in (or re-entering) poverty, pressure has been mounting to find ways to help the poor more efficiently finance or transfer through formal insurance markets. A prominent example of this rallying cry is the World Bank's 2000/2001 World Development Report, in which the authors made Enhancing Security by reducing vulnerability to risk one of the major objectives in an overall strategy to reduce extreme poverty (World Bank, 2001). Since then, the Bank, along with several other international organizations, has engaged a global campaign to develop microinsurance markets. Although excitement exists about the prospect for insurance targeted to the poor, the market for microinsurance today can probably best be described as in its infancy. Unlike microcredit where Grameen Bank introduced a major innovation that produced a dramatically different outcome, to date no single advance has emerged that has revolutionized the approach insurers have to contract with poor in a way that mitigates the informational and transactional costs associated with supplying insurance at prices that poor consumers are willing to pay. As a result, there is extensive experimentation in the design and distribution of microinsurance as market participants search for strategies that will unlock its potential for low-income households. Recognizing the need for the proponents of microinsurance to learn what works and what does not, in 2005 Munich Re Foundation hosted its first annual international conference designed to bring the early innovators together to facilitate knowledge sharing. The conference attracted 100 attendees representing international organizations, NGOs, insurers, and development agencies coming from 24 countries. …

Early Use of Pressure Flaking on Lithic Artifacts at Blombos Cave, South Africa

Pressure flaking has been considered to be an Upper Paleolithic innovation dating to ~20,000 years ago (20 ka). Replication experiments show that pressure flaking best explains the morphology of lithic artifacts recovered from the ~75-ka Middle Stone Age levels at Blombos Cave, South Africa. The technique was used during the final shaping of Still Bay bifacial points made on heat-treated silcrete. Application of this innovative technique allowed for a high degree of control during the detachment of individual flakes, resulting in thinner, narrower, and sharper tips on bifacial points. This technology may have been first invented and used sporadically in Africa before its later widespread adoption.

Symmetric allosteric mechanism of hexameric Escherichia coli arginine repressor exploits competition between L-arginine ligands and resident arginine residues.

An elegantly simple and probably ancient molecular mechanism of allostery is described for the Escherichia coli arginine repressor ArgR, the master feedback regulator of transcription in L-arginine metabolism. Molecular dynamics simulations with ArgRC, the hexameric domain that binds L-arginine with negative cooperativity, reveal that conserved arginine and aspartate residues in each ligand-binding pocket promote rotational oscillation of apoArgRC trimers by engagement and release of hydrogen-bonded salt bridges. Binding of exogenous L-arginine displaces resident arginine residues and arrests oscillation, shifting the equilibrium quaternary ensemble and promoting motions that maintain the configurational entropy of the system. A single L-arg ligand is necessary and sufficient to arrest oscillation, and enables formation of a cooperative hydrogen-bond network at the subunit interface. The results are used to construct a free-energy reaction coordinate that accounts for the negative cooperativity and distinctive thermodynamic signature of L-arginine binding detected by calorimetry. The symmetry of the hexamer is maintained as each ligand binds, despite the conceptual asymmetry of partially-liganded states. The results thus offer the first opportunity to describe in structural and thermodynamic terms the symmetric relaxed state predicted by the concerted allostery model of Monod, Wyman, and Changeux, revealing that this state is achieved by exploiting the dynamics of the assembly and the distributed nature of its cohesive free energy. The ArgR example reveals that symmetry can be maintained even when binding sites fill sequentially due to negative cooperativity, which was not anticipated by the Monod, Wyman, and Changeux model. The molecular mechanism identified here neither specifies nor requires a pathway for transmission of the allosteric signal through the protein, and it suggests the possibility that binding of free amino acids was an early innovation in the evolution of allostery.

Transferring research and innovation Living Lab (TRAIL): Experience of a living lab

In 2006, the Finnish EU Presidency launched a new public-private-partnership (PPP) innovation model called the European Network of Living Labs (ENOLL). There are currently over 100 labs accounting for a network of more than 70 million-end users that connect the capabilities of local prototyping-grounds with a critical mass to attract investments (Annerstedt and Haselmayer, 2006). The University of Ulster is making a significant contribution to the living lab concept through its TRAIL initiative. TRAIL represents a developing Public-Private Partnership (PPP) where companies, public authorities and communities work together creating, prototyping, validating and testing new services, businesses, markets and technologies in real-life contexts in the regions, rural areas and virtual spaces between public and private players in the region of the North of Ireland. It is our strategic intention to collaborate further with our existing international networks and to integrate fully our activities with ENOLL members and other international clusters.Methods:This paper presents two case studies of research projects adopting the living lab approach of user-driven innovation, where empirical research suggests that user-driven innovations are more fruitful as a major source of innovation (von Hippel, 1988). Specifically this work engages with older people as the co-creators of innovation close to market, central to the research and innovation of devices and services to address their specific needs. NOCTURNAL is a project with a focus on the night-time needs of people with early stage dementia exploring if technology can be used as a therapeutic intervention building on the telecare risk management platform. A second project will be presented “myHealth@age” which explores the specific needs of healthy older people living in isolated rural communities. Both research projects have developed consortiums including older people, academia, public sector healthcare providers and industry.Results and Discussion:Delivering user-driven innovation in practice within TRAIL is rewarding and challenging, this paper will focus on some of the emerging issues within the lab. There is a significant body of academic research that supports the premise that user-driven innovation creates value in markets and for society. The network of living labs in Europe has been created, partly based upon this premise, but it can be argued that there is a lack of evidence that demonstrates how such living labs articulate their value proposition, and how they carry out activities on the ground to work with users to create the added valued inherent in early innovation processes. The issues of working with vulnerable users; managing the tension between users needs and advancing the research agenda and balancing this with the desires of the industrial partners will be considered within this presentation.

“We All Got History”

This review essay places Local Histories in the context of recent books and studies examining the wide variety of composition and rhetoric courses and pedagogical practices that existed in nineteenth-century America. The book has two general foci as represented in its split title: Local Histories, or microhistories of institutions, curricula, and figures; and Reading the Archives of Composition, an extended look at several hitherto unexamined archival sources and their associated projects. The editors identify three central purposes for their book: to challenge the “Harvard narrative,” which, they claim, places the origin of “composition” at Harvard and other elite Eastern colleges; to offer several alternative “microhistories” from various institutional sites, and to document, interpret, and interrogate specific archival holdings and the nature of archival work in composition. While the reviewers find the challenges to “the Harvard model” as history and historiography overstated, overall, they find the collection important for its studies of diverse sites and its attention to less visible figures: teachers who acted as early innovators, and students whose written compositions, informal diaries and letters offer new lenses for making history. The authors of various chapters who unveil their documentary and archival work in process, disclosing both finds and gaps and offering their developing understandings of the archive as construct, perform a valuable service to future scholars of composition studies.

Is HAP2-GCS1 an ancestral gamete fusogen?

Eukaryotes employ a diversity of strategies to ensure that gametes come together, but the cellular climax is less varied: gamete plasma membranes must fuse to allow the combination of parental genomes. Recent studies of HAP2-GCS1, a sex-restricted transmembrane protein found in genomes representing all major eukaryotic taxa except fungi, suggest that a broad array of eukaryotic organisms could share a common mechanism for gamete fusion. Plant, protozoan, and algal gametes carrying loss-of-function mutations in HAP2-GCS1 fail to fuse with their complements. We propose that HAP2-GCS1 is a crucial component of an ancient mechanism that mediates the fusion of gamete plasma membranes and could have been a key early innovation in the evolution of sexual reproduction.

Negative side effects of customer integration

Customer integration has many recognised advantages, but also entails negative side effects that may impair the success of innovative activities. These negative side effects have not yet been sufficiently investigated. Whereas some may occur within the entire early innovation phase, others are likely to affect only few sub-phases. Each sub-phase, defined in a slightly new way as compared with existing models to meet the investigation subject, has different activities and aims, and therefore requires special integration methods and customer types. On the basis of extensive research and empirical studies, the paper illustrates different integration methods, negative effects of customer integration, and measures to avoid them.

Thoracolumbar spinal deformity: Part II. Developments from 1990 to today

In the first part of this 2-part historical review, the authors outlined the early diagnostic and therapeutic strategies used in the management of spinal deformity. In this second part, they expand upon those early innovations and further detail the advances from 1990 to the modern era.

The Future of Technology in Health Education

I am fully cognizant of my strengths and weaknesses as both a person and professional. To consider my work comparable to the likes of the previous scholars is a mistake. I don't have the research skills of an Elbert Glover. I don't have the statistical understanding of person like Mohammad Torabi. I don't have the grant procurement history like Randy Black. I don't have speaking skills like those of Buzz Pruitt and Skip Valois. I don't have the writing skills of Robert McDermott. I don't have the technology skills of a person like Robert Gold. I don't have the skills to take research into practice like a Jim Eddy. So why was I selected? I've been blessed with an opportunity to contribute to the profession via a technology that 20 years ago did not exist. The HEDIR catapulted me into the national limelight. As most know, I created the HEDIR in 1992-the profession's first email directory and listserv. The profession has found the HEDIR to be an exceptional tool to communicate thoughts, solicit ideas, and to share information. Currently the HEDIR has over 1,700 participants and has sent over 22,000 messages in its history. There are many other lists that people subscribe to, or use technologies that are way more interactive, expansive and creative. Yet, the HEDIR continues to survive. I think the HEDIR did (and still does) three things: (1) It allows an individual to not feel so isolated. Jim Girvan told me that at one time he was the only health educator in Idaho--the HEDIR gave him an opportunity to communicate with others and he felt less alienated; (2) The HEDIR allows everyone an equal voice. Where national conferences tend to be overrepresented by college faculty, the HEDIR allows the teacher and the public health educator an opportunity to be part of the profession and to have an equal voice; (3) the HEDIR introduced people to the use of technology when technology was in its infancy. For many health educators (especially of my generation) we were thrown into technology. I believe the HEDIR helped with that transition. (1) TECHNOLOGY Figure 1 shows a graph that was created by Rogers. (2) If we review this in terms of the profession of health education and technology, we have those early innovators like Robert Gold, early adopters like Alyson Taub, early majority like myself, late majority like Elbert Glover and the laggards ... well, we all know who those people are, right? I can't speak for everybody in my age group, but I'm constantly amazed at the technological advances that are being made. For those of us over 50, we remember sitting in front of a TV in the summer of 1969 watching Neil Armstrong take the first step on the moon. It was an incredible experience. Yet, today, my smart phone has more computer capability than that Apollo system had. (3,4) Morris Massey, the University of Colorado human relations expert, stated early in his career that people tend to NOT value things if they've always had them. (5) For my generation, we think it's normal to have electricity--because we've always had it. What does the younger generation think is normal? We now see young children with their own cell phones. They always had access to them, and they think that this is normal. Mention to them the concept of a party-line telephone system and they'll look at you like you're a space alien. Students entering college today have always had access to email, the Web, cell phones, text messaging, and all other sorts of gizmos. To them, these are normal. Plus, it's normal for them to see technology constantly changing. Four-out-of-five teens now own a cell phone. (6) Cell phones are the second leading item for a teen's social status (clothing is still ranked number one) and 42% of teens indicate they could text blind-folded. (7) In a broader sense, the U.S. saw 14.3 billion searches (via Google and Yahoo) in April 2009. (8) It was estimated that in August 2008, over 210 billion emails were sent daily, (9) and an estimated 2. …

Rooted in the Experiential

Gary Hill is a Seattle-based media artist and writer whose work has been exhibited internationally for the past thirty years. One of the early innovators in video art, Hill's work addresses themes of and communication. Inspired by philosophy and linguistics. Hill continues to reinvent the medium of video. This interview was conducted via Skype on August 4, 2009. COLETTE COPELAND: Michael Rush, in his 2003 book Video Art, categorizes you as a video installation artist. In George Quasha and Charles Stein's essay, Speaking for Before, (1) both avoid categorizing you as a video artist, citing it as reductive or condescending. You are quoted as saying that video is ultimately the wrong word for what you are involved with. It seems that this paradox of the inadequacy, yet necessity, of and our desire to name and categorize is an underlying theme throughout your work. How would you describe yourself and your work? GARY HILL: Categories aside, would say my work resides between media; it rather deals with the flux of poetic space. George and Chuck make the argument that I'm perhaps more a artist than a video artist, and there is indeed some, truth to that. The reality is that, when one is working, the question of what it is that one does vanishes into the process that is happening at that given moment. The culture of mind and creativity is very different than the world that is attempting to put things in their proper places so as to be understood. These worlds mix about the same as oil and water, though. work with more than or installation. work with stuff and what's happening now. Most of the time the materials and initial impulse tell me which way to go with a work--it is very hard to put one's finger on it. Nonetheless, go with that kind of unseen energy. CC: In many of your video installations, both written and spoken become a tangible, physical entity. Large-scale projected text asserts its authority beyond the textual. Quasha and Stein question this notion of as object: Language wants to surround us like air, to be the medium in which we live and breathe ... Is or any instance of an object ... its status equal to the thing it represents or communicates or speaks for? (2) How do your works transcend the notion that exists only in what it can represent or communicate? GH: don't think of as something external that we use to communicate with. It's more the sense that I am language from the get-go. We have become divorced from our being by representation. A linguist once pointed out to me that when we begin to speak, to tell, we don't know how we are going to end the thought, how the sentences are going to form and transform. We are in a process of thinking it through, thinking out loud, so to speak. Getting back to your question, guess I'm returning to and coming upon the root of as a continuous process. It's extremely powerful when words open up, and suddenly meaning [and] syntax come alive and you're kind of swimming in language. try to use this process to open up images too, beyond representation. [ILLUSTRATION OMITTED] [ILLUSTRATION OMITTED] CC: When watch or read about your work, always have more questions than do answers. Because of the multiple interpretations, many of your works speak to the frustrations or miscommunications inherent in language, rather than the structural or semiotic aspects of language. The works are philosophical yet evoke an emotional response. GH: Maybe there's a kind of work that's not necessarily tied to questions or answers, that's not entrapped by such a duality. mean, is wondering a mode of questioning? would say not. This is a space like to evoke--one of wonder. Wonder opens up when we are delighted by the mystery of something--knowing we cannot know something. think of the Cheshire cat smiling behind the mind. …

Innovating for an Uncertain Market: A Literature Review of the Constraints on Environmental Innovation

Innovating for an Uncertain Market: A Literature Review of the Constraints on Environmental Innovation

Braille Becomes Electric: The Trials and Triumphs of Braille Translation Software

When a person converts the text of a print document to braille, it is usually called transcription. When a computer program does the same thing, it is often called translation. Some people think translation is an ill-chosen term, since the term usually connotes changing text from one natural language to another, whereas braille--thanks to the genius of Louis Braille's original design--is not a separate language from print but rather an alternate way of writing the same text. There are a number of reasons described in this essay why early braille translation software came to use the term translation, and Louis Braille himself could not have imagined the ongoing controversies and neverending intricacies of translation when computers were first used to produce braille from print and vice versa. EARLY INNOVATIONS The first software for braille translation was developed in the 1960s, well over a century after Louis Braille first developed his code. The in-house program developed for the IBM 704 computer by the American Printing House in Louisville, Kentucky, progressed in its development through several research projects until the first commercial braille translation product for literary braille appeared in 1975 (Sullivan, 2008). In those early days, the hardware that was typically available for running such application programs afforded vastly less computing power than we enjoy, and often take for granted, today. At the time the translation program was being developed, it was not clear that the available computing power would be sufficient to create software that could implement the trickier rules of English Braille, American Edition (EBAE) with an acceptable degree of accuracy. Although some artificial intelligence researchers believed automated natural language translation, such as from Russian to English, was just another grant and a few years away, individuals who were familiar with the intricacies of literary braille knew that its code was written with human transcribers in mind, and understood that teaching a computer to anticipate and apply correctly the many rules referring to the sound or meaning of the text to be transcribed would be challenging to say the least. For example, could a computer be taught to decide if do in a text refers to the verb denoting action or noun indicating the musical note? EBAE requires that the two dos be brailled differently in contracted braille, the most widely used form of English braille in which many words and letter groups are written in a shortened form. In contracted braille, do the verb is reduced to the letter d. Despite the concern that computers cannot directly discern sound or meaning when translating braille, the need for at least partial automation was increasing rapidly in the 1970s. The trend of enrolling children who are blind in mainstream public schools, such as was seen in Atlanta around this time, created a need for rapid production of informal classroom materials in braille, which existing braille printers could not meet in a timely fashion. In addition, braille printing houses and braille producers required skilled braille transcribers to oversee the production process, and social and economic trends combined to make such transcribers ever harder to find. Under such conditions, the speed of braille production was of the greatest importance, and a low level of error was tolerated. The braille translation software developed in the 1970s was able to accurately translate braille in an expedient manner. The deeply intractable problem situations, subjects of considerable debate, turned out to be statistically infrequent. For example, do very seldom refers to the musical note except in text that is actually about music. The braille translation software, thus, was programmed to assume that do always referred to action. Exceptions to such rules needed to be handled by humans, who marked the text prior to translation or proofread it afterwards. …

Optimal Timing of Climate Change Policy: Interaction Between Carbon Taxes and Innovation Externalities

This paper addresses the impact of endogenous technology through research and development (R&D) on the timing of climate change policy. We develop a model with a stock pollutant (carbon dioxide) and abatement technological change through R&D, and we use the model to study the interaction between carbon taxes and innovation externalities. Our analysis shows that the timing of optimal emission reduction policy strongly depends on the set of policy instruments available. When climate-specific R&D targeting instruments are available, policy has to use these to step up early innovation. When these instruments are not available, policy has to steer innovation through creating demand for emission saving technologies. That is, carbon taxes should be high compared to the Pigouvian levels when the abatement industry is developing. Finally, we calibrate the model in order to explore the magnitude of the theoretical findings within the context of climate change policy.

Ion channel clustering at the axon initial segment and node of Ranvier evolved sequentially in early chordates.

In many mammalian neurons, dense clusters of ion channels at the axonal initial segment and nodes of Ranvier underlie action potential generation and rapid conduction. Axonal clustering of mammalian voltage-gated sodium and KCNQ (Kv7) potassium channels is based on linkage to the actin–spectrin cytoskeleton, which is mediated by the adaptor protein ankyrin-G. We identified key steps in the evolution of this axonal channel clustering. The anchor motif for sodium channel clustering evolved early in the chordate lineage before the divergence of the wormlike cephalochordate, amphioxus. Axons of the lamprey, a very primitive vertebrate, exhibited some invertebrate features (lack of myelin, use of giant diameter to hasten conduction), but possessed narrow initial segments bearing sodium channel clusters like in more recently evolved vertebrates. The KCNQ potassium channel anchor motif evolved after the divergence of lampreys from other vertebrates, in a common ancestor of shark and humans. Thus, clustering of voltage-gated sodium channels was a pivotal early innovation of the chordates. Sodium channel clusters at the axon initial segment serving the generation of action potentials evolved long before the node of Ranvier. KCNQ channels acquired anchors allowing their integration into pre-existing sodium channel complexes at about the same time that ancient vertebrates acquired myelin, saltatory conduction, and hinged jaws. The early chordate refinements in action potential mechanisms we have elucidated appear essential to the complex neural signaling, active behavior, and evolutionary success of vertebrates.

Where is the ethical knowledge in the knowledge economy?

There is a growing discussion of intellectual capital and the knowledge economy more generally within the accounting literature. This literature, however, has focused narrowly on the considerable discrepancy between book and market values and the inability of traditional accounting concepts and methods to deal with the intangible nature of key sources of corporate competitive advantage. This essay contributes to this literature by providing a broadly poststructuralist reading of the emergence of ethical knowledge as a component of intellectual capital, a category of asset that has almost been completely overlooked within the extant accountant literature on the knowledge economy. The paper does three things. Firstly, it draws on a broad review of the accounting literature to explore how intellectual capital is being defined and constructed within that literature. Secondly, it provides a poststructural analysis of the way ethical knowledge emerged within the intellectual capital statements of an early innovator in Intellectual Capital reporting. Finally, the paper tentatively hints towards the moral and civic potential of alternative conceptualisations of ethical knowledge networks at the margins of the knowledge economy and considers some areas for further research in this regard.

Farmers’ coping response to the low flows in the lower Yellow River: A case study of temporal dimensions of vulnerability

Water scarcity in northern China has been a topic of concern in China for many years, but the increased frequency and duration of “no-flow” events in the Yellow River in the 1990s created a flurry of recent activity in the academic and policy arenas. These low-flow events severely disrupted the supply of irrigation water for agriculture in the lower reaches of the Yellow River and posed a substantial threat to farmers’ livelihoods. Within a broader effort to assess farmers’ vulnerability to water shortages, this qualitative research focuses on the coping mechanisms and adaptive strategies adopted by farming households in three villages in Shandong Province (Ma, Ding, and Xing). With increasing water stress and other stresses from land degradation and lack of market access, farmers’ coping mechanisms have evolved, expanding from one-time adjustments to long-term adaptations, and switching focus from securing reliable water sources to improving irrigation efficiency and diversifying both on-farm and off-farm production. The three villages have different vulnerability profiles and adopted different patterns of adaptive processes that reveal the key roles played by community leaders and the early innovators. The research presented here contributes a temporal and dynamic dimension to the study of vulnerability which is largely missing from the current literature, and provides practical insights about how to improve farmers’ adaptive capacities in the face of water shortages in northern China.

Physician perception and recommendation of insulin pens for patients with type 2 diabetes mellitus

ABSTRACTObjective: To determine the way in which physicians perceive insulin pens and the factors that affect their recommendations and their patients' pen initiation/use.Research design and methods: Primary care physicians (N = 300; 108 family practice, 192 internal medicine) and endocrinologists (N = 225) were recruited from national databases (IMS and AMA) to participate in an Internet survey. All data are self-reports. Measures include five dependent variables (the extent of suitability for patient segments, two pen-related behaviors – their frequency of presenting patients with the pen as a treatment option and strength of pen recommendation – and extent of their patients' pen initiation and use) and several potential correlates: practice characteristics; therapeutic philosophy and practices; perceptions of insulin pens (convenience, facilitation of self-care, blood glucose control efficacy, cost/coverage). Correlates of dependent variables were examined using multiple linear regression.Results: Significantly (p < 0.05) more patient pen use and/or successful pen initiation was reported by physicians who: (1) were more involved in clinical practice, were early adopters of clinical innovations or instructed their patients regarding insulin use; (2) reported less insulin mixing or therapeutic inertia; (3) perceived pens as efficacious and facilitating self-care; and (4) presented and recommended pens to their patients. More frequent presentation of pens to patients and/or stronger recommendation of pen use was reported by physicians who were early innovation adopters, reported less insulin mixing or therapeutic inertia, and perceived pens as convenient and efficacious (p < 0.05).Limitations: The study is a cross-sectional survey using a self-administered questionnaire yielding unverified self-reports. Physicians treating few patients with diabetes mellitus or prescribing no insulin were excluded from the study.Conclusions: Physicians' pen-related actions are a function of their personal and practice characteristics as well as their perceptions of pens. Physicians' presentation of pens as an option is strongly associated with perceived pen convenience, but physicians' pen recommendations and the estimated pen use/initiation of their patients are most strongly associated with the perception of clinically relevant pen attributes – glucose control efficacy and/or self-care facilitation.

Managing The Unmanageable

OVERVIEW:The lesson from this research into covert research—also known as “bootlegging”—is clear: do not even try to organize the early stages of innovation through formal processes. Interviews at 70 European companies reveal that organizing for creativity is impossible to tackle without contravening one or another organizational protocol. Consequently, it is recommended that managers abandon the arguments over control versus freedom to leave creativity and early innovation where it belongs: in the chaotic, messy and wild terrain of the corporate underground. Management should accept that innovative output emerges from the hidden life of corporations and, moreover, that it is more often than not in line with overall corporate strategy. The research shows that both organizational bureaucracy and the underground world co-exist and interact positively; hence, the long-running debate about how to integrate creativity into the formal organization becomes moot.