No description available.

This thesis is an exploratory study of the factors that account for the construction of a local social world around a frontier medical technology. The analysis is based on participant-centred accounts of the structuring of a PET world in the MNI&H. According to local actors, the following factors can be identified to have played a role in the birth, promotion, structuring, and maintenance of the local PET world: the personalities; the institution; the resulting tradition; the assessment of PET; the sense of quality; the size of the local PET world and of the institution; elements of the environment such as cost, finding sources, and manufacturers. The data show that the structuration of the PET world in this elitist research cum hospital institution cannot serve as a model for the diffusion of this frontier technology, although the demarcated pattern exhibits some characteristics common with those described in the literature for similar innovations.

Thesis (M.A.)--Miami University, Dept. of Communication, 2006. / Title from first page of PDF document. Includes bibliographical references (p. 56-59).

Over the past 60 years, India has undergone immense political, economic, and social changes, which have led to its emergence as a global economic power and regional military power. During this period, the population has surged, growing from 233 million to 1.2 billion people, making India the second most populous nation in the world. In the course of this change, there have been key indicators of medical progress, such as rising life expectancy and a falling infant mortality rate. Another striking indicator, specifically in the area of medical technology, is the fact that India in 2006 was a net exporter of HIV medications to dozens of countries around the globe, earning a reputation as the pharmacist of the developing world. Although many books and papers have been written about the emergence of the country's economy and military, little has been written on how it has been able to achieve its leadership in medical technology. This thesis, 'A History of Medical Technology in Postcolonial India: 1947-1991', is the first major study examining the development of medical technology in India in the period directly following colonial rule. The period covered in this research is crucial because it highlights the evolution and impact of medical technology in postcolonial India, leading up to, but excluding, the free-market reforms enacted by the Indian government in 1991. This thesis will also illustrate the impact diffusion had on the evolution of medical technology. Most importantly, this thesis introduces a new concept appropriate to understanding India's trajectory in this period: the medical technology complex. It will be shown that this complex consists of different groups working toward an aligned objective. It is not the point of this thesis to characterize the medical technology complex in a positive light or a negative one. Its primary concern is to demonstrate through historical evidence that this construct grew throughout the twentieth century and still exists today.

No description available.

Le travail de cette thèse s’interroge sur les réponses à apporter en terme d’organisation de l’offre médico-technique et de sa juste répartition sur les territoires en particulier pour les patients âgés poly-pathologiques. Il part de l’hypothèse qu’il existe un espace pour des concepts de petits établissements de santé ambulatoires pluridisciplinaires, dotés d’un petit plateau médico-technique, qui permettraient de participer à fluidifier et optimiser les parcours de soins. La méthode a consisté d’une part à étudier des structures plus petites de proximité en Allemagne, les MVZ, avec une expérience plus ancienne que celle dont nous disposons en France avec les MSP ou les Centres de Santé, et d’autre part à analyser les données PMSI pour faire émerger à la fois l’existence de groupes homogènes de co-morbidités et de groupes homogènes de parcours de soins. Les résultats sont constructifs, à la fois dans l’analyse par les sciences des réseaux et par l’automatisation de représentations de parcours de soins complexes. Ils ont permis de faire émerger des patterns représentatifs de groupes, d’en caractériser la consommation de soins, en matière de dispositifs médicaux et de ressources humaines, de quantifier les distances parcourues cumulées et les coûts cumulés par les patients selon leur lieu d’habitation et les institutions de santé auxquelles elles sont adressées. Nous en tirons des éléments pour la définition et la labellisation de nouvelles structures de santé de proximité satellites d’hôpitaux plus importants. Ce travail représente une avancée particulièrement utile, à la fois conceptuelle et pratique, pour les études de données de santé complexes des personnes âgées. / This work questions the answer to be given in terms of organization of the health technical offer and its fair distribution in the territories especially for the elderly patients with multimorbidities. It is based on the assumption that there is space for a concept of small multi-disciplinary outpatient health facilities, with a small health-technical platform, which would help to streamline and optimize care pathways. The method consisted on the one hand to study in Germany smaller community interdisciplinary health care center (the MVZ) in operation for a longer time than the the French multidisciplinary médical care centers. And on the other hand it analyzed the national heath data to reveal both the existence of comorbidités related groups and homogeneous care pathways related groups. The results are positive, both in network science analysis and in the automation of representations of complex care pathways. They made it possible to create representative patterns of groups, to characterize the consumption of care, in terms of medical devices and human resources, to quantify the cumulative distances traveled and the costs accumulated by patients according to their place of residence and the health institutions to which they are sent. We get addition elements for the definition and labeling of small community health centers, satellite of larger hospitals. This work represents a particularly useful step, both conceptual and practical, for complex health data studies of elderly.

Nos últimos anos, o paradigma da Internet das Coisas (IoT) foi introduzido, ganhando relevância como uma tecnologia emergente, composta por redes amplamente conectadas e heterogêneas. No contexto médico essas redes suportam diferentes tipos de processos, sendo compostas por diversos tipos de dispositivos denominados objetos, os quais são capazes de interagir uns com os outros, colaborando para atingir um objetivo comum (diagnóstico, tratamento, monitoramento e reabilitação de pacientes). Este cenário caracteriza-se como Internet de Coisas Médicas (IoMT) e um dos maiores desafios a serem superados é o desenvolvimento de mecanismos de gestão de confiança para assegurar trocas de dados com um certo nível de credibilidade. Este trabalho propõe um modelo para gestão de confiança em redes IoMT a partir de conceitos de redes sociais e critérios de relevância biomédica. O modelo proposto baseia-se em um índice de recomendação calculado por um protocolo determinístico de gestão de confiança. Para avaliar sua eficácia, foram criadas simulações com diferentes cenários de redes IoMT. O modelo demonstrou ser útil para detectar objetos com comportamento suspeito na rede, evitando o estabelecimento de relações com estes objetos e minimizando os danos causados à IoMT durante as trocas de dados. / In recent years, the Internet of Things (IoT) paradigm has been introduced, getting attention as an emerging technology, built upon pervasive connectivity of objects in heterogeneous networks. Medical environments are composed by many devices named objects that are able to interact with each other and collaborate in order to achieve a common objective (diagnosis, treatment, monitoring and patient rehabilitation). This scenario is characterized as Internet of Medical Things (IoMT) and one of its greatest challenges is to develop trustworthiness mechanisms to assure data exchanges in a certain level of credibility. This work proposes a model to manage trustworthiness for IoMT networks based on social network concepts and biomedical relevance criteria. The proposed model is based on a trust recommendation index, computed by a deterministic trustworthiness management protocol. To evaluate the model effectiveness, simulations were created with different IoMT scenarios. The model demonstrated to be useful to detect objects with suspicious behavior in the network, avoiding their relationships establishment and minimizing the IoMT damage during the data exchanges.

Nos últimos anos, o paradigma da Internet das Coisas (IoT) foi introduzido, ganhando relevância como uma tecnologia emergente, composta por redes amplamente conectadas e heterogêneas. No contexto médico essas redes suportam diferentes tipos de processos, sendo compostas por diversos tipos de dispositivos denominados objetos, os quais são capazes de interagir uns com os outros, colaborando para atingir um objetivo comum (diagnóstico, tratamento, monitoramento e reabilitação de pacientes). Este cenário caracteriza-se como Internet de Coisas Médicas (IoMT) e um dos maiores desafios a serem superados é o desenvolvimento de mecanismos de gestão de confiança para assegurar trocas de dados com um certo nível de credibilidade. Este trabalho propõe um modelo para gestão de confiança em redes IoMT a partir de conceitos de redes sociais e critérios de relevância biomédica. O modelo proposto baseia-se em um índice de recomendação calculado por um protocolo determinístico de gestão de confiança. Para avaliar sua eficácia, foram criadas simulações com diferentes cenários de redes IoMT. O modelo demonstrou ser útil para detectar objetos com comportamento suspeito na rede, evitando o estabelecimento de relações com estes objetos e minimizando os danos causados à IoMT durante as trocas de dados. / In recent years, the Internet of Things (IoT) paradigm has been introduced, getting attention as an emerging technology, built upon pervasive connectivity of objects in heterogeneous networks. Medical environments are composed by many devices named objects that are able to interact with each other and collaborate in order to achieve a common objective (diagnosis, treatment, monitoring and patient rehabilitation). This scenario is characterized as Internet of Medical Things (IoMT) and one of its greatest challenges is to develop trustworthiness mechanisms to assure data exchanges in a certain level of credibility. This work proposes a model to manage trustworthiness for IoMT networks based on social network concepts and biomedical relevance criteria. The proposed model is based on a trust recommendation index, computed by a deterministic trustworthiness management protocol. To evaluate the model effectiveness, simulations were created with different IoMT scenarios. The model demonstrated to be useful to detect objects with suspicious behavior in the network, avoiding their relationships establishment and minimizing the IoMT damage during the data exchanges.

The purpose of this study is to demonstrate that within the United States health care system, a number of institutions have evolved which have given rise to a perverse set of incentives that direct technological change. As a result of these incentives, the diffusion and utilization of new and existing technologies is carried out in a random and indiscrete fashion, subsequently placing upward pressure on the costs of health care. This analysis relies on the empirical work, observations, and writings of a large number of physicians, social scientists, hospital administrators, and federal bureaucrats.