bluuebunny/crossref_metadata_2025 huggingface dataset:
Linear robust trajectory control of flexible joint manipulators
Authors: Lin Yueh-Jaw , Yu Aiping
Published: March 2009

This paper presents a practical approach for the point-to-point control of elastic-jointed robot manipulators. With the proposed approach only position and velocity feedback are referenced, as opposed to most of the existing control schemes of elastic-jointed manipulators which require additional acceleration and/or jerk feedback. To guarantee the robustness of the controller, it is designed on extreme parameter uncertainties due to highly elastic joints of manipulators and energy motivated Lyapunov functions are used to derive the control law. Four pertinent controller gains are chosen in light of the on-line position and velocity feedback of the links and joint sensors. Through a simulated experimental verification, it is demonstrated that the designed simple position and velocity feedback controller, similar to that used for rigid-jointed robots, can globally stabilize the elastic-jointed robot for a bounded reference position. In addition, the tracking performance of the controller reveals that this simple control algorithm is robust in terms of joint flexibility. And the simplicity of the presented control algorithm, as compared to other model-based techniques for flexiblejoint robots, is particularly advantageous. Even though the simulated experiments are conducted on a single-link flexible joint robot, control law derived in this paper has general meaning for multi-link flexible joint robots.
Integrated flexible microactuator systems
Authors: Suzumori Koichi , Koga Akihiro , Kondo Fumika , Haneda Riyoko
Published: March 2009

The flexible microactuator (FMA) is a novel pneumaticrubber actuator developed for use in microrobots. Thispaper reports on integrated FMA systems to achievedistributed motion as occurs in intestinal villi, and withmulti-legged arthropods such as centipedes.

For the purpose of miniaturization and integration of FMAs, the authors focussed on two technical issues: A new fabrication process based on stereo lithography and a new FMA design called a restraint beam FMA. Stereo lithography enables fabrication of micro-structures with rubber-like materials suitable for integrated FMAs. The restraint beam FMA makes it possible to fabricate FMAs from a single material, allowing stereo lithography to be used.

As examples of integrated FMA systems, four prototypes are shown: a 5 × 5 FMA array, a 3 × 3 FMA array which has pneumatic circuits at its base, a pipe interior mobile robot, and an amusement system consisting of 30 FMAs, which demonstrates ball handling ability.
Automatic training method applied to a WiFi+ultrasound POMDP navigation system
Authors: Ocaña M. , Bergasa L. M. , Sotelo M. A. , Flores R. , Llorca D. F. , Schleicher D.
Published: March 2009

This paper presents an automatic training method based on the Baum–Welch algorithm (also known as EM algorithm) and a robust low-level controller. The method has been applied to the indoor autonomous navigation of a surveillance robot that utilizes a WiFi+Ultrasound Partially Observable Markov Decision Process (POMDP). This method uses a robust local navigation system to automatically provide some WiFi+Ultrasound maps. These maps could be employed within probabilistic global robot localization systems. These systems use a priori probabilistic map in order to estimate the global robot position. The method has been tested in a real environment using two commercial Pioneer 2AT robotic platforms in the premises of the Department of Electronics at the University of Alcalá. Some experimental results and conclusions are presented.
Development and target following of vision-based autonomous robotic fish
Authors: Hu Yonghui , Zhao Wei , Xie Guangming , Wang Long
Published: March 2009

A novel ostraciiform swimming, vision-based autonomous robotic fish is developed in this paper. Its feasibility and capability are shown by implementing a dynamic target following task in a swimming pool. Inspired by boxfish that is highly stable and fairly maneuverable, the robotic fish is designed and constructed by locating multiple propulsors peripherally around a rigid body. Swimming locomotion of the robotic fish is achieved through harmonic oscillations of the tail and pectoral fins. The forces and moments acting on the fins and body are analyzed and the governing motion equations are derived. Through coordinating the movements of the propulsors, several typical swimming patters are empirical designed and realized. A digital camera is integrated in the robotic fish, and the visual information is processed with the embedded microcontroller. To treat the degradation of underwater image, a continuously adaptive mean shift (Camshift) algorithm is modified to keep visual lock on the moving target. A fuzzy logic controller is designed for motion regulation of a hybrid swimming pattern, which employs synchronized pectoral fins for thrust generation and tail fin for steering. A simple target following task is designed via an autonomous robotic fish swimming after a manually controlled robotic fish with fixed distance. The swimming performance of the robotic fish is tested and the effectiveness of the proposed target following method is verified experimentally.
The law of Hobson-Jobson
Authors: Purcell Susan
Published: March 2009

Yule and Burnell's 1886 Anglo-Indian dictionary still fascinates and informs today. It is not the finest of Salman Rushdie's writings, but this is the first paragraph of his essay Hobson-Jobson (italics in original):

“The British Empire, many pundits now agree, descended like a juggernaut upon the barbicans of the East, in search of loot. The moguls of the raj went in palanquins, smoking cheroots, to sup toddy or sherbet on the verandahs of the gymkhana club, while the memsahibs fretted about the thugs in bandannas and dungarees who roamed the night like pariahs, plotting ghoulish deeds.” (Rushdie, 1992:81)

Rushdie points out that the italicised words all appear in the celebrated dictionary Hobson-Jobson: a glossary of colloquial Anglo-Indian words and phrases, and of kindred terms, etymological, historical, geographical and discursive by Henry Yule & A.C. Burnell, first published in 1886.

This gem of a dictionary gives definitions and origins of words in common use by the British in colonial India in the late nineteenth century. Some of the entries won't be a surprise to readers – we all know that raj, mogul and memsahib are Indian words. But there are many words with their origins in Hindustani, Bengali, Sanskrit or other Indian or Eastern languages, whose origin is perhaps not quite so well known.
The Rationale for Siting Advanced Health Technologies at Home
Authors: McNerney Walter J.
Published: March 2009

In the United States, there is growing determination among health care institutions to slow down cost increases, particularly in acute hospital situations.

One major strategy is to finance and deliver more health care in the home, which is seen as less expensive than institutional alternatives, of equal quality, often more humane, and preferred by many patients. As a result, this practice will most likely become more prevalent as long as quality of care is sustained, even if the costs are comparable to hospital care.
Reflections on Home-based Health Services and the Future of the Service Sector
Authors: Gershuny Jonathan I.
Published: March 2009

It has long been assumed that the service sector—that part of the economy devoted to producing intangible commodities—will continue to grow and become the major employer and generator of wealth in developed societies. Such writers as the American sociologist Daniel Bell assume that countries of the first world will advance naturally to become “postindustrial” (i.e., postmanufacturing) societies.

“Service workers” already constitute over half the work force in most developed countries, and take comfort from a view which seems to guarantee their future livelihoods. But, their comfort may be unfounded. I shall outline a contrary, less cozy, alternative view, and suggest its implications for the medical sector.
Use of Data Registries to Evaluate Medical Procedures: Coronary Artery Surgery Study and the Balloon Valvuloplasty Registry
Authors: Davis Kathryn
Published: March 2009

Large registries have been used by the National Heart, Lung, and Blood Institute to evaluate a number of medical procedures. Two of these, the Coronary Artery Surgery Study (CASS) and the Balloon Valvuloplasty Registry (BVR), are described to illustrate potential problems in using registry data to compare medical procedures.
Current Uses of Large Data Sets to Assess the Quality of Providers: Construction of Risk-Adjusted Indexes of Hospital Performance
Authors: Desharnais Susan
Published: March 2009

This article examines how large data sets can be used for evaluating the effects of health policy changes and for flagging providers with potential quality problems. An example is presented, illustrating how three risk-adjusted measures of hospital performance were developed using patient discharge abstracts. Advantages and disadvantage of this approach are discussed.
Policy Implications of Outcomes Research
Authors: Kahn Charles N.
Published: March 2009

The discussion of the effectiveness of the use of large bases for technology and quality assessments in health care is important to policy makers because of their increasing concern about the value of the dollars spent on health care. The focus on value is particularly acute for those policy makers having responsibility for the Medicare program. Recognizing that knowledge regarding medical outcomes will be imperfact, nevertheless, they have put the wheels in motion to empand research in this area beyond clinical trials.
Need for Technology Assessment in Oral Health Care
Authors: Löe Harald
Published: March 2009

Technology today is often seen as the tail wagging the dog. Discoveries or inventions are made, new devices or techniques are developed, and the move to capitalize on them follows immediately. This rush to market is especially evident in the United States, where there is a long-established tradition of investing in technological advances to deal with problems in science and health.
Pit and Fissure Sealants: An Underutilized Preventive Technology
Authors: Cohen Leonard D.
Published: March 2009

The dramatic decrease in dental caries among children in the United States has been well documented and widely reported. In the early 1970s, only approximately 28% of children were free of dental caries; by 1980, this figure increased to 36.6% (53). The most recent national survey results reported by the National Institute of Dental Research found approximately 50% of all school children to be free of caries (50).
Imaging Technologies
Authors: Cockshott W. Peter , Palmer P. E. S.
Published: March 2009

High technology developments in diagnostic imaging raise a number of issues that are disturbing. New developments do not always favor greater diagnostic efficacy since fads, marketing promotion, and entrepreneurs can distort medical goals. New advances disseminate rapidly in affluent societies before formal benefit evaluations are completed. We suggest that digitization of radiography must be critically assessed, and simplicity of equipment design should be promoted. Though medical and economic factors can provide guidelines for policy making, the ultimate priority decisions are political in nature.
The Assessment of a New Technology for Evaluating Respiratory Abnormalities in Sleep
Authors: Nino-Murcia German , Bliwise Donald L. , Keenan Sharon , Dement William
Published: March 2009

This study assessed the diagnostic utility of two technologies for evaluating respiratory abnormalities in sleep. We compared conventional polysomnography with a new, ambulatory microprocessor technology. Two key features of the comparison involved: (a) the use of multiple, skilled interpreters of each system; and (b) inter-rater agreement within the systems as a crucial test for the diagnostic utility of each. Results indicated that general categories of respiratory abnormalities could be judged more reliably than more specific categories, regardless of technology. For certain categories of respiratory abnormalities, however, inter-rater agreement with the newer technology was extremely low (e.g., reliability coefficients of.12,.09, and –.06). Factors contributing to these low diagnostic reliabilities are discussed. Our data indicate that any assessment of new technology cannot be made apart from the clinical judgments to be rendered with that new technology. This approach may be generalizable to the assessment of other diagnostic technologies.
Magnetic Resonance Imaging:Overview of the Technology and Medical Applications
Authors: lezzoni Lisa I. , Grad Oren , Moskowitz Mark A.
Published: March 2009

The physical phenomenon of nuclear magnetic resonance (NMR) was first characterized almost forty years ago in 1946 by the simultaneous but independent experimental successes of American scientists Felix Bloch and Edward Purcell. Their discoveries prompted development of conventional NMR spectroscopy. a technique used to describe the molecular composition and behavior of chemical compounds. Twenty-five years later, in 1971, Damadian used NMR to demonstrate differences in the behavior of water in malignant and benign tissues, and he suggested that NMR possessed “many of the desirable features of an external probe for the detection of internal cancer” (7). In the same year, Lauterbur produced the first two-dimensional NMR image, a cross-sectional portrait of two tubes of water (25). The potential utility of this technique to medical imaging was obvious, and soon afterwards multiple researchers began development of clinical NMR imaging systems. The first human whole-body NMR scan was accomplished by 1977. Improvements in the scanning process and image quality continue with, as yet, no limits in sight. In this clinical context, NMR techniques have experienced a name change to the current prevailing appellation, magnetic resonance imaging (MRI).
Magnetic Resonance Spectroscopy Emerges as a Quantitative Diagnostic Tool and an Aid to Therapeutic Procedures
Authors: Chance Britton , Wheatley Roger
Published: March 2009

These new developments show the value of MR in studying a phase of metabolism hitherto unavailable, namely that of “preventive” study prior to significant lactate formation and surely prior to the cell damage edema and cell death so characteristic of stroke and heart disease. We believe that these approaches can be developed appropriately for clinical application and will thereby open a new type of diagnosis and therapy.
The Clinical Use of Nuclear Magnetic Resonance Spectroscopy for Studying Human Muscle Metabolism
Authors: Cady E. B. , Griffiths R. D. , Edwards R. H. T.
Published: March 2009

Nuclear magnetic resonance (NMR) imaging has recently become an accepted technique in the medical practitioner's armory (38). NMR spectroscopy (44) is a subtly different application of the same physical principles underlying NMR imaging, but the clinical potential for this modality is currently still under evaluation. The most important application of clinical NMR spectroscopy is for the nonin-vasive monitoring of changes in metabolite levels and intracellular pH of intact tissues during physiological stress or in response to pharmacological agents or disease. The31phosphorus (31P) nucleus has been the most commonly investigated in muscle disease (39) but the applications of proton (1H), (4,5,8) and13carbon (13C), (2,7) are currently being explored.
Safety Aspects of Magnetic Resonance Examinations
Authors: Persson Bertil R. R. , Ståhlberg Freddy
Published: March 2009

In a standard whole-body NMR-scanning machine, the static magnetic field is generated by an electric current driven through large solenoid coils. Dynamic magnetic gradient fields are generated by electric current pulses in coils located at various orientations, thus producing magnetic gradients inx, y, andzdirections. The Rf (radiofrequency) radiation is transmitted through a specially shaped coil which also serves as an antenna receiving the NMR signals.
Prenatal Care—An Introduction
Authors: Banta H. David , Houd Susanne , Ojeda Elbio Suarez
Published: March 2009

Prenatal care is all of the care that a pregnant woman receives from organized health care services, as well as from family, relatives, and friends. It begins with planning for pregnancy, and should be seen by those who give it as part of a process that continues through labor and delivery and into the neonatal period. The primary aim of prenatal care is promotion of maternal and fetal health, viewed as a unit until the pregnancy reaches full term (3). This encompasses the goals of reducing maternal and infant mortality and morbidity, detecting early factors that heighten the perinatal risk in both individual pregnancies and vulnerable groups, intervening to improve outcomes, educating all who provide or receive prenatal care, and helping women make their pregnancies and birth a positive life experience.
Machines and Medicines: A Projection of Analogies between Electric Power Systems and Health Care Systems
Authors: Hughes Thomas P.
Published: March 2009

If medicine is becoming mechanized, as many indications suggest, then those interested in policy making for medical matters have much to learn from the history of technology. The mechanization of medicine, as in the case of the mechanization of production, will accelerate the transfer of skill and knowledge from people to machines and the transition of health care to a capital intensive industry (19, 196–226). Furthermore, mechanization and increasing capital intensification may bring the increased systematization of health care. If the development of mechanized medicine follows the precedent of the mechanization of production, then our society must deal with the evolution of another set of extremely large systems, systems that will become virtually impervious to social control. Historians of technology are currently providing a better understanding of the evolution of large systems of production (3;9;10); there are lessons to be learned from this history by policy makers in health care.
Controlled Studies in Measuring the Efficacy of Medical Care: A Historical Perspective
Authors: Bloom Bernard S.
Published: March 2009

There are three phenomena unique to medical research. First, unlike most historic events and their time- and culture-specific relationships, determination of the efficacy of medical care cuts across national and cultural boundaries in the Western world. Second, most of the study methods currently used to determine whether a specific medical intervention works have a long tradition, usually stretching back over centuries. Third, it is difficult to predict whether, and how readily, research results will be incorporated into medical practice.
Obstacles to Developing and Using Technology: The Case of the Artificial Heart
Authors: Maxwell James H. , Blumenthal David , Sapolsky Harvey M.
Published: March 2009

For some observers, the artificial heart represents the latest, and perhaps the most flagrant example of the health system's tendency to favor the rapid introduction of expensive but ineffective technologies over efforts to prevent disease and to improve access to care (5;6;19;44;45). Even if it can be perfected, they argue, its opportunity cost in terms of other foregone health benefits would be exorbitant. The ultimate failing of the health care system, it would seem, is its failure to establish mechanisms to select among alternative uses of resources. If such mechanisms had existed, some critics believe that the quest for an artificial heart never would have begun and certainly its premature clinical uses could have been prevented (6;45).
An Appraisal of Liver Transplantation in Great Britain
Authors: O'Grady John G. , Williams Roger
Published: March 2009

Since the National Institutes of Health (NIH) Consensus Development Conference (1983) concluded that liver transplantation was a procedure deserving of wider application to the treatment of end-stage liver disease, there has been a very considerable increase in the number of centers performing liver transplantation, in Europe as well as in the United States. The number of operations performed has increased logarithmically (Figure 1, in Höckerstedt and Kankaanpää, p. 453). With the detailed overall assessment of liver transplantation in Europe by Höckerstedt and Kankaanpää, we will take the opportunity to review the position in Great Britain from a physician's, i.e., non-surgeon's, viewpoint as seen from one of the two centers (Cambridge/King's College and Birmingham) currently recognized in this country. This is based on an experience of 255 cases dating from the first liver transplant performed in Great Britain by Professor Roy Y. Calne in May 1968.
Data Acquisition for Assessment of Medical Technology: Methods Other than Technical Trials
Authors: Moses Lincoln E.
Published: March 2009

The term “assessment of medical technologies” does not appear to have a unique meaning that always applies to its use. It seems wise, then, to state what will be meant by the term in this chapter. “Medical technology” is regarded here as including drugs, devices, procedures, (whether preventive, diagnostic, or therapeutic) that bear more or less directly on patients. Thus, an educational program for patients might be a technology, but a training program for dietitians would not. A surgical procedure or a prosthesis would; but a scale for assessing quality of life would not. “Assessment,” as used here, refers to a complex set of activities that comprise data acquisition, analysis, and interpretation concerning properties of medical technologies. Assessment tends to be comparative, either explicitly (as to a control group) or implicitly (as looking toward “usual experience”). In any case, the goal of assessment is to increase understanding of such properties of a medical technology as its applicability, convenience, efficacy, safety, effectiveness, cost, etc.
Transfer of Information and Its Impact on Medical Practice: The U.S. Experience
Authors: Jacoby Itzhak , Rose Martin
Published: March 2009

Since 1977, the Consensus Development Program of the Office of Medical Applications of Research (OMAR), part of the National Institutes of Health (NIH), has sponsored more than 50 consensus development conferences (CDCs) on the safety and efficacy of important biomedical technologies. The aim of these conferences, described fully elsewhere (4), is to inform the health care community, and to some extent the public, of the status of emerging biomedical technologies and the need for change in the use of existing health-related technologies. OMAR has therefore, worked diligently to publicize conference findings among these audiences. Further, OMAR has sought to improve the effectiveness of these transfer activities by conducting assessments of the impact of CDCs on their primary audience, U.S. physicians.
Is High-Flux Dialysis Cost-Effective?
Authors: Hornberger John C. , Garber Alan M. , Chernew Michael E.
Published: March 2009

High-flux dialysis is a new method for providing routine-maintenance hemodialysis to patients with endstage renal disease. It promises to shorten the duration of the dialysis session, but poses potential clinical risks to patients and financial risks to dialysis centers because of the high unit cost of purchasing new dialysis equipment. We retrospectively evaluated the cost-effectiveness of high-flux dialysis compared to conventional dialysis in a hospital-based center. The center provided only conventional dialysis until March 1989, when it initiated high-flux dialysis. The estimated annual costs of treatment were US $31,249 (high-flux) and $32,562 (conventional). The rate of hospital admissions was almost identical in both groups (conventional, 1.29 admissions per year; high-flux, 1.24 admissions per year; p = 0.23). Predicted prolongation of life expectancy with high-flux dialysis was significantly higher after statistical adjustment for observable patient characteristics (1.8 to 4.5 years; p <0.01). The cost-effectiveness ratio was $28,188 per life-year saved for high-flux compared to conventional dialysis. These findings suggest that the added capital expense of purchasing high-flux equipment can be justified from the perspective of its societal cost-effectiveness.
Data Bases for the Assessment of Medical Technologies: Examples from Europe
Authors: Gutzwiller Felix , Chrzanowski Richard , Paccaud Fred
Published: March 2009

The assessment of medical technologies has to answer several questions ranging from safety and effectiveness to complex economical, social, and health policy issues. The type of data needed to carry out such evaluation depends on the specific questions to be answered, as well as on the stage of development of a technology.

Basically two types of data may be distinguished: (a) general demographic, administrative, or financial data which has been collected not specifically for technology assessment; (b) the data collected with respect either to a specific technology or to a disease or medical problem.

On the basis of a pilot inquiry in Europe and bibliographic research, the following categories of type (b) data bases have been identified: registries, clinical data bases, banks of factual and bibliographic knowledge, and expert systems. Examples of each category are discussed briefly. The following aims for further research and practical goals are proposed: criteria for the minimal data set required, improvement to the registries and clinical data banks, and development of an international clearinghouse to enhance information diffusion on both existing data bases and available reports on medical technology assessments.
Canadian Drug Regulatory Programs
Authors: Henderson Ian W. D.
Published: March 2009

At about the time of national confederation in Canada, in the 1860s, profound changes had begun to take place in the field of chemical science, although most of these had not yet been translated into any advances in drug treatment. This was the era of chemical brilliance in Germany. Paul Ehrlich (1854–1915), often referred to as the father of modern pharmacology, had applied, with great foresight and considerable courage, the 1865 insights of August Kekulé, the chemist who had accomplished the difficult transition between inorganic and organic chemistry. Indeed, it was Kekulé who made possible the chemical –magic bullet— that could reach body organs to effect therapeutic changes, a realistic goal for Ehrlich, especially in his work associated with the treatment of syphilis.
Commentary
Authors: Bergström Jonas
Published: March 2009

That the United Kingdom has comparatively low figures for acceptance of patients over the age of 55 for renal replacement therapy is remarkable, because, on a comparative basis, the United Kingdom is not a poor country and many U.K. nephrologists were pioneers in the technical and medical development of he-modialysis. While most nephrologists in the United Kingdom agree that age per se is not a valid criterion to be used for excluding patients, the “hard” use of age as a rigid line demarcating those to be treated from those to be denied treatment predominates. Professor Halper has made a very thorough analysis of which factors at the macroallocative as well as the microallocative level are responsible for this. It would have been of interest to know how the health system in the United Kingdom deals with other categories of elderly, severely ill patients (e.g., patients with malignant diseases), for whom immediate surgery may be life-saving, but the long-term prognosis is questionable. Are such patients also denied treatment in the United Kingdom because of age?
Technology Acquisition in Canada: control in Regulated Market
Authors: Deber Raisa B. , Thompson Gail G. , Leatt Peggy
Published: March 2009

The authors provide a detailed overview of how the national and provincial health systems of Canada exercise control over the diffusion of medical technology. In particular, they examine the diffusion of CT scanning and the adoption of non-ionic radio contrast media. While the nature of the parliamentary system theoretically aflows the government, especially the executive, to exert more control over its policy agenda than in the United States, the authors believe that effective control is hampered by a lack of political will and insufficient “teeth” in the Ministry of Health' mandate and policy. The authors also conclude that the manipulation of reimbursement systems to encourage or discourage the diffusion of various medical technologies is not always effective, and that political clout often triumphs over rational decision making.
Health Care Technolgies in The Netherlands
Authors: Rutten Frans , David H. Banta
Published: March 2009

This article argues that while health care and government authorities in the Netherlands in the last decades have attempted to rationalize the diffusion of medical technology, much work remains to be done. The authors contend that though a mix of direct government regulation and economic incentives will be needed, regulation by incentive is more effective than regulation by directive in achieving cost effective use of technology. Generally, bureaucratic structures provide only limited opportunities for tight control of the diffusion of medical technologies. The article offers possible future strategies for directing the adoption and use of medical technologies and stresses the importance of reliable infor mation culled from comprehensive technology assessments.
Evaluation of the Costs and Relative Effectiveness of Alternative Strategies for the Removal of Mandibular Third Molars
Authors: Tulloch J. F. Camilla , Antczak-Bouckoms Alexia A. , Ung Nancy
Published: March 2009

Decision analysis is used to compare the cost and disability of alternative treatment strategies for asymptomatic mandibular third molars. The analysis shows that extracting only those third molars that remain impacted and become pathologically involved is always associated with less expected cost and disability than prophylactic removal of asymptomatic wisdom teeth.
Cost–Benefit Evaluation of Dental Implants
Authors: Jönsson Bengt , Karlsson Göran
Published: March 2009

The growing evidence of the efficacy and effectiveness of dental implants calls for economic evaluations to determine the economic efficiency of this technology for different indications. Such studies must be integrated with the clinical evaluations in order to produce the relevant data. In most cases, dental implants will produce a better outcome than the best alternative technology, but this improvement will only come at greater cost. Cost–benefit evaluations of dental implants must therefore address the difficult task of assessing the value of the improvement in oral health.
Technological Methods in the Diagnosis and Treatment of Temporomandibular Disorders
Authors: Laskin Daniel M. , Greene Charles S.
Published: March 2009

Although there have been numerous technological devices introduced for the diagnosis and treatment of temporomandibular disorders, many are either ineffective or are research tools without direct clinical application. This article reviews the various modalities and makes recommendations regarding their effectiveness based on the available clinical and scientific evidence.
Antibiotic prophylaxis for Dental Patients with Joint Prostheses? A Decision Analysis
Authors: Jacobson Jed J , Schweitzer Stuart , DePorter David J. , Lee J. Jack
Published: March 2009

A decision analysis was performed to assess the risks, costs, and effects of no prophylaxis, oral penicillin, and cephalexin regimens currently being debated for dental patients at risk for late prosthetic joint infection (LPJI). The analysis suggests that there is a very small risk of LPJI (29.3 cases per 106dental visits), which is outweighed by a greater risk of death with an oral penicillin strategy than with a “no prophylaxis” strategy (2.31:1.93). An oral cephalosporin appears to spare life and limb but does so at an extremely high cost. Over $500,000 must be spent to spare one year of life, while $480,000 needs to be spent to prevent one case of LPJI. Some individual dental patients may still be at a much greater risk for LPJI than others. However, from the evidence to date, routine predental antibiotic prophylaxis for all prosthetic joint patients is a very expensive preventive strategy and is not cost-effective. However, clinical experience suggests that antibiotic prophylaxis may be appropriate in some situations.
Treatment of Traumatic Dental Injuries: Shift in Strategy
Authors: Andreasen Frances M. , Andreasen Jens O.
Published: March 2009

Absract

A more conservative approach to the treatment of traumatic dental injuries has been made possible by knowledge concerning the pathogensis of external root resorption, increased knowledge about wound healing processes in the pulp and periodintium, as well as by advances in restorative dentistry (reattachment of crown fragments with a dentin bonding system, the use of adhesive bridges, and advances in autotransplantation and implantation). However, a rethinking by the public, clinicians, and third-party payers is necessary for these procedures to gain wider acceptance. The present article describes the state of the art of treating dental trauma in the hope that these advances cam become an accepted part of the dental trauma armamentarium and not merely scientific curiosities.
Patients' Quality of Life Following Extracorporeal Shock-Wave Lithotripsy and Percutaneous Nephrolithotomy for Renal Calculi
Authors: Mays Nicholas B. , Petruckevitch Ann , Snowdon Claire
Published: March 2009

The objective of this study was to test whether the relatively new, noninvasive technique of extracorporeal shock-wave lithotripsy (ESWL) for renal stones resulted in a measurably better outcome from the patients' point of view than percutaneous surgery. The claimed superiority of ESWL was not demonstrated with the data available.
Managing the Integration of Technologies: Development of the Immunoassay
Authors: Erickson Tamara J.
Published: March 2009

Many factors, including cultural, economic, technical, and regulatory influences, affect how different technologies come together for today's medical diagnostic products. An analysis of the development of automated immunoassay systems reveals that companies used a variety of approaches to access needed technologies, that mature technologies play an important role in the development of new products, and that implementation seemed more important in these companies than strategy.
Problems with Toxicity Studies in the Assessment of New Drugs
Authors: Werkö Lars
Published: March 2009

The development of new medicines requires a lot of time and the efforts of many researchers. One of the most taxing parts of this endeavor is the need for long-term toxicity studies in different animals. This paper describes the development of two different medicines: zimeldine, an antidepressant, and omeprazole, a compound that acts against a specific enzyme in the gastric mucosa that is necessary for the production of gastric acid. Zimeldine was launched in the international market but had to be withdrawn when it caused severe unexpected adverse reactions. Omeprazole has been marketed successfully after a prolonged development phase characterized by difficult problems with the toxicity studies. Against the background of these two descriptions, this article questions the rationale for the present rules for long-term toxicity studies and emphasizes the need for leaders in the pharmaceutical industry to have a solid scientific background in order to be able to decide whether to abandon a project.
Carotid Endarterectomy for Asymptomatic Patients:Assessing Results of a Quantitative Synthesis
Authors: Langenbrunner John C. , Wortman Paul M. , Yeaton William H. , Holloway James J.
Published: March 2009

Carotid endarterectomy (CE) surgery for asymptomatic patients remains controversial despite hundreds of published studies and recent randomized trials. Safety and efficacy are assessed using a quantitative synthesis method derived from meta-analysis and a “critical multiplist” inference approach. In addition, multivariate analyses reveal that use of a surgical shunt could further improve CE outcomes. Methods are examined for both their “confirmatory” and “exploratory” value.
Health Technologies for the Developing World: Promoting Self-reliance through Improving Local Procurement and Manufacturing Capabilities
Authors: Free Michael J. , Green Jonathan A. , Morrow Margaret M.
Published: March 2009

To reduce their dependency on donors or the international currency costs of essential health care products, developing countries are building or improving capability for local manufacturing or competitive international procurement. Through long-term strategic planning, public/private partnerships, collaboration with firms in industrialized nations, and farsighted donor policies, the capacity for alternative supply can be increased in stages from importation through local processing and packaging to full production and multiproduct enterprises.
Transferring Manufacturing Technology: Producing Essential Vaccines in Pakistan
Authors: Burney M. I.
Published: March 2009

Pakistan has produced essential vaccines as part of an Expanded Program on Immunization. The program has been successful in achieving high rates of immunization in pregnant women and children under two years of age. This paper focuses on key events in the development of Pakistan's capacity to produce vaccines.
The Spread of Upper Gastrointestinal Endoscopy in Japan and the United States:An International Comparative Analysis of Technology Diffusion
Authors: Kasumi William T. , Kasumi Asao , Ishikawa Benjamin
Published: March 2009

The use of upper gastrointestinal (Gl) fiberoptic endoscopy has spread at different times and rates in Japan than in the United States. Factors that explain this disparity and its effects on patient outcomes are reported. This essay outlines Japanese data in gastroenterology, giving an account of the resources and time that were spent on the development of upper Gl endoscopy in Japan. It also draws implications for the assessment of endoscopy for populations at high risk for gastric cancer.
Assessment and Diffusion of Computerized Decision Support Systems
Authors: Weaver Robert R.
Published: March 2009

This article discusses and identifies the weaknesses of approaches to assessing computerized decision support (CDS) systems, examining the design of two CDS systems, “DXplain” and the “Problem Knowledge Coupler” (PKC). It suggests that the inadequate assessment of CDS technologies will promote a conservative orientation toward their diffusion.
Evaluating Treatments for Childhood Cancer: A Process for Critical Appraisal of the Literature and a Summary of the Results
Authors: Barr Ronald D. , Furlong William , Feeny David , Horsman John , Rosenbaum Peter , Weitzman Sheila
Published: March 2009

An overview of published studies on three common cancers in childhood was conducted to estimate the effectiveness and consequences of treatment. Of 1,016 separate citations, 316 were reviewed in detail but only 162 were deemed to be “useful.” An approach to a structured appraisal of the literature is presented.
Assessing School Health Education Programs
Authors: Dwyer Terence , Viney Rosalie , Jones Michael
Published: March 2009

This review focuses on the component of health education directed at achieving changes in health behavior. Much of the work in this field has centered on health behavior that has a role in preventing future disease. Because the evidence is strongest in relation to coronary heart disease (17), considerable effort has been devoted to this area. Walter et ai. (34) indicated that the most relevant forms of health behavior to be considered in school-based programs on heart disease are those relating to diet, physical activity, and smoking. Programs relating to each of these behaviors are addressed here.
Primary Care and Diagnostic Testing Outside the Hospital
Authors: Stoeckle John D.
Published: March 2009

This article enumerates and describes the wide range of sites at which primary care is now offered; analyzes the impact of diagnostic testing procedures used in locations outside the doctor's office, such as imaging centers, hospices, and nursing homes; and looks at the effect of this decentralization on patients and medicine.
Current Issues in Health Care Technology Assessment
Authors: Mosteller Frederick , Burdick Elisabeth
Published: March 2009

This article presents an overview of technology assessment in the United States. The authors argue that while there are numerous institutions carrying out assessments, the United States requires an overall plan that would provide a national system for technology assessment. If technology assessment were more organized and systematized, the authors argue, it would be more efficient and would reach the public and the medical world effectively.
Increasing Physician Acceptance of Technology Assessment Through a Focused Training Program
Authors: Goodman Gerald R.
Published: March 2009

This paper presents the framework for a one-semester course to give physicians a better understanding of the core concepts of technology assessment, using medical instrumentation technology as a vehicle to stimulate the discussion of technology assessment and its applications. An assessment matrix has been developed as an organizational tool to identify issues in assessment to be addressed under each topic and to identify those issues that are of key importance to particular technologies. At the end of the class, the physician-student should be able to identify major types of medical instrumentation and the instrument's principal application(s), to identify the techniques of technology assessment, and to analyze the economic, ethical, and legal issues that are applicable to instrumentation.
A Cost-Utility Analysis of Preoperative Total Parenteral Nutrition
Authors: Goel Vivek , Detsky Allan S.
Published: March 2009

It has been suggested that preoperative total parentetal nutrition may be used to reduce the risk of nutrition-associated postoperative complications in high-risk patients. These patients can be identified based on their nutritional status. The efficiency of this intervention is assessed using the technique of cost-utility analysis. Data from multiple sources is integrated to perform the economic assessment.

The cost-utility ratios for treating several malnourished patients with localized upper gastrointestinal cancer are below $40,000. These cost-utility ratios compare favorably with published results of other programs. The ratios increase considerably if patients who are better nourished (at lower risk of postoperative complication) receive the intervention. The analysis is very sensitive to the efficacy of the intervention.
Finnish Consequensus Development Conference on the Teratment of Schizophrenia
Authors: Lehtien Ville , Panelius Martin , Tienari Pekka
Published: March 2009

Since 1982, the Medical Research Council of the Academy of Finland, together with other interested parties, has tried to develop systematically the evaluation research of medical technology. The broadly based working group set up by the Council is preparing a program dealing with this issue to promote research work and the training of researchers. The arrangement of consensus development conferences, held on various topics in many countries, is another means of reaching these goals. In Finland, the arrangement of such conferences has been the responsibility of the Medical Research Council.
Prognostic Factor Analysis and Treatment Results of Ovarian Cancer in Japan
Authors: Ochiai Kazunori , Sasaki Hiroshi , Terashima Yoshiteru , Fukushima Masanori
Published: March 2009

Prognostic factors were analyzed among women with ovarian cancer. Stage, histologic subtype and grade, age, performance status, residual tumor size, and platinum-based chemotherapy were factors that significantly influenced the survival rate. Based on these findings, we performed maximal cytoreductive surgery and gave dose-intensified platinum-based chemotherapy to patients with advanced disease and were able to improve survival rate significantly.
An Elemental Resource for the Human-Task Interface
Authors: Kondraske George V.
Published: March 2009

Abstarct

The elemental resource model (ERM) attempts to provide a quantitative and straightforward framework for characterizing the human system, tasks, and their interface. It evolved in large part from the general systems performance theory (GSPT), which was developed first and independently. Resource constructs are used exclusively for modeling the abstract idea ofsystem performanceand for subsequent measurement of performance resource capacities. Resource economic principles provide a cause-and-effect description of the human-task interface. While argued to have immediate utility, it also provides the motivation to consider coordinated, collaborative, long-term developments that could facilitate effective decision making and technology utilization in rehabilitation.
Adapting Work Sites for Disabled Persons Using Advanced Technology
Authors: Malmsborg Thomas
Published: March 2009

Abstarct

This paper describes the technical approach in the TUFFA (Technology Procurement for Disabled in Working Life) project and a model for cooperating areas of competence based on a holistic view of the individual's abilities, the environmental conditions at the work site, and technical solutions.
The Cost of the Swedish Handicap Service System: Implications for Technology Assessment
Authors: Jonsson Dick , Hass Ursula , Persson Jan
Published: March 2009

Abstarct

The total cost of the Swedish handicap system is estimated at US $ 10.7 billion for 1989. The cost is distributed across different authorities with separate legal and financial responsibility. The concept of technology must be extended to include consideration of both the resources spent and benefits gained in the public sector and the magnitude and distribution of transfer payments from social insurance to fulfill its function in handicap policy decision making.
Hemophilia Home Treatment:Economic Analysis and Implications for Health Policy
Authors: Ross-Degnan Dennis , Soumerai Stephen B. , Avorn Jerry , Bohn Rhonda L. , Bright Rosalie , Aledort Louis M.
Published: March 2009

Abstarct

This analysis describes the development of technology for home self-infusion of factor VIII in the treatment of hemophilia and its clinical, economic, and social consequences, and uses the case study of such home care treatment to illustrate the potentials and pitfalls of formal economic analyses of programs to treat chronically ill children. A comprehensive review of all original data on hemophilia programs, their related costs, and outcomes, conducted from 1966 through 1993, examined the economic outcomes for two hypothetical cohorts, one aged 0–4 years and the other aged 30–34 years. Including the measurement of treatment effects on the productivity of parental caregivers substantially increases the benefit-cost relationship of an intervention directed at chronically ill children. Increased economic productivity and societal return resulting from such a program for young adults exceeds those for a cohort of children, primarily due to assumptions related to discounting. However, estimation of quality-adjusted life years favors the younger age cohort, since children survive for a longer period of time and with each year survived comes a higher quality of life. Unlike simpler instances in which economic benefits can be shown to outweigh resource costs, policy decisions concerning services for chronically ill children raise an additional set of complex analytic issues. Inclusion of the benefits in productivity experienced by family caregivers provides an important added dimension to such analyses. The development of cost-benefit or cost-effectiveness analyses of these programs illustrates the importance of careful measurement of outcomes and explicit statements of underlying assumptions. Such an analysis of home care for children with hemophilia therefore demonstrates both the strengths and the limitations of this approach.