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While it sucks to say it, but there is no clear "most effective" way to enhance working memory, but the methods that have shown success are:Brain TrainingPharmaceuticalsneocortical stimulationBut for now, I'm sad to say, nothing's gonna turn you into Eddie Morra from Limitless quite yet...For details and controversy, read on.First, a big disclaimer: in my research I've published work looking into the neuroanatomical basis for visual working memory (Voytek & Knight, Prefrontal cortex and basal ganglia contributions to visual working memory, PNAS 2010 [open access] http://www.pnas.org/content/early/2010/09/29/1007277107). This is a very complex field, because "working memory" isn't one single process controlled by one brain region, but it does appear to be critically reliant on the dorsolateral prefrontal cortex, among others (see: Neuroanatomy: What are the primary functions of the dorsolateral prefrontal cortex?).It's also intricately linked to attention and other cognitive processes (very roughly, see Voytek et al., Dynamic Neuroplasticity after Human Prefrontal Cortex Damage, Neuron 2010). Check out the relationships to different cognitive tasks and working memory according to brainSCANr:The task referred to in the question, the n-back task, is a type of serial working memory task wherein a person must hold a series of information in memory. The simplest version of the task, the 0-back, requires the person to respond every time they see the target stimulus. At 2-back, the task becomes very difficult. In the 2-back version below, for example, correct responses would be to the second and third Cs, because in both cases there was a C 2-letters prior.If presented with the following letters:A D E Q E X S C E C T M T P Wthen correct responses would be for the letters in bold:A D E Q E X S C E C T M T P WThis is but one of many forms of experimentally testing working memory.BRAIN TRAININGThere are several online systems for brain training, which aim to enhance cognitive performance (including working memory), such as Lumosity (company) (http://www.lumosity.com/) and Posit (http://www.positscience.com/).(See my answer to Cognitive Enhancement: Does memory improvement software work?)Some research has shown that fluid intelligence (which is a catch-all term) can be improved with working memory training (Improving fluid intelligence with training on working memory, PNAS 2008):Fluid intelligence (Gf) refers to the ability to reason and to solve new problems independently of previously acquired knowledge. Gf is critical for a wide variety of cognitive tasks, and it is considered one of the most important factors in learning... Although performance on tests of Gf can be improved through direct practice on the tests themselves, there is no evidence that training on any other regimen yields increased Gf in adults. Furthermore, there is a long history of research into cognitive training showing that, although performance on trained tasks can increase dramatically, transfer of this learning to other tasks remains poor. Here, we present evidence for transfer from training on a demanding working memory task to measures of Gf. This transfer results even though the trained task is entirely different from the intelligence test itself. Furthermore, we demonstrate that the extent of gain in intelligence critically depends on the amount of training: the more training, the more improvement in Gf. That is, the training effect is dosage-dependent. Thus, in contrast to many previous studies, we conclude that it is possible to improve Gf without practicing the testing tasks themselves, opening a wide range of applications.This issue of transfer is important, because it's easy to show that training someone on a working memory task can improve performance on that task, but does that improvement generalize to other aspects of cognition?When you ask "What is the most effective way to enhance working memory?" you don't really care about just improving working memory. You want to be smarter all around!Given that things such as attention and working memory are so intimately related, we would think that training would transfer, but the evidence is still quite murky.For example, last year there was a big study that got a lot of coverage (Putting brain training to the test, Nature 2010) that found that:‘Brain training’, or the goal of improved cognitive function through the regular use of computerized tests, is a multimillion-pound industry, yet in our view scientific evidence to support its efficacy is lacking. Modest effects have been reported in some studies of older individuals and preschool children, and video-game players outperform non-players on some tests of visual attention5. However, the widely held belief that commercially available computerized brain-training programs improve general cognitive function in the wider population in our opinion lacks empirical support. The central question is not whether performance on cognitive tests can be improved by training, but rather, whether those benefits transfer to other untrained tasks or lead to any general improvement in the level of cognitive functioning. Here we report the results of a six-week online study in which 11,430 participants trained several times each week on cognitive tasks designed to improve reasoning, memory, planning, visuospatial skills and attention. Although improvements were observed in every one of the cognitive tasks that were trained, no evidence was found for transfer effects to untrained tasks, even when those tasks were cognitively closely related.(emphasis mine)Contrast this with a review from this year (Does working memory training work? The promise and challenges of enhancing cognition by training working memory. Psychon Bull Rev 2011) that broke training into strategy and core training:Strategy training paradigms involve teaching of effective approaches to encoding, maintenance, and/or retrieval from WM. The primary aim of most strategy training studies is to increase performance in tasks requiring retention of information over a delay. In strategy training studies, experimenters introduce participants to particular task strategies, and then provide practice sessions encouraging the strategy of interest. Some strategy training programs aim to increase reliance on, and facility with, articulatory rehearsal,while other programs aim to train elaborative encoding strategies...Core training studies typically involve repetition of demanding WM tasks that are designed to target domain-general WM mechanisms. To achieve this purpose, core training paradigms are commonly designed to: 1) limit the use of domain-specific strategies, 2) minimize automization, 3) include tasks/stimuli that span multiple modalities, 4) require maintenance in the face of interference, 5) enforce rapid WM encoding and retrieval demands, 6) adapt to participants’ varying level of proficiency, and 7) demand high cognitive workloads or high intensity cognitive engagement (though different studies place variable emphasis on these factors). Tasks utilized in core training programs also commonly involve sequential processing and frequent memory updating.The authors conclude:In particular, core WM training studies seem to produce more far-reaching transfer effects, likely because they target domain-general mechanisms of WM. The results of individual studies encourage optimism regarding the value ofWM training as a tool for general cognitive enhancement.However, we discuss several limitations that should be addressed before the field endorses the value of this approach.MEDICATIONThe issue of using medication for cognitive enhancement is very contentious, however I will not discuss the ethics here.In 2008, Nature ran a commentary on this topic: Towards responsible use of cognitive-enhancing drugs by the healthy in which the authors outline the evidence in favor of the efficacy of "smart drugs" (nootropics):Many of the medications used to treat psychiatric and neurological conditions also improve the performance of the healthy. The drugs most commonly used for cognitive enhancement at present are stimulants, namely Ritalin (methyphenidate) and Adderall (mixed amphetamine salts), and are prescribed mainly for the treatment of attention deficit hyperactivity disorder (ADHD). Because of their effects on the catecholamine system, these drugs increase executive functions in patients and most healthy normal people, improving their abilities to focus their attention, manipulate information in working memory and flexibly control their responses...A newer drug, modafinil (Provigil), has also shown enhancement potential. Modafinil is approved for the treatment of fatigue caused by narcolepsy, sleep apnoea and shift-work sleep disorder. It is currently prescribed off label for a wide range of neuropsychiatric and other medical conditions involving fatigue as well as for healthy people who need to stay alert and awake when sleep deprived, such as physicians on night call. In addition, laboratory studies have shown that modafinil enhances aspects of executive function in rested healthy adults, particularly inhibitory control. Unlike Adderall and Ritalin, however, modafinil prescriptions are not common, and the drug is consequently rare on the college black market. But anecdotal evidence and a readers' survey both suggest that adults sometimes obtain modafinil from their physicians or online for enhancement purposes.A modest degree of memory enhancement is possible with the ADHD medications just mentioned as well as with medications developed for the treatment of Alzheimer's disease such as Aricept (donepezil), which raise levels of acetylcholine in the brain. Several other compounds with different pharmacological actions are in early clinical trials, having shown positive effects on memory in healthy research subjects.It is too early to know whether any of these new drugs will be proven safe and effective, but if one is it will surely be sought by healthy middle-aged and elderly people contending with normal age-related memory decline, as well as by people of all ages preparing for academic or licensure examinations.Regarding the last class of drugs--the cholinergic drugs--my friend Ariel Rokem published research last year on the effect of Aricept on visual perceptual learning (Cholinergic enhancement augments magnitude and specificity of visual perceptual learning in healthy humans, Curr Biol 2010):Acetylcholine (ACh) has been suggested to regulate learning by enhancing the responses of sensory cortical neurons to behaviorally relevant stimuli. In this study, we increased synaptic levels of ACh in the brains of healthy human subjects with the cholinesterase inhibitor donepezil (trade name: Aricept) and measured the effects of this cholinergic enhancement on visual perceptual learning. Each subject completed two 5 day courses of training on a motion direction discrimination task, once while ingesting 5 mg of donepezil before every training session and once while placebo was administered. We found that cholinergic enhancement augmented perceptual learning for stimuli having the same direction of motion and visual field location used during training. In addition, perceptual learning with donepezil was more selective to the trained direction of motion and visual field location. These results, combined with previous studies demonstrating an increase in neuronal selectivity following cholinergic enhancement, suggest a possible mechanism by which ACh augments neural plasticity by directing activity to populations of neurons that encode behaviorally relevant stimulus features.(emphasis mine)But again, remember the caveats about transfer in training: just because a drug enhances one aspect of cognition (visual perceptual learning) does not mean it will transfer to others (e.g. working memory).Just this year, a study in Nature (A critical role for IGF-II in memory consolidation and enhancement, 2011) showed that another type of drug, insulin-like growth factor II, enhances memory in rats:We report that, in the rat, administering insulin-like growth factor II (IGF-II, also known as IGF2) significantly enhances memory retention and prevents forgetting. Inhibitory avoidance learning leads to an increase in hippocampal expression of IGF-II, which requires the transcription factor CCAAT enhancer binding protein β and is essential for memory consolidation. Furthermore, injections of recombinant IGF-II into the hippocampus after either training or memory retrieval significantly enhance memory retention and prevent forgetting. To be effective, IGF-II needs to be administered within a sensitive period of memory consolidation. IGF-II-dependent memory enhancement requires IGF-II receptors, new protein synthesis, the function of activity-regulated cytoskeletal-associated protein and glycogen-synthase kinase 3 (GSK3). Moreover, it correlates with a significant activation of synaptic GSK3β and increased expression of GluR1 (also known as GRIA1) α-amino-3-hydroxy-5-methyl-4-isoxasolepropionic acid receptor subunits. In hippocampal slices, IGF-II promotes IGF-II receptor-dependent, persistent long-term potentiation after weak synaptic stimulation. Thus, IGF-II may represent a novel target for cognitive enhancement therapies.BRAIN STIMULATIONThis is seriously DO NOT TRY THIS AT HOME territory.DO NOT TRY THIS AT HOMEBut this year, a cool study was published in Clinical Neurophysiology (Improving working memory: Exploring the effect of transcranial random noise stimulation and transcranial direct current stimulation on the dorsolateral prefrontal cortex, 2011) showing that transcranial direct current stimulation (tDCS) of the dorsolateral prefrontal cortex (a brain region known to be critical for maintaining items in working memory) may enhance working memory. tDCS is a simple system wherein a low, direct current is passed between two electrodes on the scalp, inducing a current between them intracerebrally. The researchers report that:There was significant improvement in speed of performance following anodal tDCS on the 2-back WM task; this was the only significant finding... The results do not provide support for the hypothesis that tRNS improves WM. However, the study does provide confirmation of previous findings that anodal tDCS enhances some aspects of DLPFC functioning. Methodological limitations that may have contributed to the lack of significant findings following tRNS are discussed.

This is a part of an exercise for MBA Bootcamp.My dream organization would be an idea for a start-up which I have been thinking about for quite some time to build a central portal which would link all the stakeholders in the healthcare ecosystem like Patients, doctors, hospitals, pharmaceutical stores, insurance companies and also act as a marketplace for products and services related to health-care.Vision:To enhance healthcare ecosystem using technology.How does it make revenue? What products or programs or services does it provide? Who are its customers?This organization would be adding value to all the stakeholders/customers and would generate revenue by providing products and services for all of them. It can add value in the following ways:Patients:1. They can store all their medical history, blood groups, allergies,etc2. Search for doctors in the vicinity & schedule appointments which can automatically be added their calendar with reminders.3. Do a preliminary diagnosis of possible diseases by entering symptoms prior visiting the doctor.4. Make payments via an app.5. Search for pharmaceutical stores via app where the prescribed medicines are available or buy them online.6. Purchase wearable devices, medical equipments.7. Link their wearable health-care devices to the app and get analytics for data collected. This can also be fed into patient history. Get an alarm in case of abnormalities.8. Search and choose insurance plans. Link their insurance plans so they can easily pay premiums and get medical bills easily re-imbursed.9. They would be given cards using which they can easily check in hospitals, clinics,etc and it would contain details regarding their insurance and people to be informed in case of emergencies,etc.Doctors:1. Get an online presence so that they are easily discovered by patients.2. Online payments and appointments facility3. Easily access patient history, their allergies, current medications,etc4. Give prescriptions via application. No need for printing. The prescriptions can be de-activated and archived to prevent abuse of drugs after a time period.5. Get information on seminars and events related to his specialization in medicine.6. Get information about new breakthrough medicines, research articles/papers,etc.Pharmaceutical stores:1. Get orders online from patients which can be later collected from counter or delivered to home.2. Manage their inventory, procure and pay for their orders online.Pharmaceutical Companies:1. Get region-wise analytics on diseases so that they can target them more efficiently.2. Get analytics on their region-wise sales3. Channel to provide informational/promotional materials to doctors.4. Better connectivity and reach to pharmaceutical distributors and retailers.5. Real time information regarding sales of their products.Insurance Companies:1. Easy facilitation of payments of premium and disbursements of claims2. Can take decision on premium amounts to be paid based on medical history.Revenue generation by:1. Advertisements on free versions (Limited features)2. Paid services for premium versions.3. Building & selling health-care specific products/devices (eg. wearable healthcare devices)4. Commission on selling medicines, products and equipments through its marketplace.5. by subscription fees from pharmaceutical stores for inventory management, procuring and selling medicines online through our portal.6. Paid analytics and services for pharmaceutical companies.Growth & Funding:As it is still just an idea, there may be a lot of assumptions regarding the needs of stakeholders and what would they be willing to pay for. So, initially a thorough market research can be done by reaching out to all stakeholders and experts in relevant fields to validate the ideas and identify even more gaps in the healthcare ecosystem.Then based on the inputs, a minimum loveable product can be designed for which people would be willing to pay(using a seedfund if needed). This would kick-start our revenues and can be scaled while adding on more features. Based on the market response and kind of growth needed we can go for further rounds of funding.Also, we can tie up with insurance companies for special plans bundled with our offerings, so that we reach the general public more efficiently and at a faster rate.Challenges:1. Regulatory: As it is a highly regulated industry, designing a product or service meeting all the regulatory requirements would be a big challenge.2. Competition from existing players like practo for searching doctors, companies who are already in wearable devices space, online health care related marketplaces.3. People may not be comfortable or willing to share their medical history.4. Bringing pharmaceutical stores on our portal - as already many people have their own inventory management systems.Thank you Ellen Vrana & User for this exercise. This is the first time I have put it in form of writing and has certainly brought a lot of clarity and things that i still need to address more. I would really like to hear your feedback on this.

I can think of a few different cases where this problem had arisen before:You have hired (explicitly) a team of programmers (and not a technical partner).Your definitions are indeed quite vague (i.e. “Build me a search engine”).Your roadmap is changing way too fast (causing friction on the technical end).You put a hard limit on time/budget but often introduce scope creep within the initial time frame which requires solid refactoring.I’ve been on both sides of the table and faced all of those problems myself.1. Hiring “Taskers”Many outsourcing agencies are indeed “bricklayers”. Some of my friends lease developers for a monthly fee and require a well defined scope that works as initially defined.We also worked with an outsourcing agencies 5 years ago while we were still a small team. The folks were great developers but couldn’t understand business problems. We had intentionally introduced them to the product owner but the user stories did no good.Our technical lead back then was translating all of those user stories into technical requirements for each of the user cases. It was an overhead that we included separately which was one of the reasons why we are no longer working with them.Our retainers nowadays are deeply embodied in the business model of our accounts. Our tech, creative, and marketing people work together on identifying areas for improvement, scheduling iterations for cleaning “technical debt” and reviewing competitors for potential features that we could introduce instead. But some agencies simply don’t have the resources (or the desire) to implement a similar workflow (nor do all clients, for that matter).2. Vague DefinitionsSome of our former clients were quite vague in terms of defining business requirements.In most cases, we worked with a product owner in a small company (a funded startup) dealing with dozens of activities at a time. They were somewhat sloppy in defining the scope and tried to offload all of that to the technical team.Which is fine - until you get into an endless loop of iterations and interpretations dependent on different stakeholders on the client’s end.That’s especially true in terms of design iterations or general, large features like an eCommerce, a training platform, an LMS and the like.3. The Endless RoadmapSure - agile is all about flexibility and change.But there is a limited step of change sets that a developer should grasp until they can mix up different instructions for the same features over the course of a few weeks.Ideally, the product would define an MVP which is somewhat “fixed”. And build atop of that MVP. Changes would be minor modifications of the workflow, additional features, or other forms of enhancements that don’t require rebuilding the entire product all over.On top of that, defining the flexibility of the architecture early on is important.If you overengineer the application, it might be an overhead that will take forever to rebuild.If you go lean and simple, introducing new generic layers later may be problematic (especially post-live where the live customers are interacting with the app).This “always evolving” roadmap should be limited to some extent for maximum efficiency and productivity.4. Hard LimitsNon-technical people may have a hard time understanding how a seemingly minor change may take weeks. This puts some pressure on the tech team whenever the scope and the budget are somewhat predefined.Recently, we launched the public portal for a website. The client was great and the website was quite interesting. The platform interacted with a few other applications that we had to integrate ourselves.The retainer plan was 250 hours a month and our initial planning included some buffer for unexpected surprises.Suddenly, it turned out that our front-end layer integrated with the other platforms caused a wide set of conflicts. There were 4 different versions of jQuery defined across different pages (including one back from 2009) - with another set of dependent libraries for each of those. We were using jQuery for some animations, interactive menu items and the like.We ended up with a list of 100+ pages causing different problems with some of the pages, some of the time. There was a launch date planned for version 1 which we had to get sorted asap. It required rewriting a big chunk of our integration, including the SSO and some of the APIs built initially that worked on our end.Another instance was a WordPress platform migrating from a visual builder to another dynamic solution with editable fields. There were 4 different teams involved and 3 sites updating content simultaneously. The hosting vendor was inadequate, limited technical support (no ssh), a broken migration and sync feature and the like. That brought a hundred extra hours to our previously assigned 30-hour task.Sure, all of those could be handled earlier - but not all stakeholders are fully aware of the impact of those changes or the complexity of the different components across the technical stack.Back to your original question - figure out if your roadmap is actually defined and what is the impact of regular changes in terms of billable hours. Understand the complexity of the underlying layer and the architecture - and suggest a lighter approach if needed.And last, have an open conversation with your technical team. If you want them to take more initiative and become a technical partner of yours, let them know. If they are opposed to investing in a business growth mindset, you probably need to look for a different sort of vendor.