bluuebunny/crossref_metadata_2025 huggingface dataset:
An interactive robot control environment for rehabilitation applications
Authors: Dallaway J. L. , Mahoney R. M. , Jackson R. D. , Gosine R. G.
Published: March 2009

Interactive robot systems are under active investigation as aids for people with impaired manipulating ability. Under the direction of a disabled operator, a robot can manipulate objects, thereby increasing the independence of the operator in home, school and work activities. This paper describes a high-level control language CURL developed to facilitate communication between a disabled operator and the task environment. CURL is a Windows-based application. Interactive robotics requires a different approach from mainstream robotics where humans are kept out of the robot's work area.
Numerical robot kinematics based on stochastic and molecular simulation methods
Authors: Kastenmeier Thomas , Vesely Franz J.
Published: March 2009

Multilink robot arms are geometrically similar to chain molecules. We investigate the performance of molecular simulation methods, combined with stochastic methods for optimization, when applied to problems of robotics. An efficient and flexible algorithm for solving the inverse kinematic problem for redundant robots in the presence of obstacle's (and other constraints) is suggested. This “Constrained Kinematics/Stochastic Optimization” (CKSO) method is tested on various standard problems.
Experimental evaluation of time-varying impulse shaping with a two-link flexible manipulator
Authors: Cho Jung-Keun , Park Youn-Sik
Published: March 2009

In the authors' previous paper,10 an input shaping method was presented to reduce motion-induced vibrations effectively for various classes of flexible systems. In this paper, the effectiveness of the shaping method is experimentally demonstrated with a two-link flexible manipulator system

The manipulator for experiments includes two revolute joints and two flexible links, and moves on a vertical plane under gravity. An analytic model is developed considering the flexibility of the system and its joint stiffness in order to derive an appropriate estimation of dynamic modal properties. The input shaping method used in this work utilizes time-varying modal properties obtained from the model instead of the conventional input shaping method which employs time-invariant modal properties. A point-to-point motion is tested in order to show the effectivess of the proposed shaping method in vibration reduction during and after a given motion. The given reference trajectories are shaped to suppress the motion induced vibration. The test results demonstrate that the link vibration can be greatly suppressed during and after a motion, and the residual vibration reduction was observed more than 90% by employing this time-varying impulse shaping technique.
Application of adaptive neural network to localization of objects using pressure array transducer
Authors: Leung Anderson , Payandeh Shahram
Published: March 2009

Pattern recognition and object localization, using various sensors such as vision and tactile sensors, are two important areas of research in the application of robotic systems. This paper demonstrates the feasibility of using some relatively inexpensive array of pressure sensors and a neural network approach to achieve object localization and pattern recognition. The sensors that are used are force sensing resistors (FSRs), more specifically, a 16 x 16 array of FSRs. Because of the nonlinearity associated with a FSR, three possible approaches for gathering output from the sensor array are used. The neural network that is used consists of two 2-layer counterpropagation networks (CPNs). One of the CPNs is trained to recognize contact signatures of different objects placed on a fixed reference position on the sensor array.
Nonlinear regular dynamics of a single-degree robot model
Authors: Paar V. , Pavin N. , Paar N. , Novaković B.
Published: March 2009

This paper presents a mathematical model of a robot with one degree of freedom and numerical investigation of its dynamics in a particular parameter scan which is close to the upper boundary of the estimates for the parameters of rigidity and friction, while the length parameter L is treated as a free control parameter. In this L-scan the quasiperiodic and frequency locked solutions, their pattern and order of appearance are studied in the interval from the parameter range of immediate engineering significance to the point of appearance of transient chaos. In particular, a fractaltype multiple splitting of Arnold tongues is found in the parameter region bordering the range of engineering significance.
Insitumeasurement of motor electrical constants
Authors: Corke Peter I.
Published: March 2009

Motor torque constant is an important parameter in modeling and controlling a robot axis. In practice this parameter can vary considerably from the manufacturer's specification, if available, and this makes it desirable to characterise individual motors. Traditional techniques require that the motor can be removed from the robot for testing, or that an elaborate technique involving weights and pulleys be employed. This paper describes a novel method for measuring the torque constant of robot servo motors insituand is based on the equivalence of motor torque and back EMF constants. It requires a very simple experimental procedure, utilizes existing axis position sensors, and eliminates effects due to static friction and joint cross coupling. A straightforward extension to this approach can provide a measurement of motor armature impedance. Experimental results obtained for a Puma 560 are discussed and compared with other published results.
Micromagnetic actuators
Authors: Arai K.I. , Honda T.
Published: March 2009

Recent topics in the development of micromagneticactuators in Japan are reviewed. Electromagneticmicroactuators less than 1 mm in diameter, e.g.micromotor, and microvalves have been fabricated andtheir high performance has been demonstrated. A newtype microactuator based upon magnetostriction has alsobeen developed and has shown a large cantileverdeflection. In addition, some models of the microrobotsusing micromagnetic actuators were able to move using awireless remote power supply.
Multi-link active catheter snake-like motion
Authors: Lim Geunbae , Minami Kazuyuki , Yamamoto Keisuke , Sugihara Masahisa , Uchiyama Masaru , Esashi Masayoshi
Published: March 2009

A prototype of a catheter which can move like a snake, incorporating distributed shape memory alloy actuators, is described. Since this active catheter has an instrumental navigation ability, minimally invasive diagnosis and interventional therapy will be possible. The outer diameter of the active catheter is 2.8 mm and it has many links fabricated by 3-dimensional silicon micromachining. The silicon batch process was used for the fabrication of the link to minimize assembly work. A new heating method (indirect heating) is suggested which is necessary when the JC chip is mounted on the link.
Multipath Bayesian Map Construction Model from Sonar Data
Authors: Lim Jong Hwan , Chof† Dong Woo
Published: March 2009

A new model for the construction of a sonar map in a specular environment has been developed and implemented. In a real world, where most of the object surfaces are specular ones, a sonar sensor surfers from a multipath effect which results in a wrong interpretation of an object's location. To reduce this effect and hence to construct a reliable map of a robot's surroundings, a probabilistic approach based on Bayesian reasoning is adopted to both evaluation of object orientations and estimation of an occupancy probability of a cell by an object. The usefulness of this approach is illustrated with the results produced by our mobile robot equipped with ultrasonic sensors.
Dynamic world modeling for a mobile robot among moving objects
Authors: Zhang Yuefeng , Webber Robert E.
Published: March 2009

A grid-based method for detecting moving objects is presented. This method involves the extension and combination of two methods: (1) the Hough Transform and (2) the Occupancy Grid method. The Occupancy Grid method forms the basis for a probabilistic estimation of the location and velocity of objects in the scene from the sensor data. The Hough Transform enables the new method to handle non-integer velocity values. A model for simulating a sonar ring is also presented. Experimental results show that this method can handle objects moving at non-integer velocities.
Experimental identification of dynamic parameters for a class of geared robots
Authors: Kozłowski Krzysztof R. , Dutkiewicz Piotr
Published: March 2009

The main objective of this paper is a presentation of an experimental identification of a non-direct drive robot and load dynamic parameters, which appear in the integral model. The last one is based on the energy theorem formulation. In the robotics literature there are not many experimental results known to the authors, concerning the identification of the dynamic parameters of different models. In order to satisfy this, the experimental system has been built around an industrial ASEA IRp-6 robot. In this paper we propose to precompute the friction characteristics which are separated in the integral model. Various aspects of the exciting trajectories are considered. It is shown how to identify the friction coefficients using a short integral model. The experimental results are presented, including comparison of the results for both integral and differential identification. The identified models are verified by computing the predicted torques and trajectories
It's kuloo tu: recent
developments in Kenya's Englishes
Authors: Meierkord Christiane
Published: March 2009

In most areas where English is spoken today, it is part of a multilingual
context. English is one component of the sociolinguistic profile of many
nations. In nations where English is a mother tongue or first language for the
majority of the population, other speech communities contribute further
languages to the linguistic environment. And in contexts where the majority
speak a language other than English, it may serve as a language of
administration or as a medium of instruction in the educational domain. Over
the past few decades, speech communities have also increasingly been influenced
by languages usually spoken outside the community. A particular case is the
spread of English via music and films through the radio, television, and the
internet. As a result, English is part of the linguistic repertoire of many
nations and the individuals living in them. These multilingual contexts have in
common the fact that individuals can draw on the various languages to meet their
diverse communicative needs and to construct their identities. This article
describes how this may result in changes to the English language and even in the
emergence of new linguistic forms, with particular reference to the
post-colonial nation of Kenya.
Assessing the status of lesser-known varieties of English
Authors: Schreier Daniel
Published: March 2009

The study of lesser-known varieties of English is opening up new research. Over the last twenty years or so, the role(s) and function(s) of English around the world have received a great deal of interest from linguists concerned with research on topics as diverse as sociolinguistics, variation and change, contact linguistics, language typology, genetic linguistics, etc. Kachru's work (The Inner Circle, the Outer Circle, and the Expanding Circle) inspired others and alternative models were put forward by McArthur (1987) and Görlach (1990). Though they differ on how the varieties should be classified (varying in criteria such as geographic distribution, usage and function, development history, etc.), they share the idea that varieties of English can be grouped in first- (or native-), second- and foreign-speaker groups.
World Englishes, English as a Lingua Franca, and the case of Hong Kong English
Authors: Sewell Andrew
Published: March 2009

Perspectives from both World Englishes (WE) and English as a Lingua Franca (ELF) can assist in the description of Hong Kong English phonology. Mario Saraceni's article (English Today 94) provides some useful insights into the current debates about English as a Lingua Franca (ELF). His discussion of the background to this debate identifies three viewpoints: a traditional ENL view with its adherence to native-speaker models; the WE (World Englishes) paradigm with its ‘pluralised and pluricentric view of English in the world’; and the emerging ELF position, with its rejection of native-speaker norms in favour of ‘endonormative realisations of lingua franca varieties’ (Alessa Cogo, English Today 95). However, Cogo believes that the second and third positions are not separate paradigms, and that ELF sits ‘comfortably within a WE framework’, as claimed by Jenkins (2007:17). In this article, I would like to show how the two positions can work together to inform pedagogy by exploring the possible options for English pronunciation models in Hong Kong.
English in China: some thoughts after the Beijing Olympics
Authors: Fong Emily Tsz Yan
Published: March 2009

Institutional and learners' discourses about English and the implications for ‘China English’. China's politics and international relations with Western powers have historically determined the role and status of the English language in China (Adamson, 2004). Following the country's Open Door Policy in the 1970s, the entry into the World Trade Organization (WTO) and the Beijing Olympics, English, once considered a barbaric language, has been enjoying unprecedented popularity. The seven years leading up to the 2008 Beijing Olympics saw a series of foreign language campaigns in different sectors of Chinese society. The Beijing Olympics provided China with an opportunity to improve its world position and to ‘reclaim’ – and show the world – its glorious past. Since 2001, when China won the bid to host the Olympics in 2008, English learning campaigns have promoted both so-called ‘standard’ and ‘authentic’ English. The purpose of these campaigns was not only to ensure a successful Olympics, but also to equip the people with a tool essential for modernising and integrating China into the global community.
Home Total Parenteral Nutrition in France
Authors: Joyeux H. , Gouttebel M. C. , Rodier F. , Lacour B. , Solassol C.
Published: March 2009

This essay traces the evolution in France of a clinical research program to perfect an artifical parenteral nutrition device which would be well tolerated by the patient, an ambulatory system which could eventually be used at home. It began in 1970, when we were struck by the number of patients being treated in hospitals for denutrition and the length of time required to reestablish nutritional equilibrium. Moreover, the denutrition of these patients retarded their oncological therapy. Our main goal was home nutrition. Adequate nutrition should be viewed as an adjunct therapy and since people generally eat at home, why not artifical nutrition at home?
High and Low Technology
Authors: Orleans Miriam , Orleans Peter
Published: March 2009

In 1971, Victor Papanek published Design for the Real World (1), a book which attacked the lack of problem-oriented and population-based reasoning in industrial design. The lack of congruence between need and production, from Papanek's perspective, had resulted in exotic, costly, and idiosyncratic responses to a gadget-oriented market (2).
Diffusion of Western Medical Technology in China Since the Economic Reform
Authors: Hu Teh-wei
Published: March 2009

This article reviews the diffusion of western medical technology in China since 1978. The author demonstrates how medical organization and financing at both the national and hospital levels have contributed to a relatively rapid diffusion. The example of the CT scanner is used to evaluate the financing, distribution, and utilization of medical technology in China. The author concludes with an examination of the policy implications and practical impact of current trends.
Distributing and Transferring Medical Technology
Authors: Peña-Mohr Jorge
Published: March 2009

Great variation exists in the health care delivery systems throughout Latin America and the Caribbean. In general, medical technology is concentrated in large cities at private hospitals that serve a small, elite segment of the population. What is missing in most of these countries is a clearly defined social policy guaranteeing distribution of medical technology to all segments of society. While data is scarce, it appears that political and economic concerns, rather than medical concerns, determine what and how much technology will be available to all segments of the society. Products are sometimes imported that compete with domestically produced ones. Moreover, transfers of technology often fail to include the necessary knowledge to make imported technology truly useful. However, current economic crises throughout the region are forcing changes in policies; as a result, there is a new emphasis on domestic production of technology over imports and the evaluation of medical technology for its appropriate use in Latin America and the Caribbean.
Technology Assessment Using Insurance Claims: Example of Prostatectomy
Authors: Fisher Elliott S. , Malenka David J. , Wennberg John E. , Roos Noralou P.
Published: March 2009

This article describes the findings of an ongoing assessment of prostatectomy that relied on the use of administrative data bases. Examples of the use of claims data for monitoring outcomes and treatment comparisons are provided, as well as a discussion of the strengths and limitations of administrative data for technology assessment.
Problems in the Use of Large Data Sets to Assess Effectiveness
Authors: Temple Robert
Published: March 2009

Large data sets are an attractive source of information for outcome assessment, but their use involves certain problems and risks. Data base evaluations are retrospective and unblinded; they often represent the result of multiple analyses of multiple endpoints, and it is difficult to identify the procedures used and analytic choices made because critical details are often omitted. While data bases can suggest problems and offer answers, they cannot prove them; data base analyses must be followed by trials.
Inherent Limitations of Hospital Death Rates to Assess Quality
Authors: Dubois Robert W.
Published: March 2009

Modeling death rates has been suggested as a potential method to screen hospitals and identify superior and substandard providers. This article begins with a review of one hospital death rate study and focuses upon its findings and limitations. It also explores the inherent limitations in the use of large data sets to assess quality of care.
Use of Insurance Claims Data in Measuring Quality of Care
Authors: Lohr Kathleen N.
Published: March 2009

This article discusses data that might be used for measuring quality of care, for health care administrative purposes, and for tracking the use of technologies. The advantages and limitations of administrative data banks for research purposes and some process-of-care and outcome analysis are noted. Three important obstacles to their use—reliability of diagnosis and service information, unique patient identifiers, and provider identifiers—are discussed briefly.
Impact of Claims Data Research on Clinical Practice
Authors: Steinberg Earl P. , Whittle Jeffrey , Anderson Gerard F.
Published: March 2009

Despite their potential utility, clinicians are skeptical about claims data as a substrate for clinical research. Clinicians' concerns are centered on two issues—the quality of the data and the fairness of comparisons that are made. To increase the impact of claims data research on clinical practice, several strategies should be pursued.
Creonization of Health Care
Authors: Bulger Roger J.
Published: March 2009

As prefigured in the Greek tragedy Antigone, one of the primary conflicts in contemporary health care is that between humane concern for the individual and concern for society at large and administrative rules. The computerization of the health care system and development of large data bases will create new forms of this conflict that will challenge the self-definition of health care and health care professionals.
Value of Technology Assessment in Developing Countries
Authors: Barmes David E.
Published: March 2009

The contrasting cycles of changing caries prevalence in developing and industrialized countries are described, as they relate to differing needs in technology. Using this contrast as a background, the selective needs for technology in measurement, adequate quality of treatment and materials, appropriate personnel, and simplicity and mobility in equipment are discussed.
On Amalgam Toxicity
Authors: Glantz Per-Olof , Mjör Ivar A.
Published: March 2009

Toxicity implies an adverse effect. It may be caused by an overdose of any substance or combination of substances, either by an initial high dose or by the accumulation of a toxic substance over a long period of time. Thus, toxicity is dose dependent. It is also a relative term in that therisk involved must be evaluated and the available alternatives assessed.
Long-Term Assessment of Periodontal Surgery Versus Curettage or Scaling and Root Planing
Authors: Ramfjord Sigurd P.
Published: March 2009

The various treatments for periodontal disease must be assessed in light of the recently articulated goals of periodontal therapy to preserve teeth for a lifetime and to enhance esthetics and comfort as well as oral health. This article examines the long-term comparisons of periodontal surgery, curettage, and scaling and root planing in improving attachment levels instead of the more traditional pocket depth.
Rationale for the Use of Antimicrobial Agents in Periodontal Disease
Authors: Loesche Walter J.
Published: March 2009

The traditional approach to treating dental decay and periodontal disease has often focused on caries, neglecting periodontal infection. The past 15 years have seen significant advances in the treatment of periodontal disease with antimicrobial therapy, both with and without moretraditional debridement or surgery. This article presents an overview of the use of antimicrobials, including an examination of treatment philosophies and the diagnosis of periodontal infection.
Format and Conduct of Consensus Development Conferences
Authors: McGlynn Elizabeth A. , Kosecoff Jacqueline , Brook Robert H.
Published: March 2009

The consensus development conference method developed by the National Institutes of Health in the United States has been adopted and modified by a number of countries. Based on published articles and communication with representatives from each country, we examined whether the organization and conduct of these conferences in nine countries (United States, Canada, Denmark, Finland, the Netherlands, Norway, Sweden, Switzerland, and the United Kingdom) enhanced or detracted from achieving the stated conference goals and objectives. We conclude that improvements in the process by which consensus conferences are conducted may be warranted. More scientific methods for synthesizing literature, such as meta-analysis, should be used in developing inputs for the conference panel. Formalizing the decision-making processes through polling or other methods that allow for structured disagreement with parts of a consensus statement would potentially expand the range and type of issues that can be addressed in such conferences. Finally, countries should consider having the consensus statement written over a longer period of time than the traditional overnight session, which seems unlikely to promote clear thinking.
Two Strategies For Prophylaxis of Fatal Postoperative Pulmonary Embolism
Authors: Hilson Steven D. , Rich Eugene C.
Published: March 2009

While subcutaneous heparin is a standard prophylaxis for death from pulmonary embolism following general surgery, it has been suggested that adding the vasoconstricting drug dihydroergotamine would improve survival compared to heparin alone. Dihydroergotamine may be associated with rare but life-threatening side effects; thus, reduced mortality from pulmonary embolism could be offset by increased mortality from other causes. Because a clinical trial to examine this possibility would be impractical, we performed a cost-effectiveness analysis to evaluate the effects of prophylactic dihydroergotamine on mortality. Based on published data, despite its favorable effects on the prevention of deep vein thrombosis, the addition of dihydroergotamine did not appear to save lives when added to heparin as prophylaxis. Probabilistic sensitivity analysis demonstrated that even if published risk estimates are in error, substantial changes would still not support the conclusion that dihydroergotamine is lifesaving. In the absence of clear potential for improved survival, the increased costs associated with dihydroergotamine provide reason to question its routine prophylactic use in general surgery.
Assessing Technology for Rehabilitation
Authors: Finkelstein Stan N. , Hutton John , Persson Jan
Published: March 2009

The rehabilitation field has not always been regarded as the most glamorous or commercially promising section of medical care. But changing attitudes and demographics in many industrial countries have led to increased recognition of opportunity to provide services for individuals with disabilities and those in need of chronic care. As hospitals are under increasing pressure to offer rehabilitation services, this article focuses on three different technologies developed in three different countries, Sweden, the United Kingdom, and the United States.
Epilogue
Authors: Grossman Jerome H.
Published: March 2009

“From a distant vantage the [Mandelbrot] set resembles a squat wart-covered figure eight lying on its side. The inside of the figure is ominously black. Surrounding it is a halo colored electric white, which gives way to deep blues and blacks in the outer reaches of the plane.

Approaching the Mandelbrot set, one finds that each wart is a tiny figure shaped much like the parent set. Zooming in for a close look at one of the tiny figures, however, opens up an entirely different pattern: a riot of organic-looking tendrils and curlicues sweeps out in whorls and rows. Magnifying a curlicue reveals yet another scene: it is made up of pairs of whorls joined by bridges of filigree…, and in the center of these curlicues another version of the Mandelbrot set is found.

The magnified version is not quite the same Mandelbrot set. As the zoom continues, such objects seem to reappear, but a closer look always turns up differences. Things go on this way forever, infinitely various and frighteningly lovely.” (4)
The Diffusion of Magnetic Resonance Imagers in the United States and Worldwide
Authors: Steinberg Earl P. , Sisk Jane E. , Locke Katherine E.
Published: March 2009

Magnetic resonance (MR) imaging is an exciting new diagnostic modality that has created tremendous interest in the medical profession. Although not unparalleled, the excitement engendered by MR imaging conjures up memories of the “CAT fever” induced by introduction of X-ray computed tomography (CT) scanners in 1973 (19).
Cost-Benefit and Cost-Effectiveness Analyses of Magnetic Resonance Imaging
Authors: Gillespie Kathleen N. , Elixhauser Anne , Reker Dean M. , Fletcher James W. , Wolinsky Fredric D.
Published: March 2009

Any new technology that promises significant costs as well as potential benefits generates considerable interest. Such innovations bring into bold relief the fundamental problem of achieving maximal medical benefits while efficiently and equitably allocating scarce resources (II). Two tools that decision makers can use to assess the benefits and costs of implementing new technologies are cost- benefit analysis (CBA) and cost-effectiveness analysis (CEA). One technology that seems especially appropriate for the application of CBA and CEA is nuclear magnetic resonance (NMR) imaging.
Commentary on Guyatt and Drummond
Authors: Wulff Henrik R.
Published: March 2009

Magnetic resonance (MR) undoubtedly constitutes a major technological advance, but as yet we do not know whether this invention also represents a breakthrough from the clinician's point of view.

Guyatt and Drummond suggest that the clinical value of MR is tested by means of a randomized clinical trial (RCT) in a well-defined and limited clinical area, and I fully agree with the authors that the use of such trials should not be confined to the testing of new treatments. In this particular field, however, I miss a discussion of alternative options. With few exceptions, new drugs can only be tested satisfactorily by means of an RCT, but the superiority of one imaging technique over another can sometimes be proved in other ways. Imagine, for instance, that the CT-scan is normal but that MR reveals a space-occupying lesion, the presence of which is confirmed by surgical operation or an autopsy. In that case the diagnostic superiority of MR has been proved in that particular patient. If such cases are seen frequently, and if it is known from controlled therapeutic trials that they are susceptible to treatment, then the value of MR has been proved without doing an RCT.
Technology Assessment: Monitoring Fetal Growth
Authors: Villar José , Belizán José M.
Published: March 2009

The field of perinatal medicine has been experiencing dramatic changes recently, mostly due to technological breakthroughs in antepartum and intrapartum care. Concomitantly, a substantial decline in perinatal morbidity and mortality has been observed. Whether these two phenomena are causally related has yet to be demonstrated. In fact, a recent report has suggested that this may not be the case (18).
Social Support and Perinatal Outcome
Authors: Oakley Ann
Published: March 2009

As critics such as Thomas McKeown (12) have pointed out, Western medicine is concerned firstly with the promotion of medical care and only secondarily with the promotion of health care. Medical care and health care are not necessarily the same thing. There are ways of caring for people's health which do not involve medical examinations, procedures, and drugs—they involve such activities as health education, preventive health care, self-help, and community support. However, since these alternative routes to health mostly lie outside the theory and practice of professional medical care provision, their impact on health and illness is largely unexamined.
Cultural Transformations of Biomedicine in Japan—Hospitalization in Contemporary Japan
Authors: Ohnuki-Tierney Emiko
Published: March 2009

A widely held assumption today is that biomedicine is “scientific” and therefore “objective,” thus, “culture-free.” It epitomizes the objectivism falsely attributed to technology in general. Contemporary Japan is seen to epitomize non-Western modernity with its high development of industrialization and scientific technology. It follows then that biomedicine in Japan today should remain as such without cultural transformations. Yet, in post-industrial Japan today biomedicine takes an almost entirely different form and meaning from biomedicine practiced elsewhere, especially in Western societies such as the United States. The purpose of this paper is to describe the experience of hospitalization in contemporary Japan in order to demonstrate how Japanese culture and society have powerfully transformed the underlying concepts and practices of biomedicine, which was originally introduced from the West and has been highly acclaimed by the Japanese as the epitome of superior Western science and technology. Due to space limitations, however, it will not be possible to engage in an extensive discussion of theories about technological impact, or issues involved in the broader theoretical concern variously referred to as “modernization,” “industrialization,” “rationalization,” “secularization,” etc.
What Makes Medical Systems Indian?: A Consideration of Doctor, Family, and Gender in India
Authors: Sheehan Helen E.
Published: March 2009

In a short story entitled “Second Opinion,” R. K. Narayan, one of India's foremost writers in English, introduces us to Sambu, a young man who spends his days and nights at the “Boardless” coffee shop with friends, avoiding work, marriage, and his widowed mother. One day a local doctor, Dr. Kishen, informs Sambu that his mother is suffering from fainting spells, possibly a heart condition, and is in a “leave-taking” (dying) mood. Dr. Kishen, who knows the family, suggests to Sambu that he marry, thereby easing his mother's anxieties and ill health, and making her last days happy. However, he also gives his usual advice to get a “second opinion.” Sambu does, taking his mother to Dr. Natwar, a foreign-trained doctor, who has a spotless clinic with many rooms housing the latest medical equipment, a contrast to Dr. Kishen's ill-equipped, disorderly clinic. After his mother has undergone tests, Sambu meets with Dr. Natwar. The doctor gives him various documents and states that they show there is nothing wrong with his mother. Thus, armed with irrefutable proof provided by technology, Sambu avoids marriage and responsibility; his mother, afraid of losing her son altogether, acquiesces to his wishes, telling him to do whatever he wants (5).
Creating the Costliest Orphan:The Orphan Drug Act in the Development of Ceredase™
Authors: Goldman Dana P. , Clarke Ann E. , Garber Alan M.
Published: March 2009

The FDA recently approved Ceredase™, a new treatment for Gaucher's disease, under the provisions of the Orphan Drug Act. Ceredase™ is unusually expensive, but there are no satisfactory alternative therapies. It appears likely that Ceredase™would not have become available without the protection of the Orphan Drug Act, but its expense and the lack of information about its long-term effects on health raise questions about whether the ODA provides appropriate incentives to develop cost-effective technologies.
Recombinant Erythropoietin:Orphan Product with a Silver Spoon
Authors: Coster John M.
Published: March 2009

The U.S. Food and Drug Administration's (FDA) approval of the orphan biological product recombinant erythropoietin (rEPO) in June 1989 resulted both in a breakthrough treatment for the chronic anemia of people who suffer from chronic renal failure and a powerful argument for change in the legislation that spawned its development: the Orphan Drug Act of 1983. At a cost of over $6,000 per patient per year, Congress could not understand how a product that no manufacturer wanted to produce was suddenly costing the federal government hundreds of millions of dollars each year. Congress attempted to change the act in 1990 to preclude a manufacturer from using its provisions to secure lucrative monopolies in certain drug markets. In early 1991, the FDA finally issued regulations to implement the act that addressed some of the very concerns that were caused by rEPO.
Evaluation of Orphan Products by the U.S. Food and Drug Administration
Authors: Haffner Marlene E. , Kelsey John V.
Published: March 2009

Orphan drug products generally are used in treating or preventing rare diseases. The small number of patients available for study may create special problems in the evaluation of these products. This paper examines some of the special problems that are associated with the design and implementation of studies to evaluate the safety and efficacy of orphan drugs. The U.S. Food and Drug Administration (FDA) has not established special criteria for evaluating orphan drugs per se, but the FDA has been flexible in evaluating drug products that present special problems, especially when these products are for treatment of serious of life-threatening illnesses. The FDA and other U.S. governmental agencies also have taken steps to promote the development and availability of drugs for rare diseases, including making these products available to patients who are in need, even before the drugs have full FDA marketing approval.
Contraceptives: On Their Own
Authors: Kaeser Lisa , Darroch Forrest Jacqueline , Rosenfield Allan
Published: March 2009

Despite the need for more safe and effective contraceptive drugs and devices, enormous barriers to contraceptive research and development have been raised in the United States. The designation of contraceptives as orphan drugs, with concomitant incentives, may be warranted to encourage private manufacturers to reenter the field.
The Artificial Heart: Costs, Risks, and Benefits—An Update
Authors: Lubeck Deborah P.
Published: March 2009

For several decades, major advances in medicine have increased dramatically our ability to prevent, diagnose, and manage a wide variety of chronic and acute health problems. However, medical innovations also pose significant economic, social, and ethical questions. How do we best utilize scarce medical resources? How do we balance anticipated benefits against the dollar cost or associated risk? What is the impact on total health care spending now and in future years? As concern over these issues grows concomitant with increased health care spending, technology assessment is often promoted as a method for determining whether a biomedical innovation should be encouraged to disseminate rapidly in order to maximize its benefits to individual patients, or constrained to develop slowly in order to minimize collective costs or risks. But, the art and practice of evaluating medical technologies, especially innovations still in the research and development phase, are not well developed (6;8;11;14;16;34;35).
Developing and Assessing an Implantable Insulin Infusion Pump: Interactions of University, Industry, and Government
Authors: Saudek Christopher D.
Published: March 2009

The validity of technology assessment may depend largely upon who performs the job, and when they get involved. The options are many. Industry may hire a small private laboratory to perform animal trials on a completed device or drug; manufacturers may support their own in-house laboratories or even study beds; industry may contract with hospitals or private medical groups to evaluate a potential product. It is the thesis of this discussion that there is a different option which brings together the strengths of three often stubbornly independent institutions: industry, university-based investigators, and federal science granting agencies.
Kidney Transplantation in the United Kingdom
Authors: Macpherson Stuart G.
Published: March 2009

The National Health Service (NHS) supplies the majority of health care in Great Britain but is virtually the monopoly provider of high technology and disaster services such as treatment for chronic renal failure or end-stage renal disease (ESRD).
Status of Insurance Coverage for Organ Transplants in the United States: A Review of Recent Surveys
Authors: Hellinger Fred J.
Published: March 2009

The economic, political, ethical, and medical issues surrounding organ transplantation are complex, and coverage policies for it vary considerably among insurers. Some insurers cover virtually all transplants, while others cover few or none (Wyoming Medicaid does not cover any transplants) (3;4;5;6;7). In the past, insurers have followed Medicare's lead regarding coverage of new technologies. This has not been the case with organ transplantation. Although Medicare does not cover heart transplants, almost all Blue Cross/Blue Shield plans and commercial health insurers, as well as one-half of the state Medicaid plans and one-third of the Health Maintenance Organizations (HMOs), do cover heart transplants. (See note, p. 570.) In addition, although Medicare does not cover heart–lung transplants, a substantial proportion of Blue Cross/Blue Shield plans, commercial health insurers, state Medicaid plans, and HMOs cover it. At present, Medicare covers kidney and cornea transplants, selected pediatric liver transplants, and selected bone marrow transplants.
Assessment and the Technologic Present
Authors: Reiser Stanley Joel
Published: March 2009

Do we have the will, the power of innovation, to lift ourselves above our own creations and control them? This is the central question of modern medicine, a question which for some time has dominated current discourse in health care and which gave rise in the early 1970s to the field of technology assessment. The technologic armory that has been developed over the past one and a half centuries is vast, formidable, and expanding. Its presence must be reckoned with, and to do this we must begin by understanding our relationship to it.
Strategies in Technology Assessment and Implementation in the United States
Authors: Young Donald A.
Published: March 2009

There are many ongoing activities in the United States that can be characterized as strategies in technology assessment and implementation. A comprehensive strategy, however, is lacking. The richness and diversity of the groups with a stake in technology assessment is in part responsible for the inability to move to a comprehensive strategy. Important conflicts within and across groups must be resolved before a comprehensive program of technology assessment can be put in place.
A Method for the Detailed Assessment of the Appropriateness of Medical Technologies
Authors: Brook Robert H. , Chassin Mark R. , Fink Arlene , Solomon David H. , Kosecoff Jacqueline , Park R. E.
Published: March 2009

The standard way to assess medical technologies is to conduct a randomized clinical trial. Patients are randomly assigned to groups receiving alternative treatments, and outcomes are monitored over a long period of time. For example, some victims of left main coronary artery disease may undergo coronary artery bypass surgery, and others may receive medical treatment with nitroglycerine and beta blockers. Comparison of five-year mortality and morbidity in the two groups helps to determine the relative appropriateness of the two procedures. In addition, information about quality of life and cost can also be collected and compared.
The Consensus Development Conference and the European Experience
Authors: Vang Johannes
Published: March 2009

The consensus development program for health care is an American invention which dates back to 1977. It is derived out of concern for the appropriate use of medical technology and designed to formalize the process by which research pertinent to health care is disseminated and used.
Decision Analysis as a Synthetic Tool for Achieving Consensus in Technology Assessment
Authors: Pauker Stephen G.
Published: March 2009

Over the past decade the Office of Medical Application of Research (OMAR) of the National Institutes of Health has developed the consensus development conference (18) to assess technologies in cases where the scientific community has been unable, or unwilling, to reach a firm position as to efficacy but which require some better form of assessment than expert opinion (8). Another paper in this issue describes the principles that underlie such conferences (9).
Ethical Considerations in Data Acquisition
Authors: Riis Povl
Published: March 2009

It is the aim of the present paper to emphasize the uniformity of ethical principles which are applied in the large variety of methods for technology assessment, ranging from the level of the individual citizen to that of society as a whole. A further aim is to emphasize that the application of such ethical principles is necessary not only for assessment situations comprised within the classical doctor-patient relationship, but also for assessing mass applications of preventive interventions (a type of application which is not to be confused with the widespread post-assessment application of already-tested methods).
Percutaneous Ultrasound Procedures for the Treatment of Kidney Stones
Authors: Farrell John R.
Published: March 2009

Percutaneous lithotripsy has achieved widespread diffusion throughout the medical community and is described by many authors as the manipulative treatment of choice in an increasing number of patients with renal stones. Appropriate use of percutaneous lithotripsy is not an isolated event of patient management but is considered to be one episode in the medical#surgical management of nephrolithiasis. Medical management must be initiated at the first determination of the presence of the stone or at the time of the diagnosis of one of the underlying conditions which predispose to stone formation. In spite of the fact that no randomized prospective trial studies are available, the overall preponderance of the available information is that percutaneous lithotripsy for the treatment of kidney stones is a safe and efficacious procedure. In addition, it has achieved widespread acceptance and is generally employed throughout the country. Cooperation between the physician responsible for medical management of the patient, the urologist, and the radiologist appears to be an essential ingredient for successful management. Long-term studies are indicated to determine the true incidence of complications and the long-range effects of the procedures employed by the percutaneous route.
Transurethral Ureteroscopic Lithotripsy Procedures for the Treatment of Kidney Stones
Authors: Farrell John R.
Published: March 2009

The available information on transurethral ureteroscopic ultrasound and electrohydraulic wave lithotripsy in the surgical treatment of upper renal tract stones is presented above. It is significant that most reports add only 2–5 case studies to the literature and no large series of cases are reported. This approach to the surgical care of renal stones will have to be considered over the next several years against a backdrop of the current rapid spread in the use of percutaneous lithotripsy and the potential rapid diffusion of ESWL in the United States.
Ambulatory Cardiac Monitoring for the Evaluation of Antiarrhythmic Agents
Authors: Antczak-Bouckoms Alexia , Tulloch J. F. C. , Adams Miriam E.
Published: March 2009

This decision-analysis model assesses ambulatory cardiac monitoring (ACM), ACM followed by exercise testing, and electrophysiologic studies (EPS) in the evaluation and selection of antiarrhythmic agents in postinfarct patients with malignant arrhythmias. With existing data, we find no consistent advantage for one method of drug testing over another, although ACM appears to require fewer resources than does EPS. More patients qualify for EPS, but this fact does not increase the proportion of patients for whom a drug can be identified. These methods may test different aspects of arrhythmia activity and drug response, and sequential use may provide additional benefits. Such benefits must be determined empirically.
Accidental Injuries of Hospitalized Patients: A Prospective Cohort Study
Authors: Groves James E. , Lavori Philip W. , Rosenbaum Jerrold F.
Published: March 2009

Eight hundred and six medical and surgical patients who were hospitalized via the emergency ward were followed over their entire inpatient stays and rated in anterograde, double-blind fashion for inpatient incidents (falls, medication errors, other). Injuries were minor but affected 2.2% of admissions, a figure which is strikingly similar to studies in other hospitals. There was a statistical trend toward a higher-than-normal risk of hazardous in-hospital incidents for males age 20 to 40 admitted because of injury and for medically ill females over 60 years old.
When Does Information Change Practitioners' Behavior?
Authors: Kanouse David E. , Jacoby Itzhak
Published: March 2009

Programs that disseminate information to health care practitioners often do so partly to encourage appropriate changes in practice. However, merely providing information is seldom enough to accomplish such changes. If information transfer programs are to influence practice, they must be designed to maximize the conditions facilitating change. Reliance on a diffusion model for thinking about how information reaches practitioners has led researchers to over-emphasize the importance of exposure to information and ignore other factors that determine whether change will occur, such as practitioners' motivation to change, the context in which clinical decisions are made, and how information is presented. The fact that successful dissemination will not necessarily produce change also has implications for how information transfer programs should be monitored and evaluated.