How medical practice evolves: Learning to treat failing hearts with an implantable device

In this article we propose that medical practice evolves as a result of progress along three different pathways: improvement in the ability to develop effective medical technologies, learning in medical practice, and advances in biomedical scientific understanding of disease. The relative importance of these three pathways varies from case to case, and often they interact strongly. More specifically, we argue here that in cases of therapeutic innovation where a new medical technology is involved the advance in medical practice is driven largely by the ability to develop and use effective medical artifacts and the interactive sequence among these interdependent pathways often starts with what is learned in practice and not in science. While we state this argument in general, we develop it in detail in a longitudinal and contextual case study of the emergence and evolution of a treatment for advanced heart failure based on an implantable device, the Left Ventricular Assist Device (LVAD). Our findings show that an essential aspect of the evolution of the LVAD therapy is collective and cumulative learning that requires experience that only can be gained through the actual use of LVADs. We discuss the theoretical and policy implications that follow from our understanding of how medical practice evolves for research on the evolution of medical practices and new medical technologies, and policies about the evaluation of rapidly moving medical practices and clinical research involved in their advancement.     

Alternatives for protecting privacy while respecting patient care and public health needs

This paper begins with a discussion of the value of privacy,especially for medical records in an age of advancing technology.I then examine three alternative approaches to protection ofmedical records: reliance on governmental guidelines, the useof corporate self-regulation, and my own third hybrid view onhow to maintain a presumption in favor of privacy with respectto medical information, safeguarding privacy as vigorously andcomprehensively as possible, without sacrificing the benefitsof new information technology in medicine. None of the threemodels I examine are unproblematic, yet it is crucial to weighthe strengths and weaknesses of these alternative approaches.     

The emergence of the silent witness: the legal and medical reception of X-rays in the USA

The late 19th-century discovery of X-rays befuddled not only the scientific world but also the medical and legal worlds. The possibility of looking into the human body as if through an open window challenged the time-honored medical monopoly over the inner cavities of the human body. Likewise, the possibility of visualizing objects unavailable to the naked eye challenged the established legal theories and practices of illustration and proof. This paper describes the reactions to those challenges by the medical and the legal professions in the USA. The two professions are treated as connected social institutions, producing ongoing negotiations through which legal doctrines affect medicine no less than scientific discoveries and medical applications affect the law. This joint analysis rewards us with a rich story about an early and overlooked chapter in X-ray history on the professionalization of radiology, the origins of defensive medicine, and the evolution of the legal theory and practice of visual evidence.     

Dermatoglyphics and the persistence of 'Mongolism'

In 1961, a prestigious group of medical researchers called on their colleagues to stop using the language of 'Mongolism' to describe people with what we now call 'Down's syndrome' (or Trisomy 21). This call responded to new knowledge about the biological basis of Down's syndrome: rather than the product of racial degeneration, as had been hypothesized in the 19th century, the condition was the result of an extra chromosome, dubbed '21'. Yet, despite this plea, the terms 'Mongol' and 'Mongolism' continued in scientific use through the 1960s. Drawing on published and archival materials, I argue that the new knowledge about chromosomes did not rupture older patterns of scientific practice or interpretation, and with them, older terminological habits. The persistence of the language of Mongolism reflects the continuity of a network of older approaches to interpreting the condition within the community of human and medical geneticists, including an enduring diagnostic and interpretive technology, dermatoglyphics. Old networks were not supplanted; they were re-aligned.     

Becoming an expert practitioner: court experimentalism and the medical skills of Anna of Saxony (1532-1585)

This essay proposes that the well-documented interest in empirical and experimental practice at the early modern German courts was not limited to male practitioners. Just as princes evinced an interest in practical alchemy, mathematics, and astronomy, a large number of gentlewomen became expert medical practitioners. Using a case study of one noblewoman, Electress Anna of Saxony, I would like to expand the notion of "prince-practitioning" to a more general and inclusive "court experimentalism." Like the prince-practitioners, Anna engaged in a laborious attempt to learn the hands-on techniques involved in becoming an expert; she collaborated with both noblewomen and noblemen in her efforts; and she semantically linked her medicine to the alchemical skills (Künste) practiced by her husband, Elector August. Although court experimentalism cannot be equated with experimentation in the modern sense, medicine is one area in which women actively shared in the early modern fascination with empirical knowledge.     

超越追赶下制造企业服务化能力的动态演化

中国的后发企业在技术追赶时期积累了一定的创新基础,一些企业实现了从追赶到超越追赶的跨越。后发企业通过技术追赶,到达了相对成熟的技术水平,新的价值主张能够帮助后发企业继续提高市场份额。服务化不仅提高了产品的附加值,而且帮助制造企业更加准确地把握客户需求,为后发企业在超越追赶阶段持续获取竞争优势提供了新的路径。本文通过杭氧2007～2019年服务化过程的纵向案例分析发现,后发企业所构建的服务化能力发生了从离散型到合作型再到融合型的动态演进,同时用企互动和技术能力共同影响了这一演进过程。研究结果加强了对后发企业服务化能力动态演化的理解,并为制造企业进行服务化实践提供了新的参考策略。     

Investigating the role of a Web-based tool to promote collective knowledge in medical communities

The paper reports a case study where a relatively lightweight technology in the form of a Web-based questionnaire was used to support members of a real community of professionals in externalizing and sharing their good practices and achieving a better awareness of and agreement on topics of common interest. We focused on an important medical association that counts more 1000 doctors all around the world as its members. In particular, we report how this association used the occasion of the on-line survey enabled by our technology to increase the awareness of its members about the actual heterogeneity of preferences existing in their daily clinical practice, and to trigger discussion toward a better consensus on best practices, appropriate indications, and treatments of choice for their profession and practice. We also report the result of a post-hoc evaluation of the Web-based technology employed, and draw some implications for the better design of this kind of tool in order to collect and share collective knowledge in specific professional domains.     

Does a focal firm's technology entry timing depend on the impact of the technology on co-opetitors?

In this paper, I explore the role that the impact of a technological change on a firm's co-opetitors plays in the firm's technology entry timing. I hypothesize that where a co-opetitor dominates in the co-opetitor-firm relationship, a firm's technology entry timing does not depend on the impact of the technology on the firm's capabilities as predicted by previous research. Rather, it depends on the impact of the change on the dominant co-opetitor. If the change is incremental to a dominant customer, for example, the focal incumbent firm will start development of the new technology before new entrants, irrespective of whether it is radical or incremental to focal firms. If the change is radical to the dominant co-opetitor, new entrant focal firms will start development of the new technology before incumbent focal firms. I explore these hypotheses using the case of three major technological changes in supercomputers: vector processors, minisupercomputers, and massively parallel processors.     

Privacy and Policy for Genetic Research

I begin with a discussion of the value of privacy and what we lose without it. I then turn to the difficulties of preserving privacy for genetic information and other medical records in the face of advanced information technology. I suggest three alternative public policy approaches to the problem of protecting individual privacy and also preserving databases for genetic research: (1) governmental guidelines and centralized databases, (2) corporate self-regulation, and (3) my hybrid approach. None of these are unproblematic; I discuss strengths and drawbacks of each, emphasizing the importance of protecting the privacy of sensitive medical and genetic information as well as letting information technology flourish to aid patient care, public health and scientific research.     

一种由需求驱动的信息技术创新与扩散政策生成体系

分析了信息技术创新扩散的因果关系。认为 ,IT市场的信息不完全性、市场结构、信息技术网络外特性 ,是决定信息技术创新扩散的原因。针对传统的、单一的以信息技术R&D为目标的IT政策 ,或单一的面向扩散的信息技术政策 ;提出了一种由信息技术市场需求驱动的、协调信息技术供应商、信息技术潜在接受者、信息技术政策决策者关系的IT政策产生系统及其输出 ,其目的在于调节信息技术扩散速率 ,使其达到Pareto意义下的最优扩散路径 ,并详细地分析了该信息技术政策体系的结构与原理。     

A Review on the Article: Role of Common Biochemical Markers for the Assessment of Fracture Union

Criterion for patient selection and demographic comparison between the two groups, the numbers in individual groups (normal union or defective union) how the observers were blinded for the samples and control group measurements in the graphs were not mentioned. No data on actual measurement levels is given. No where it is mentioned like it is an average of all normal union or defective union in tables or diagrams. The treatment methodology maybe still focused including either conservative or surgical treatment since a displaced fracture cannot be compared with an osteotomy. The cases shall be followed up for a longer period. Some suggestions on how to blind the observers is given. In the one year period there was neither mention of the failure of treatment or complications of any of neither these 36 cases nor any drop out for follow-ups. There was also no mention of any case which initially put on conservation was changed to surgical management. The authors could have one group of patients taking this food stuff and another group who refused this food stuff. The statistical test used to compare the levels of factor is not mentioned. Mere statement that ‘p’ values were significant will not benefit the reader. Failure to produce X-rays even for a single case weakens the study. X-rays are needed to confirm the diagnosis of a fracture and confirm the position of implants and fracture fragments. The remaining period after confirming the fracture/implant position the case shall be followed only with marker estimation. Once the desired levels of increase or tapering of marker level achieved then X-rays can be taken to correlate with clinical findings and radiology. Union as one group and the second group shall be called as non-union or delayed union. The second group (the poor callus group) is mentioned as malunion possibly by over-sight. Probably they were meaning the non union or delayed union group or defective union as malunion. This should be preferably be written non union or delayed union. Malunion means the fracture actually unites and union process is completed. In a group of fractures (hypertrophic non unions) the callus formation is excessive, still the fracture is ununited. Thus the enzyme or markers alone cannot disclose the details of the completion of union they can herald bone formation.     

Caught inside the black box: Criminalization,opaque technology,and the New York subway MetroCard

Abstract

This article investigates how an account of hidden, internal properties of an everyday technology became a framework to interpret human action as a serious crime. Using a case study situated in the New York subway system, I examine the criminalization of a practice of New York’s poor known as “selling swipes” performed by so-called “swipers”. A high court came to classify the practice as felony forgery, interpreting it though an expert-witness account of how objects physically manipulated by swipers interact with a secretive, proprietary digital information system. Thousands of felony arrests – overwhelmingly of nonwhite men – have been legitimated under this theory, in which the crime occurs on a plane of technical interactions to which swipers have no access. Through close examination of the underlying technology (known as MetroCard), however, I show considerable problems in the authorities’ understanding of the technology, illustrating the hazards of interpreting human action through proprietary or complex systems, especially as they are represented solely through expert accounts. The case demonstrates fresh connections between technology and unequal outcomes in the U.S. criminal justice system, and suggests an emerging form of social vulnerability, to interpretations of our actions through the logic of technologies black-boxed to us.     

Chemistry as the defining science: discipline and training in nineteenth-century chemical laboratories

The institutional revolution has become a major landmark of late-nineteenth century science, marking the rapid construction of large, institutional laboratories which transformed scientific training and practice. Although it has served historians of physics well, the institutional revolution has proved much more contentious in the case of chemistry. I use published sources, mainly written by chemists and largely focused on laboratories built in German-speaking lands between about 1865 and 1900, to show that chemical laboratory design was inextricably linked to productive practice, large-scale pedagogy and disciplinary management. I argue that effective management of the novel risks inherent in teaching and doing organic synthesis was significant in driving and shaping the construction of late-nineteenth century institutional chemical laboratories, and that these laboratories were essential to the disciplinary development of chemistry. Seen in this way, the laboratory necessarily becomes part of the material culture of late-nineteenth century chemistry, and I show how this view leads not only to a revision of what is usually known as the laboratory revolution in chemistry but also to a new interpretation of the institutional revolution in physics.     

Licensing standard-essential patents in the IoT – A value chain perspective on the markets for technology

Innovative industries need efficient markets for technology (MFTs). One determinant of MFT efficiency neglected until now is licensing level—that is, the level in the value chain where patents are licensed. Patents may be licensed upstream, to firms that put the patented knowledge into practice. I refer to this as integrated licensing. Alternatively, patents may be licensed further downstream in the value chain, in particular to makers of final devices. I call this bifurcated licensing since it separates intellectual property rights from the technical knowledge they cover. I study the licensing level of essential patents on communication standards such as LTE and Wi-Fi in relation to the Internet of Things (IoT). The choice of licensing level in this context is currently a hotly debated topic. To show how bifurcated licensing affects MFT efficiency, I present empirical evidence from a qualitative study comprising interviews with 30 individuals from 22 diverse firms, focusing on startups. IoT device makers clearly find the uncertainty regarding infringement, patent validity, and the licensing process hinders efficient licensing, which is compounded by the large number of IoT device makers and, for SMEs and startups, by resource constraints. As a theory contribution, I show that a patent's licensing level need not correspond with the implementation level of the patented knowledge—in other words, licensing may be bifurcated rather than integrated. I develop a model of how licensing level affects MFT efficiency. Implications for practice are that device-level licensing of standard-essential patents (SEPs), if broadly implemented, would have a negative effect on innovation and entrepreneurship in the IoT. Policymakers should ensure that SEP licensing is simplified.     

基于创新生态系统的高校科技育人模式研究

从创新生态系统理论视角分析高校科技育人外部环境、政策支持以及校内科技资源,并将广东省某医科大学作为案例高校。分别设计教师版与学生版高校科技育人现状调查问卷,通过问卷调查分析案例高校教师的科技育人理念认同、教学实践、科技资源教学转化、环境支持相关情况,以及本科生的科研需求、学习方式、环境支持相关情况。研究发现:创新型人才需求变得更为迫切,科技育人政策关注度显著提升,但省级层面予以高校科技育人政策支持的细化程度不足,高校层面推动科技育人的措施不成体系,高校内部科技资源较为丰富但教学转化率低,本科生科研实践程度不足。最后依据创新生态系统理论,从顶层制度设计、整合育人要素、革新组织架构、建设师资队伍4个方面对构建高校科技育人模式提出建议。     

Treating sensitive topics online: a privacy dilemma

This paper aims to provide new insights to debates on group privacy, which can be seen as part of a social turn in privacy scholarship. Research is increasingly showing that the classic individualistic understanding of privacy is insufficient to capture new problems in algorithmic and online contexts. An understanding of privacy as an “interpersonal boundary-control process” (Altman, The environment and social behavior, Brooks and Cole, Monterey, 1975) framing privacy as a social practice necessary to sustain intimate relationships is gaining ground. In this debate, my research is focused on what I refer to as “self-determined groups” which can be defined as groups whose members consciously and willingly perceive themselves as being part of a communicative network. While much attention is given to new forms of algorithmically generated groups, current research on group privacy fails to account for the ways in which self-determined groups are affected by changes brought about by new information technologies. In an explorative case study on self-organized therapy groups, I show how these groups have developed their own approach to privacy protection, functioning on the basis of social practices followed by all participants. This informal approach was effective in pre-digital times, but online, privacy threats have reached a new level extending beyond the scope of a group’s influence. I therefore argue that self-determined sensitive topic groups are left facing what I present as a dilemma: a tension between the seemingly irreconcilable need for connectivity and a low threshold, on the one hand, and the need for privacy and trust, on the other. In light of this dilemma, I argue that we need new sorts of political solutions.     

"What do you think about genetic medicine?" Facilitating sociable public discourse on developments in the new genetics

An important aspect of any meaningful public discussion about developments in gene technology is the provision of opportunities for interested publics to engage in sociable public discourse with other lay people and with experts. This article reports on a series of peer group conversations conducted in late 1996 and early 1997 with sixteen community groups in Perth, Western Australia, interested in gene therapy technology. With the case of cystic fibrosis as a particular focus, and using background resource material as a stimulus for discussion, the participating groups explored a range of value issues arising from the new genetic medicine. This more discursive context enabled participants to express a number of background or life-world concerns about genetic medicine, concerns that are often obscured by the dominant biomedical and bioethical discourses.     

从产品主导逻辑到服务主导逻辑：能力重构视角下企业的数字化转型研究

在数字化经济时代,越来越多的企业在数字化转型中将战略思维从产品主导逻辑升级为服务主导逻辑,以适应变化的外部环境。本文采用案例研究方法,基于能力重构视角深入分析3家企业数字化转型中的主导逻辑升级现象。结论显示：企业从产品主导逻辑向服务主导逻辑的升级可以解构为核心资源、价值创造以及创新模式的转变,能力重构在这一主导逻辑升级中产生了重要的作用机制,具体表现为适应能力重构、学习能力重构与创新能力重构。本文最终所形成的理论框架,填补了现有文献对于企业数字化转型中的主导逻辑升级现象关注不足所造成的理论缺口,并对实践中欲利用数字化实现主导逻辑升级的企业给出借鉴与参考。     

论技术“价值分裂”的四大根源

技术在现代社会中起着举足轻重的作用。本文针对技术既行善又作恶这一可称之为“价值分裂”的现象 ,从多个角度进行了剖析和说明 ,论述了导致技术“价值分裂”的四大根源 ,进一步揭示了技术的本质     

Rethinking the role of the state in technology development: DARPA and the case for embedded network governance

This paper explores the role of the state in re-architecting social networks and thereby new technology directions in the United States. It draws on a case study of DARPA's Microsystems Technology Office from 1992 to 2008. Leveraging one of the most radical directorships in DARPA's history, I argue that the perceived “death” of DARPA under Tony Tether was because past analyses, by focusing on the organization's culture and structure, overlooked a set of lasting, informal institutions among DARPA program managers. I find that despite significant changes in the recipients and outcomes of DARPA attentions, these same institutions for directing technology were in place both before and during Tether's directorship. Drawing on these results, I suggest that we must add to technology policy-making a new option—embedded network governance.