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[Controlling science and technology, 1965-2000].

Over the last 35 years ideas about the development of science and technology have taken a new turn. The optimistic period of post-war reconstruction that lasted until the nineteen sixties saw science and technology as almost autonomous phenomena and as the source of our wealth. This view came to be criticized in the seventies, and the social impact of the intertwined development of science and technology came under scrutiny. Discussions about nuclear power, nuclear weapons and environmental problems induced the first attempts to control the development of science and technology. These attempts were mainly directed at minimalizing side effects, yet at the same time an increasing need was felt to adapt the course of scientific and technological developments to social needs. Governments were urged to devise mechanisms to institutionalize attempts in this direction. Social groupings began to use science and technology as a means to achieve their own ends (e.g., alternative technology). In particular, there was a growing interest in the possibilities of influencing decision-making with regard to science and technology. This paper presents an overview of these developments and illustrates the growing involvement of outside parties. Multinational companies, science organizations and the universities have thus paid increasing attention to forms of decision making that aim to give civilians a more important role.

History, 20th Century↗

Technologies -- appropriate and inappropriate.

People often think that "technology" means "machines". But according to WHO a technology is an association of methods, procedures, techniques, and equipment which, together with the people using them, can contribute to solving a health problem. An appropriate technology is one that is scientifically sound, adapted to local needs, acceptable to those who use it or for whom it is used, and that can be maintained and utilized with resources that the community can afford. Many different technologies have contributed enormously to reducing maternal and perinatal mortality and morbidity. Yet, very often, not enough attention is paid to the economic, human, and infrastructure implications of the technology or to the implications of introducing it into a new setting. This issue of Safe Motherhood looks at some of the technologies currently widely available in maternal and neonatal health care and asks two simple questions. Has this technology been evaluated in different settings? And at which level of the health care system can this technology be used appropriately?

Delivery of Health Care↗

Introducing information technology into the home: conducting a home assessment.

Abstract As the home becomes an increasingly important site for health care, an increasing number of technology applications or devices are being introduced to support health at home. However, introducing new technology into a household raises a number of issues that must be considered prior to, during, and after the technology is implemented. This paper reviews the experiences of the UW-Madison Advanced Technologies for Health@Home Project, summarizing our assessment of household requirements that should be analyzed prior to introducing new technology. The overall goal of the Health@Home project is to improve the functionality and content of information technology innovations for the home. Using Venkatesh and Mazumdar's framework this article will summarize the relevant social, behavioral, technological, and physical dimensions of households that must be carefully assessed and understood to help ensure that the technology fits the needs of home residents.

Data Collection↗

Acquiring new technology and surviving environmental pressures.

CONTEXT: The U.S. health care system faces increased pressures to expand coverage to the elderly, the uninsured and the poor, while maintaining costs and quality of care. Because of the federal budget deficit and continued fiscal uncertainties, resource allocation will become even more scrutinized. OBJECTIVE: How does a health care system allocate limited funds and still provide quality care using innovative technology? METHOD: This article reviews the literature on the acquisition of new technologies from a theoretical perspective, using positron emission tomography (PET) as an example. A unified model, including concepts from the resource dependency theory (RDT) supplemented with organizational survival concepts from the ecological theory, was used to analyze resource acquisition for technological innovation and organizational survival. An attempt was made to evaluate a hospital's profit maximization, recognition as a center of clinical excellence and role as a technological leader of the community with respect to acquisition of PET equipment. CONCLUSION: Organizations acquire new technology for a variety of reasons that can be explained by RDT and ecological theory concepts. In terms of the profit maximization motive, hospitals purchase PET equipment to enhance revenue generation. From the clinical excellence perspective, organizations seek the best available technology to meet the needs of their patients. Finally, hospitals adopt new technology to enhance their image as a technological leader.

Capital Expenditures↗

Joint report of the Council on Scientific Affairs and the Council on Medical Service. Technology assessment in medicine.

The rapid proliferation of health care technology and the increasing concern about cost containment are major converging forces in today's health care system. These forces argue persuasively for the rigorous evaluation of the safety and effectiveness of technologies and for the use of such evaluative information as the foundation of both clinical decision making and public policy formulation. Thus, technology assessment is an essential tool in improving the quality of health care delivered and in maximizing the efficiency of the health care system. The American Medical Association historically has been dedicated to the provision of sound scientific information to enhance the appropriate utilization of health care technology. This objective remains the primary goal of the American Medical Association's activities in technology assessment. Additionally, with the ascendancy of nonphysician segments of the health care community in making policies that affect the availability of technology, the American Medical Association's assessment programs must represent physicians' views and concerns cogently in public policy debates (eg, coverage). The Council on Scientific Affairs and the Council on Medical Service examined the area of technology assessment and its influence on the payment for and the utilization of health care technology. The councils made specific recommendations to ensure that the American Medical Association maintains the sophisticated capabilities and sufficient capacity to meet the needs of physicians and patients alike in today's complex health care environment.

American Medical Association↗

[Appropriate technologies in food: conceptual framework for their generation and transfer in Central America and Panama].

A conceptual framework is presented, expressing the relationship between food availability and the food and nutritional status of a population. As element of the model, the generation and transfer of appropriate food technologies were included. Based on the conceptual framework, three successful cases of food technology transfer in the Central American area were analyzed. The most important aspects of each case were identified, and a critical review of the characteristics and conditions required to generate and transfer appropriate technologies, was carried out. An inventory was made of those factors which are essential for a food technology to be appropriate; this analysis resulted in the postulation of a model describing the life cycle of appropriate food technologies. On these bases, several guidelines are postulated, which could constitute a conceptual framework to help guide actions in the generation and transference of appropriate food technologies in Central America and Panama. Essential elements of the proposed framework are: identification and characterization of the problem of the group of "users" of the technology; problem solution by a multidisciplinary group; test of the technology and evaluation of its feasibility (technical, economical, political, social and cultural), and controlled transference to the group of "users".

Central America↗

Can our health services be saved by technology evaluation? The Quebec experience.

The finances to support our health services at their present level are lacking, and much of the shortage is due to new health technologies. Through the utilisation of technology assessment (TA), it is hoped that we may be able to eliminate useless technologies and that the money so saved will allow us to maintain our health care services intact. Such hopes are exaggerated. The uses and limitations of TA are reviewed in the light of recent experience gained with the Conseil d'évaluation des technologies du Québec. Technology assessment has only limited value in exposing ineffective technologies. More often, it can illuminate inappropriate use of technologies. However, its real value lies elsewhere, namely in making difficult choices between different technologies. An example is the choice between expensive, low osmolar contrast media in radiology and the cheaper, high osmolar material which causes more frequent reactions. Credible estimates of how much benefit will result from the commitment of how many extra dollars can facilitate such decisions. However, the user must clearly understand the limitations of cost-effectiveness estimates, which should never be used for policy purposes without full knowledge of all the qualifiers on which the estimates depend.

Canada↗

The 1990s--interface of cytopathology and new technology.

In physical chemistry, the most unique and dramatic reactions occur at the interface between different phases of matter. An analogy can be drawn between this observation and the interface that currently exists between the traditional practice of cytopathology and the technologies discussed in this editorial. It is natural to be excited about new technologies. They offer the potential to improve our diagnostic ability, to save time, and to expand the range of cytopathology services. Our enthusiasm for new technology should be tempered by the inherent appeal of cytopathology--its relative simplicity. Cytologic diagnoses are possible with a glass slide, extracts of tree bark, and a well-trained observer. This can be rapid and tremendously cost effective, not only identifying the type of abnormality, but often providing prognostic information. New technology, while offering additional information, may not be cost effective, or may not offer more information than is available by traditional methods. Whether or not to accept new technologies is the choice of cytotechnologists and cytopathologists. It is the goal of the Editorial Board of Diagnostic Cytopathology that this be a well-informed choice. The current and coming issues of Diagnostic Cytopathology will describe technological advances in the Focus on Technology section of the journal. We trust that you will find this information useful in your evaluation of new technology.

Computer-Assisted Instruction↗

Outcome of home care for technology-dependent children: success of an independent, community-based case management model.

Case management is important for successful home care of technology-dependent, respiratory-disabled children. Traditionally, the medical model of hospital-based home care and case management has been used for these children. The outcome may be different from when using independent, community-based home care and case management. We evaluated the results of 28 technology-dependent children [23 receiving mechanical ventilation and 5 receiving continuous positive airway pressure (CPAP)] from 8 hospitals, who utilized an independent, community-based, case management group to coordinate home care. After 26.3 +/- 20.6 months of follow-up, 13 children (46%) remained technology-dependent, 10 (36%) were technology-independent, and 5 (18%), all with neurologic dysfunction, had died. Only one death was caused by a complication of technology. All children with congenital anomalies (n = 4), primary pulmonary disease (n = 8), and neuromuscular disease (n = 4) survived, and 9 (56%) were weaned from technological support. Children with chronic respiratory failure secondary to central neurologic dysfunction (n = 12) did poorly: 5 died, 6 remained technology-dependent, and only 1 became independent of technology. Children with neuromuscular diseases tended to use less home care nursing at a lower home care cost. Parent satisfaction was high among those who responded (82%), indicating that the child, siblings, and family were better off with the child at home. These outcomes suggest that community-based home care and case management is a reasonable alternative to the hospital-based model.

Abnormalities, Multiple↗

Perceptions and attitudes of Canadian orthodontists regarding digital and electronic technology.

INTRODUCTION: To plan for future acceptance and implementation of computer-related technology, it is necessary to understand orthodontists' current perceptions and attitudes toward emerging technologies. METHODS: An anonymous, self-administered, mail-out survey of Canadian orthodontists was conducted. The response rate was 45.6% (304/667). RESULTS: Most orthodontists indicated that computer technology could improve current practice efficiency and quality of patient care. Only 15% reported that digital models are quite or very useful; 73.6%, 69.1%, 55%, and 37.4% agreed or strongly agreed with using digital and electronic technology to consult with other dental specialists, other orthodontists, general dentists, and the public, respectively. Cost of the technology was reported as a significant or insurmountable obstacle by 54% of the respondents. Interprovincial legislation, unclear consultation remuneration guidelines, and lack of comfort with the technology were not perceived as significant obstacles. Only 36% reported security or privacy issues as a significant or insurmountable obstacle. CONCLUSIONS: Canadian orthodontists seem to view digital and electronic technology as useful and capable of improving their offices' efficiency and production. Although they are sensitive to some potential obstacles, they are willing to overcome these and incorporate the technology into their practices.

Attitude of Health Personnel↗

Diffusion and economic consequences of health technologies in prostate cancer care in Sweden, 1991-2002.

OBJECTIVE: To describe the diffusion of six main health technologies used for management of prostate cancer, to estimate the economic consequences of technological changes, and to explore factors behind the diffusion. METHODS: Data describing the diffusion 1991-2002 were obtained from population-based databases. Costs were obtained from Linköping University Hospital and Apoteket AB. Factors affecting the diffusion of the technologies were explored. RESULTS: Utilization of technologies with a curative and/or palliative aim has increased over time, except for surgical castration. PSA-tests are used increasingly. The total cost of the study technologies has increased from 20 million euros in 1991 to 65 million euros in 2002. Classification of radical prostatectomy revealed a profile associated with a slow/limited diffusion, while classification of PSA-tests revealed a profile associated with a rapid/extensive diffusion. CONCLUSIONS: Several technological changes in the management of prostate cancer have occurred without proven benefits and have contributed to increased costs. There are other factors, besides scientific evidence, that have an impact on the diffusion. Consequently, activities aimed at facilitating an appropriate diffusion of new technologies are needed. The analytical framework used here may be helpful in identifying technologies that are likely to experience inappropriate diffusion and therefore need particular attention.

Diffusion of Innovation↗

Effects of pre-treatment technologies on quantity and quality of source-sorted municipal organic waste for biogas recovery.

Source-sorted municipal organic waste collected from different dwelling types in five Danish cities and pre-treated at three different plants was sampled and characterized several times during one year to investigate the origin of any differences in composition of the pre-treated waste introduced by city, pre-treatment technology, dwelling type or annual season. The investigated pre-treatment technologies were screw press, disc screen and shredder+magnet. The average quantity of pre-treated organic waste (biomass) produced from the incoming waste varied between the investigated pre-treatment technologies: 59%, 66% and 98% wet weight, respectively (41%, 34% and 2% reject, respectively). The pre-treatment technologies showed differences with respect to distribution of the chemical components in the waste between the biomass and the rejected material (reject), especially for dry matter, ash, collection bag material (plastic or paper) and easily degradable organic matter. Furthermore, the particle size of the biomass was related to the pre-treatment technology. The content of plastic in the biomass depended both on the actual collection bag material used in the system and the pre-treatment technology. The sampled reject consisted mostly of organic matter. For cities using plastic bags for the source-separated organic waste, the expected content of plastic in the reject was up to 10% wet weight (in some cases up to 20%). Batch tests for methane potential of the biomass samples showed only minor variations caused by the factors city, pre-treatment technology, dwelling type and season when based on the VS content of the waste (overall average 459STPm(3)/tVS). The amount of methane generated from 1t of collected waste was therefore mainly determined by the efficiency of the chosen pre-treatment technology described by the mass distribution of the incoming waste between biomass and reject.

Biomass↗

Information technology in ENT: are we ready to be 'Connected For Health'?

The NHS Connecting for Health agency continues to implement the national programme for information technology within the National Health Service (NHS). In preparation, NHS employees are being encouraged to develop their information technology skills via the European computer driving licence training course. A postal survey of British Association of Otorhinolaryngologists members was undertaken to evaluate their levels of information technology training, competency and knowledge. Three hundred and thirty-six surgeons responded. Most respondents had received no formal information technology training. Only 3.9 per cent had taken the European computer driving licence course. Most surgeons felt comfortable using word processing and presentation software but were less comfortable with other applications. Junior surgeons were more confident in all areas of information technology application than senior surgeons. Seventy-two per cent of surgeons wanted more information technology training. Most felt that such training should be routine at undergraduate and postgraduate level. With the national programme committed to improving information technology infrastructure within the NHS, more formal training should be provided to ensure a basic standard of information technology competency amongst ENT surgeons.

Adult↗

Brain imaging technologies: how, what, when and why?

OBJECTIVE: Innovations in physics and computing technology over the past two decades have provided a powerful means of exploring the overall structure and function of the brain using a range of computerised brain imaging technologies (BITs). These technologies offer the means to elucidate the patterns of pathophysiology underlying mental illness. The aim of this paper is to explore the current status and some of the future directions in the application of BITs to psychiatry. METHOD: Brain imaging technologies provide unambiguous measures of brain structure (computerised tomography and magnetic resonance imaging [MRI]) and also index complementary measures of when (electroencephalography, event related potentials, magnetoencephalography) and where (functional MRI, single photon emission computed tomography, positron emission tomography) aspects of brain activity occur. RESULTS: The structural technologies are primarily used to exclude a biological cause in cases of a suspected psychiatric disorder. The functional technologies show considerable potential to delineate subgroups of patients (that may have different treatment outcomes), and evaluate objectively the effects of treatment on the brain as a system. What is seldom emphasised in the literature are the numerous inconsistencies, the lack of specificity of findings and the simplistic interpretation of much of the data. CONCLUSION: Brain imaging technologies show considerable utility, but we are barely scratching the surface of this potential. Simplistic over-interpretation of results can be minimised by: replication of BIT findings, judicious combination of complementary methodologies, use of appropriate activation tasks, analysis with respect to large normative databases, control for performance, examining the data'beyond averaging', delineating clinical subtypes, exploring the severity of symptoms, specificity of findings and effects of treatment in the same patients. The technological innovation of BITs still far outstrips the sophistication of their use; it is essential that the meaning and mechanisms underlying BIT measures are always evaluated with respect to prevailing models of brain function across disciplines.

Brain↗

Blood pumps: technologies and markets in transformation.

The heart failure industry or sector of blood pump technologies comprised of scientists, medicine, and business has inadequate attention from the financial community due to the perception of unmet market potential and regulatory hurdles. There are more than 20 mechanical circulatory support technologies currently in some stage of development. The application is defined initially for emerging technologies as bridge-to-transplant whereas more mature devices have focused on bridge-to-recovery and alternative-to-transplant. Regulatory hurdles and financing resources have dictated this initial application strategy. Whether a technology has valves, bearings, is magnetically suspended, acts as a pressure cuff, and so on, the future will belong in large part to those technologies that are less expensive, have improved ergonomics, are simpler in surgical application, and can demonstrate efficacy levels that are an improvement over today's approved devices. Today's devices have provided a valuable platform for the emerging technologies. However, there has been little market expansion over these past years, relative to the potential market. The cardiologist is the patient's gatekeeper, and drugs appear to be the therapy of choice as options are considered. Technologies without a business model will have a difficult time attracting much needed funding, the result being protracted development times or project termination. MicroMed has modified its ventricular assist device (VAD) focus, with a broader look at treating the heart failure patient. MicroMed recently entered into an agreement with Chrysalis Biotechnology, Inc., Galveston, TX, covering a synthetic peptide technology (Chrysalin) that when injected into tissue has demonstrated an angiogenic effect without the concerns inherent in recombinant angiogenic/growth factors. We believe a combination therapy of the DeBakey VAD-synthetic peptide could provide sufficient revascularization for bridge-to-recovery or as an alternative-to-transplant in certain patients.

Angiogenesis Inducing Agents↗

Application of reproductive technology to the Australian livestock industries.

Current use of reproductive technology in the Australian livestock industries is limited, though it increased in line with higher prices for beef and wool through the 1980s. The required techniques, many of which were developed in Australia, are available and the level of expertise is comparable to the best in the world. However, the extensive pastoral industries do not readily lend themselves to these procedures. Only in the dairy industry is artificial insemination used to a significant degree. On the other hand, application of the technology in the pastoral industries is confined largely to studs and breeding cooperatives which provide breeding animals for producer flocks and herds. Hence the impact of applied technology may be more widespread than first appears. Until recently, little regard was paid to application of the technology along sound breeding principles. Artificial insemination and multiple ovulation and embryo transfer (MOET) have not been used so much in planned breeding programmes aimed at local improvement of stock, but more to proliferate genes of reputedly superior stock, imported either from overseas or elsewhere in Australia. This is particularly true of MOET, where the incentive to use it is commonly a short term cash gain made from proliferating breeding stock of a particularly valuable and usually novel strain or breed. Recent technological improvements which render the use of reproductive technology cheaper and more effective will lead to its more widespread use in commercial practice. Techniques for embryo freezing and splitting have been greatly simplified and quickly put into practice. The novel livestock technologies of in vitro oocyte maturation and fertilization have already found commercial application overseas. Fecundity-enhancing products have also been adopted by the livestock industries. There is potential value for greater use of reproductive technology in the livestock industries provided it is implemented according to sound breeding principles and provided associated management practices are applied simultaneously.

Animals↗

Enhancing literacy development through AAC technologies.

There is a critical need to understand teaching and technology supports that enable students who use augmentative and alternative communication (AAC) systems to engage in meaningful literacy experiences and foster conventional literacy skills. To thrive in classroom environments, they must have access to tools that can support them in active and independent literacy learning. These students need technology that allows them to move seamlessly between reading, writing, and communicating. They require technology that takes into account access needs, individual learning needs, the learning demands of technology, and literacy development across grades. Families and school teams need information that will assist them in providing the best tools and the most appropriate content within these tools throughout the school day. Teachers need information that supports them in providing exemplary literacy instruction to students who use AAC systems. This article explores and summarizes factors impacting literacy learning, including literacy capabilities of school-age students who use AAC, communication in literacy learning and use, reading and writing instruction in general education classrooms, and technology to support literacy learning. It is important that future technology tools provide a platform for levels of literacy learning: The power of technology will be reflected in its ability to provide access to and display the right content at the right time for students who use AAC. This article summarizes current factors thought to influence literacy learning and discusses priorities for future research and technology development.

Communication Devices for People with Disabilities↗

Sources of payment for assistive technology: findings from a national survey of persons with disabilities.

This article provides an overview of who pays for the most commonly used assistive technology devices, special adaptations, and environmental accommodations by persons with disabilities in the United States. The latest findings from the 2001 survey of Use and Need of Assistive Technology and Information Technology by Persons With Disabilities in the United States conducted by the National Institute on Disability and Rehabilitation Research, Rehabilitation Engineering and Assistive Technology Society of North America, and the University of Michigan will be presented and compared to findings from earlier research and reviews of the literature. A modified discriminant function analysis was performed to determine the interaction between the source of payment for assistive technology used by persons with disabilities. In the sample of 1,414 such persons, 901 were found to use some form of assistive technology in their daily lives. Ten distinct sources of payment were specified. Respondents were able to mention up to three sources of payment for each example of assistive technology used. A total of 1,877 sources were mentioned. Overall, the most mentioned payment source was self or other family member in household, accounting for nearly 40% of all sources mentioned. The variables tested were found to have varying levels of interactive potency. Occupational status, education level, severity of impairment, opinion as to the effectiveness of assistive technology, and personal income were significant, whereas age, family income, opinion as to improvement over the past decade, and race were statistically unrelated to source of payment. From the perspective of relative discrimination on the basis of payment source, Medicare stands as the lone significant discriminant source of payment. The authors offer a summary and conclusion based on an integrated view of all available sources of information about payment.

Persons with Disabilities↗