Iterative Development Process Research Articles

Design and Development of a Smart Fidget Toy Using Blockchain Technology to Improve Health Data Control.

This study explores the integration of blockchain technology in wearable health devices through the design and development of a Smart Fidget Toy. We aimed to investigate design challenges and opportunities of blockchain-based health devices, examine the impact of blockchain integration user experience, and assess its potential to improve data control and user trust. Using an iterative user-centered design approach, we developed a mid-fidelity prototype of a physical fidget device with a blockchain-based web application. Our key contributions include the design of a fidget toy using blockchain for secure health data management, an iterative development process balancing user needs with blockchain integration challenges, and insights into user perceptions of blockchain wearables for health. We conducted user studies, including a survey (n = 28), focus group (n = 6), interactive wireframe testing (n = 7), and prototype testing (n = 10). Our study revealed high user interest (70%) in blockchain-based data control and sharing features and improved perceived security of data (90% of users) with blockchain integration. However, we also identified challenges in user understanding of blockchain concepts, necessitating additional support. Our smart contract, deployed on the Polygon zkEVM testnet, efficiently manages data storage and retrieval while maintaining user privacy. This research advances the understanding of blockchain applications in health wearables, offering valuable insights for the future development of this field.

Rights Quest: A Game for Child Rights Awareness

The interactive video game "A Way Home!" is a serious game for promoting pro-social change by raising awareness of children's rights, as outlined in the United Nations Convention on the Rights of the Child treaty. All countries except the United States have ratified this treaty. Through a collaborative effort, faculty and students developed this game using an open-source platform to create an immersive first-person video game experience to disseminate crucial knowledge about children's rights and the need for ratification. Game design guides players through real-world comparative scenarios depicting environments that support or do not support those fundamental rights. Through engaging gameplay and storytelling, iterative development processes facilitated the game's effectiveness in conveying complex concepts, such as the distinction between rights and responsibilities. The significance of children's fundamental rights, such as access to food, a safe, clean home, the right to speech, and freedom of expression, as enshrined in the CRC, are emphasized by juxtaposing different environments and depicting the consequences of choices. Grounded upon the Diffusion of Innovations theory (Rogers 2010), the first step to adopting cultural change is education. Using gameplay elements, including rewards for positive choices and learner guidance instructions, "A Way Home!" rights quest motivates players to explore and understand the principles of children's rights. The player wins the game when they achieve the goal of being heard in a court of law. By combining education with entertainment, the game aims to inspire empathy and foster understanding, with the ultimate goal of teaching about the need for ratification of the CRC Treaty in the U.S. and empowering players to take action and advocate for children's rights. This paper depicts the methodology involving participants (n=17) from one southeastern university in the States to capture qualitative and quantitative feedback through a perception survey to evaluate the first demo model. Results support advancing data collection for the next version developed using virtual reality (V.R.) headsets to further immerse the learners in the experience.

Integrating Agile Methodologies and Gamification for Student Engagement and Success

The article highlights a flexible and adaptable approach for the development of game like activities for higher education students from Politehnica University of Timisoara, Romania. The approach embraces agile methodologies to guide the iterative development process of educational games and consists of several key elements. First, it underlines the importance of defining clear learning objectives and aligning them with the game’s design. Second, it encourages multidisciplinary collaboration between teachers and instructional designers to deliver relevant information to students, but also appropriate to their learning styles and needs. Regarding engineering problems and methods, students frequently encounter several difficulties. For this reason, the article attempts to provide an organized and engaging learning environment that encourages active participation and information retention. In industrial engineering, most of the students’ exposure is to theoretical materials; nevertheless, there are several ways to give them practical experience with the topics they are studying. Using a comprehensive review of the literature, the article explores the pedagogical benefits, challenges, and practices associated with the use of agile methodologies in education. Agile methods are very based on collaboration, teamwork, flexibility, and participation, and help create a more relaxed learning environment to support students' increasing need for control over their learning path. Throughout regular communication and feedback cycles, students can iterate on content and pedagogical approaches, resulting in activities and games that are more engaging and effective for learning. In the end, the paper presents the conclusions of the authors on the current advantages and limitations of using this approach based on agility and game-based learning in higher education.

Development of an interprofessional diagnostic toolkit to enhance outside walking gait-related participation of people after stroke in Germany: study protocol of an ongoing multi-methods study

IntroductionPersons after stroke experience limitations in activities of daily living even in the chronic phase. Many patients who had a stroke report mobility limitations with loss of social roles such...

Design and Application of an Evaluation Tool to Assess World Organization for Animal Health Competencies for Graduating (Day 1) Veterinarians

Graduating competent veterinarians with the appropriate knowledge and skills to support and strengthen their country's National Veterinary Services is a key priority for veterinary institutions globally. The World Organisation for Animal Health (WOAH) developed a set of Day 1 Competencies that should be expected of every veterinary graduate. Veterinary schools need to be able to assess the coverage of these competencies in their curriculum and determine the level of proficiency of their graduates. This article describes the iterative design and development process used to create a semi-quantitative, competency-based assessment survey. The Evaluation Tool for WOAH Day 1 Graduating Veterinarian Competencies is used as part of a stepwise process to systematically assess a veterinary curriculum regarding these competencies. This tool was developed and tested at the University of Gondar College of Veterinary Medicine and Animal Sciences in Ethiopia. The Evaluation Tool was successful in systematically collecting, measuring, and analyzing the perceptions of faculty, senior veterinary students, recent graduates, and external stakeholders about the level of proficiency of graduates in all 19 WOAH Day 1 Competencies. It was specifically designed to be used in conjunction with curriculum mapping to provide a full picture of how effectively these competencies were taught and identify gaps that needed to be addressed. This tool, the supporting resources, and the methodology are now globally accessible to all veterinary institutions, enabling them to revise and update their curricula and, ultimately, improve the training of the future veterinary workforce to support veterinary services in their respective countries.

A shared decision-making intervention between health care professionals and individuals undergoing Pulmonary Rehabilitation: An iterative development process with qualitative methods.

Pulmonary Rehabilitation (PR) services typically offer programmes to support individuals living with COPD make rehabilitation choices that best meet their needs, however, uptake remains low. Shared Decision-Making (SDM; e.g., Patient Decision Aids (PtDA)) interventions increase informed and values-based decision-making between individuals and healthcare professionals (HCPs). We aimed to develop an intervention to facilitate PR SDM which was acceptable to individuals living with COPD and PR HCPs. An iterative development process involving qualitative methods was adopted. Broad overarching frameworks included: complex intervention development framework, the multiple stakeholder decision making support model, and the Ottawa Decision Support Framework. Development included: assembling a steering group, outlining the scope for the PtDA, collating data to inform the PtDA design, prototype development, alpha testing with individuals with COPD (n = 4) and PR HCPs (n = 8), PtDA finalisation, and design and development of supporting components. This took nine months. The PtDA was revised six times before providing an acceptable, comprehensible, and usable format for all stakeholders. Supporting components (decision coaching training and a consultation prompt) were necessary to upskill PR HCPs in SDM and implement the intervention into the PR pathway. We have developed a three-component SDM intervention (a PtDA, decision coaching training for PR healthcare professionals, and a consultation prompt) to support individuals living with COPD make informed and values-based decision about PR together with their PR healthcare professional. Clear implementation strategies are outlined which should support its integration into the PR pathway.

Key Improvements to the Army's Suicide Prevention and Intervention Training: An Interagency Collaboration to Develop the New "ACE Base +1" Curriculum.

Suicide is a prevalent problem impacting the military community. The U.S. Army recognized the need to address this complex issue; one line of effort has been to provide suicide prevention and intervention education and training that is informed by current research, doctrine, and implementation best practices. The purpose of this article is to outline and present the genesis of the Army's new suicide prevention and intervention training-"Ask, Care, Escort (ACE) Base +1"-that aligns with the DoD newly published regulation-driven initiatives. The development of the "ACE Base +1" curriculum was a collaborative effort between two organizations within the Defense Health Agency: The Defense Centers for Public Health-Aberdeen and the WRAIR. A multidisciplinary team was formed by selecting specific operational and subject-matter experts from each organization based on educational qualifications and practical experiences expected to aid the development of curriculum content (e.g., subject-matter experts) and/or the training design. Revisions to the curriculum were informed by the Army's existing suicide prevention training module, current research in suicide prevention and public health, updated and relevant Army regulations, and current public health policy guidance from the CDC and the Department of Suicide Prevention Office. A detailed account of the systematic and iterative curriculum development process is provided. The interagency collaborative efforts resulted in a suite of training products, "ACE Base +1" version 1.3 that is modernized in training content, delivery methods, and design. Four primary elements shaped the final products: (1) A modular framework allowing a tailored approach to mandatory training, (2) a public-health approach that focuses on earlier intervention opportunities while building trust and cohesion, (3) a training design centered on peer discussions and behavioral rehearsal, and (4) an expansion of the curriculum to be inclusive of the entire Army community. Practical implications for each element are discussed.As the program of record, "ACE Base +1" training satisfies the annual requirement for all Active Army, Army National Guard, U.S. Army Reserve, and Department of the Army (DA) civilians. Both the training content (e.g., public-health concepts) and design of "ACE Base +1" reflect a comprehensive approach, focused on developing concrete, applicable skills that support the shared responsibility to suicide prevention and intervention. Limitations, such as delayed interagency collaboration and time constraints, are discussed. Future directions include recommendations for future curriculum projects, specifically within military populations, such as interprofessional, interagency collaboration, and selecting a multidisciplinary team of subject-matter experts. Additionally, WRAIR plans to continue their support to Directorate of Prevention, Resilience and Readiness with the expansion of the +1 menu of trainings, ongoing program evaluation, and longitudinal analysis to inform future revisions and ensure the content and delivery methods remain modernized, relevant, and effective.

Developing a Guided Web App for Postpartum Depression Symptoms: User-Centered Design Approach.

Psychological internet-based interventions have shown promise in preventing and treating perinatal depression, but their effectiveness can be hindered by low user engagement. This challenge often arises from a misalignment between technology attributes, user needs, and context. A user-centered, iterative approach involving all stakeholders is recommended. In this paper, we aimed to develop a user-friendly psychological internet-based intervention aimed at addressing the symptoms of perinatal depression through an iterative, user-centered approach. The development process followed the Center for eHealth Research and Disease Management Roadmap phases of contextual inquiry, value specification, and design. It involved a comprehensive literature review, 2 surveys, 10 focus groups, 5 usability interviews, and 1 technical pilot. The contextual inquiry revealed a demand for accessible interventions for perinatal mental health, with internet-based solutions seen as viable options. Insights from the literature influenced intervention content and features. Stakeholders' openness to the intervention became evident during this phase, along with the integration of the first set of values. Initially, we assessed the broader perinatal context to identify the optimal period for the intervention. On the basis of the findings and practical considerations, we decided to specifically target postpartum depression symptoms. The value specification phase further defined the central values and translated them into requirements. In the design phase, feedback was obtained on the user experience of an early digital prototype and on the prototype's final version. The resulting intervention, named Mamá, te entiendo ("Mom, I get you"), is a guided web app based on cognitive behavioral therapy principles, integrating elements from attachment and mentalization theories. It aims to reduce depressive symptoms in women during the first months postpartum and consists of 6 core sequential modules, along with 3 additional modules, including 5 case examples illustrating depressive symptoms and therapeutic techniques. The intervention provides homework exercises and offers users the opportunity to receive feedback from an e-coach through the web app. This study emphasizes the importance of a user-centered and iterative development process for psychological internet-based interventions. This process helps clarify user needs and provides valuable feedback on service design and quality, ultimately having the potential to enhance the utility and, presumably, the effectiveness of the intervention. The Discussion section shares valuable insights from the project, such as the value of the requirement sessions.

Iterative Problem Development Process in Startup Innovation Contests

Iterative Problem Development Process in Startup Innovation Contests

Research on software reliability enhancement methods based on iterative development

Iterative development is an agile software development methodology that speeds up the development process and increases the flexibility of software delivery. However, the current software requirements change extremely fast, which leads to its increasing uncertainty, and iterative development also faces the challenge of software reliability. The software reliability enhancement method based on iterative development is researched and discussed for the current situation of insufficient reliability in the traditional software development process. In traditional software development, one-time delivery pressure and overall design complexity often lead to software functional defects and instability, affecting software reliability. The iterative development method, on the other hand, improves software reliability by decomposing the software development process into multiple iterative cycles, each of which contains requirements analysis, design, coding, and testing, updating the software functionality in smaller increments, and gradually improving the software product. This study proposes a software reliability improvement methodology by exploring and analyzing the key factors related to reliability in the iterative development process. This dissertation can establish a reliable and high-quality software development process through the steps of meticulous requirements planning and management, iterative development and testing, automated testing and continuous integration, code quality control, defect management and continuous improvement, user feedback and user engagement, and continuous learning and technology enhancement.

Development of a Model of Care resource for FASD in the justice system

ABSTRACT This article describes the development of a Model of Care (MoC) resource to support youth involved with the justice system where a neurodevelopmental disability such as Fetal Alcohol Spectrum Disorder (FASD) is suspected. Service staff within the Youth Justice sector were engaged in an iterative process of resource development over a 9-month period. A reference group was established for feedback at each stage, expert advice was sought from the Australian and New Zealand FASD Clinical Network. Five phases of iterative resource development occurred; the first three covered function, form and content of the resource while iterations 4 and 5 mainly pertained to usability. Referral pathway schematics, poster style resources and a user manual were developed and distributed to Youth Justice affiliated organizations. The aim is for the resource to assist in early and appropriate intervention and support for youth with suspected neurodevelopmental disabilities involved in the justice system.

Development of the Cutaneous Dermatomyositis Investigator Global Assessment (CDM-IGA): A De Novo IGA of Cutaneous Manifestations of Dermatomyositis.

Dermatomyositis (DM) is a rare systemic autoimmune disease characterized by a distinctive debilitating skin rash and skeletal muscle weakness. It is unclear if existing clinical outcome assessment (COA) measures include the concepts of priority to patients and those necessary to fully capture improvements in the active cutaneous manifestations of DM. This study aimed to develop the Cutaneous Dermatomyositis Investigator Global Assessment (CDM-IGA), a de novo IGA, for use in clinical trials of adult DM. Eight DM clinical experts participated in 60-min qualitative interviews consisting of concept elicitation and cognitive debriefing methodologies. Concept elicitation comprised open-ended questions with follow-up probes to explore clinicians' experiences of treating patients with DM, the impact of symptoms on patients' quality of life, and the severity levels of disease characteristics to explore DM progression. Cognitive debriefing required the clinical experts to perform a review of the CDM-IGA, designed to assess the severity of cutaneous disease activity of DM. After the interviews, a consensus meeting with three clinical experts was held to agree on any outstanding issues relating to the CDM-IGA. The CDM-IGA was iteratively developed using the opinions of nine clinical experts. Feedback provided by all clinicians agreed that erythema was the main active cutaneous manifestation of DM and should be the primary characteristic on the CDM-IGA, split by erythema color and extent. To determine cutaneous disease severity, experts suggested adding a metric called secondary changes, which combined erosion/ulceration and lichenification, which could modify the patient's final score. Three clinical experts suggested that a photo-guide to support assessments of erythema across different skin tones could be beneficial. A novel CDM-IGA was developed for use with adult patients with DM in clinical trials, based on an iterative development process that combined qualitative feedback from clinical experts of DM and importantly adult patients living with DM.

Implementing QR code and Geolocation Technologies for the Student Attendance System

Attendance is one of the important factors in supporting lecture activities that can be used to see how well the performance of student attendance in class. Traditional attendance systems used in various educational institutions often cause problems. This research aims to develop an innovative and efficient student attendance system to help the process of taking attendance by utilizing QR-Code and geo-location technologies at Klabat University. The research method employed for this development is the Prototyping Model, which involves iterative development and refinement processes. The system is designed as a web-based application and a mobile application, developed using PHP as the programming language, MySQL as the database management system, Bootstrap 5 as the CSS and JavaScript framework for creating responsive websites, Apache as the web server and Ubuntu 22.04 as the operating system for the server. QR-Code technology is proposed as a medium for recording and verifying student attendance, while Geo-Location technology is used to verify the presence of students in the right lecture venue. The results of this research are expected to make a positive contribution to Klabat University in terms of recording student attendance.

A Community-Partnered Research Process for Implementation Strategy Design: Developing Resources to Support Behavioral Classroom Interventions

Schools need effective, sustainable implementation strategies to support teachers in using effective Tier 1 (i.e., whole class) and Tier 2 (i.e., targeted) behavioral interventions in the classroom. This paper describes an iterative, community-partnered process of developing implementation resources to support teachers in using Tier 1 and 2 positive behavior management interventions; we call these resources the Positive Behavior Management Toolkit (PBMT). There were two key aspects to the iterative development process: 1) working with a Program Development Team of district—and school-employed partners to identify priorities, interpret data, provide feedback on resources, and plan for sustainment; and 2) conducting a series of tryouts in which teachers used a version of the PBMT in their classrooms and provided quantitative and qualitative feedback on acceptability, appropriateness, feasibility, and recommendations for improvement. In partnership with the Program Development Team, we used data from the tryouts to inform revisions to the PBMT. This paper presents quantitative and qualitative data from the tryouts and describes how these data informed revisions to the PBMT. We also describe the processes by which we engaged the team, considerations related to contextual appropriateness, and lessons learned related to community-engaged intervention development research.

A mobility pilot development process experimented through a MaaS pilot in Budapest

Recently, several new concepts and innovative technologies have emerged to overcome the problems of urbanization, which can be hardly solved with using exclusively private vehicles or conventional public transport services. One of the new solutions is the Mobility-as-a-Service (MaaS) concept, a user-centric mobility distribution scheme, in which the user needs are satisfied via a single platform, and multiple transport options are offered by one MaaS operator (MO). In the last years, a couple of MaaS pilots were performed, but previous papers fail to focus on the pilot development and the proper description of the minimum viable product. A pilot of MaaS in Budapest has been developed by using the innovative Scrum methodology successfully involving six mobility service providers, such as public transport, shared mobility, and taxi, in the live demonstration. Current article provides detailed information about the pilot development including technical, legal, and business use cases for all service providers. The results of the recruitment and the characterization of the early-bird users are presented, too. The iterative pilot development process can be utilized by those MOs and governmental organizations that would like to initiate a new mobility project based on the MaaS concept.

A Framework for Developing and Assessing Custom Case Definitions: A Demonstration Applied to Opioid Overdose in Maryland.

Public health epidemiologists monitor data sources for disease outbreaks and other events of public health concern, but manual review of records to identify cases of interest is slow and labor-intensive and may not reflect evolving data practices. To automatically identify cases from electronic data sources, epidemiologists must use "case definitions" or formal logic that captures the criteria used to identify a record as a case of interest. To establish a methodology for development and evaluation of case definitions. A logical evaluation framework to approach case definitions will allow jurisdictions the flexibility to implement a case definition tailored to their goals and available data. Case definition development is explained as a process with multiple logical components combining free-text and categorical data fields. The process is illustrated with the development of a case definition to identify emergency medical services (EMS) call records related to opioid overdoses in Maryland. The Maryland Department of Health (MDH) installation of the Electronic Surveillance System for Early Notification of Community-Based Epidemics (ESSENCE), which began capturing EMS call records in ESSENCE in 2019 to improve statewide coverage of all-hazards health issues. We describe a case definition evaluation framework and demonstrate its application through development of an opioid overdose case definition to be used in MDH ESSENCE. We show the iterative process of development, from defining how a case can be identified conceptually to examining each component of the conceptual definition and then exploring how to capture that component using available data. We present a framework for developing and qualitatively assessing case definitions and demonstrate an application of the framework to identifying opioid overdose incidents from MDH EMS data. We discuss guidelines to support jurisdictions in applying this framework to their own data and public health challenges to improve local surveillance capability.

Multi-stage optimization strategy based on contextual analysis to create M-health components for case management model in breast cancer transitional care: the CMBM study as an example

BackgroundNone of the early M-Health applications are designed for case management care services. This study aims to describe the process of developing a M-health component for the case management model in breast cancer transitional care and to highlight methods for solving the common obstacles faced during the application of M-health nursing service.MethodsWe followed a four-step process: (a) Forming a cross-functional interdisciplinary development team containing two sub-teams, one for content development and the other for software development. (b) Applying self-management theory as the theoretical framework to develop the M-health application, using contextual analysis to gain a comprehensive understanding of the case management needs of oncology nursing specialists and the supportive care needs of out-of-hospital breast cancer patients. We validated the preliminary concepts of the framework and functionality of the M-health application through multiple interdisciplinary team discussions. (c) Adopting a multi-stage optimization strategy consisting of three progressive stages: screening, refining, and confirmation to develop and continually improve the WeChat mini-programs. (d) Following the user-centered principle throughout the development process and involving oncology nursing specialists and breast cancer patients at every stage.ResultsThrough a continuous, iterative development process and rigorous testing, we have developed patient-end and nurse-end program for breast cancer case management. The patient-end program contains four functional modules: “Information”, “Interaction”, “Management”, and “My”, while the nurse-end program includes three functional modules: “Consultation”, “Management”, and “My”. The patient-end program scored 78.75 on the System Usability Scale and showed a 100% task passing rate, indicating that the programs were easy to use.ConclusionsBased on the contextual analysis, multi-stage optimization strategy, and interdisciplinary team work, a WeChat mini-program has been developed tailored to the requirements of the nurses and patients. This approach leverages the expertise of professionals from multiple disciplines to create effective and evidence-based solutions that can improve patient outcomes and quality of care.

Physicians found an interactive tool displaying structured evidence summaries for multiple comparisons understandable and useful: a qualitative user testing study

ObjectivesTo evaluate and improve “Making Alternative Treatment Choices Intuitive and Trustworthy” (MATCH-IT)—a digital, interactive decision support tool displaying structured evidence summaries for multiple comparisons—to help physicians interpret and apply evidence from network meta-analysis (NMA) for their clinical decision-making. Study Design and SettingWe conducted a qualitative user testing study, applying principles from user-centered design in an iterative development process. We recruited a convenience sample of practicing physicians in Norway, Belgium, and Canada, and asked them to interpret structured evidence summaries for multiple comparisons—linked to clinical guideline recommendations—displayed in MATCH-IT. User testing included (a) introduction of a clinical scenario, (b) a think-aloud session with participant–tool interaction, and (c) a semistructured interview. We video recorded, transcribed, and analyzed user tests using directed content analysis. The results informed new updates in MATCH-IT. ResultsDistributed across 5 development cycles we tested MATCH-IT with 26 physicians. Of these, 24 (94%) reported either no or sparse prior experience with interpretation of NMA. Physicians perceived MATCH-IT as easy to interpret and navigate, and appreciated its ability to provide an overview of the evidence. Visualization of effects in pictograms and inclusion of information on burden of treatment (“practical issues”) were highlighted as potentially useful features in interacting with patients. We also identified problems, including undiscovered functionalities (drag and drop), suboptimal tutorial, and cumbersome navigation of the tool. In addition, physicians wanted definition/explanation of key terms (eg, outcomes and “certainty”), and there were concerns that overwhelming evidence from a large NMA would complicate applicability to clinical practice. This led to several updates with development of a new start page, tutorial, updated user interface for more efficient maneuvering, solutions to display definition of key terms and a “frequently asked questions” section. To facilitate interpretation of large networks, we improved categorization of results using color coding and added filtering functionality. These modifications allowed physicians to focus on interventions of interest and reduce information overload. ConclusionThis study provides proof of concept that physicians can use MATCH-IT to understand NMA evidence. Key features of MATCH-IT in a clinical context include providing an overview of the evidence, visualization of effects, and the display of information on burden of treatments. However, unfamiliarity with the Grading of Recommendations Assessment, Development and Evaluation concepts, time constraints, and accessibility at the point of care may be challenges for use. To what extent our results are transferable to real-world clinical contexts remains to be explored.

Feasibility of hemoperfusion using extracorporeal therapy in the horse.

Develop, implement, and monitor for adverse effects of, a novel hemoperfusion therapy in adult horses. A prospective, observational feasibility study using three healthy adult horses from the North Carolina State University teaching herd. Health status was determined by physical exam, complete blood count, coagulation panel, and serum biochemistry. Each horse was instrumented with a 14 Fr × 25 cm double-lumen temporary hemodialysis catheter and underwent a 240 min polymer-based hemoperfusion session. Horses were administered unfractionated heparin to maintain anti-coagulation during the session. Given the novelty of this therapy in horses, each horse was treated as a learning opportunity that informed an iterative process of protocol development and modification. Our long-term goal is to investigate potential clinical applications of hemoperfusion in horses, including cytokine reduction in horses with severe SIRS/sepsis. Horses were monitored for changes in clinical exam, biochemistry and hematology parameters. Additionally, cytokines were quantified to determine whether extracorporeal hemadsorption therapy alone caused an inflammatory response. Our results show that hemoperfusion therapy was associated with decreased platelet counts and serum albumin concentration. There was no significant change in plasma cytokine concentrations with hemoperfusion therapy. In one horse, the cytokine concentrations decreased, as previously reported with hemoperfusion therapy in humans. We hypothesized that hemoperfusion therapy could be performed in healthy adult horses without significant adverse effects. Polymer-based hemoperfusion is a feasible extracorporeal therapy (ECT) modality for adult horses. Additional studies are needed to further establish clinical protocols, as well as establish efficacy of polymer-based hemoperfusion for treatment of various conditions in horses, including intoxications, immune-mediated conditions, and sepsis.

Designing a Digital Environment to Support the Co-production of Public Services: Balancing Multiple Requirements and Governance Concepts

This paper investigates the challenges of designing a computer supported collaborative environment aimed at facilitating co-production processes, i.e., those collaborative processes between Public Administrations, private stakeholders and citizens that aim at the design of public services, their implementation, and their shared delivery to the community. We argue that, for such a digital platform, different types of socio-technical requirements should be considered, i.e., those related to governance models and associated collaboration dynamics; requirements that may emerge from the specific type of public service to design; as well as user and technical requirements common to all e-government platforms. This research informed the development and testing of a digital collaboration platform that offers guidance on how to organize a co-production initiative and a network of stakeholders, functionalities to support collaborative work, and enablers (in the form of reusable knowledge and digital resources) to perform the sequence of steps to produce a public service. The lessons learned from the iterative platform development process and a preliminary evaluation study conducted with three Public Administrations in different European countries pointed at specific functionalities that are perceived as most crucial and at different appropriation practices that depend on the organizational structure of the involved Public Administrations and related multi-stakeholder networks. The innovation that is brought about with respect to general-purpose platforms for computer supported cooperative work is represented by the operationalization of co-production processes, with step-by-step guidance and potential reuse (with adaptation) of ready to use resources and processes. Based on the results of our research, general guidelines are also proposed for the design of future digital platforms supporting co-production.