Thesis (Ph.D.)--RAND Graduate School, 2007. / Includes bibliographical references.

The thesis assesses the contribution of technology option of Carbon Capture and Sequestration (CCS) to climate change mitigation. CCS means that CO2 is captured at large industrial facilities and sequestered in goelogical structures. The technology uses the endogenous growth model MIND. Herein the various climate change mitigation options of reducing economic growth, increasing energy efficiency, changing the energy mix and CCS are assessed simultaneously. An important question is whether CCS is a temporary or long-term solution. The results show that in the middle of the 21st century CCS has its peak contribution, which allows prolonged use of relatively cheap fossil energy carriers. However, this leads to delayed introduction of renewable energy carriers. The technology path ways are accombined with different costs of climate change mitigation. The use of CCS delays and reduces the costs of climate change mitigation. However, the delayed introduction of renewable energy carriers leads to reduced technological learning, which induces higher costs in the longer term. All in all the temporary use of CCS reduces the costs of climate change mitigation costs. The result is robust, which is tested with various uncertainty analysis. / Die Arbeit befasst sich mit der Bewertung der technischen Option zum Klimaschutz CO2 an grossen industriellen Anlagen abzufangen und in geologischen Lagerstätten zu speichern. Die Technologiebewertung wird mit Hilfe des endogenen Wachstummodells MIND untersucht. Darin werden die Klimaschutzoptionen geringere wirtschaftliche Entwicklung, Steigerung der Energieeffizienz, Veränderung des Energiemixes und eben CO2 Abscheidung simultan bewertet. Eine wichtige Frage ist ob die Abscheidung von CO2 eine langfristige oder eine Zwischenlösung ist. Es zeigt sich, dass sie um die Mitte des 21ten Jahrhunderts ihren grössten Beitrag zum Klimaschutz leistet und die Nutzung der relativ kostengünstigen fossilen Energieträger verlängert. Das führt zu einer späteren Einführung erneuerbarer Energietechnologieen. Mit diesen unterschiedlichen Technologiepfaden gehen auch verschiedene ökonomische Kostenverläufe des Klimaschutzes einher. Die Verwendung von CO2 Abscheidung verschiebt die Kosten in die Zukunft und drückt ihre Spitze. Da es aber gleichzeitig zu geringerer Technologieentwicklung bei erneuerbaren Energieen führt entstehen wiederum Kosten. Unterm Strich lohnt sich die Einführung der CO2 Abscheidung als temporärer Beitrag zum Klimaschutz. Dieses Ergebnis konnte mit einer Reihe von Unsicherheitsanalysen erhärtet werden.

The general framework of this thesis is that of ethical Technology Assessment (eTA). Whereas the first essay proposes an inclusive approach to technology assessment by delineating an ethical checklist, the following essays focus on two of the checklist points, i.e. “privacy” and “control, influence and power”, in relation to workspace surveillance. The core idea of Essay I (written in collaboration with Sven Ove Hansson) is that, due to its strong social impact, new technology and novel use of existing technology should be considered from the perspective of ethics. We suggest that assessments should be conducted on the basis of nine crucial ethical aspects of technology. In Essay II an in-depth analysis of the meaning and value of privacy in the realm of work is undertaken. The meaning and value of privacy is explained as well as why it should be protected. It is argued that two dimensions of privacy should be safeguarded; “informational privacy” and “local privacy” for the reason that workers’ personal autonomy is protected thereby. Essay III is concerned with how workspace surveillance requires that job-applicants claim their privacy interests in employment negotiations to a much larger extent than what was previously the case. In most cases however, a dependency asymmetry between employer and job-candidate makes the latter ill-equipped for doing so. This asymmetry serves as the point of departure for an analysis of the conditions under which consent should be considered a criterion on moral acceptability with regard to employment contracting. The analysis suggests ways of rectifying this imbalance, raising demands on the quality of contractual consent. Essay IV discusses the extent to which it should be morally permissible for current or prospective employees to trade off their privacy in employment negotiations. The analysis starts out from, and questions, a libertarian case for voluntary self-enslavement. It is concluded that not even an orthodox libertarian can justify trade offs of a social good like liberty. Neither should employees be allowed to abstain informational privacy for the reason that such a trade-off could harm their future selves. In Essay V a dimensional analysis is proposed as a means to identify actually or potentially privacy invasive surveillance practices. It discusses ways in which different types of surveillance intrude upon employees’ privacy in order to guide the evaluation of such practice. Even though negative implications cannot be avoided altogether, by means of the proposed analysis, minimally intrusive means of monitoring can be identified. / QC 20100902

This study looks at the National Citizens’ Technology Forum (NCTF), a modified version of the consensus conference, which took place in March, 2008 in six cities across the U.S. to understand how inclusive these methods of public participation are in practice. The study focuses on two of these sites. Inclusion of participants was defined in terms of presence, voice and being heard. Transcripts of the audio-visual recordings of the proceedings were the main data of analysis. By focusing on the talk within these deliberative forums, the study looked at how the rules of engagement and status (ascribed and achieved) differences between participants can affect inclusion. The analysis did not reveal any substantial effects of ascribed characteristics on deliberation. Facilitation and the presence of expertise among the participants were found to effect inclusion and equality among participants. These findings suggest that organizers and facilitators of deliberative exercises have to be reflexive of their role as well as aware of the group dynamics. The results also address the larger questions within science and technology policy like the role of expertise and the public in decision making, the institutional design of participatory exercises, and their relation to the political culture and the policy process.

This study proposes a new model for the assessment of information technology (IT) use in public and private companies, which is called ITMEM- Information Technology Management Enhancement Model. This model aims to assist decision making processes in information technology management. For this purpose, a tool is developed to explore strengths and weaknesses of a company in IT use. The model was developed upon a three-folded structure including (1) academic studies in technology management, (2) best practices which are developed for control over operations and processes including COBIT, CMMI and ITIL, and (3) standards about IT management and IT security. The conceptual framework of ITMEM is based on technology management process assessment model of M.J. Gregory. Methodological triangulation approach is adopted for the model for retrieving valid and reliable results. Triangulation consists of (1) semi structured interview, (2) presented company documents and (3) questionnaire developed upon relevant academic researches, best practices and standards. ITMEM was practiced on ten domestic and experienced companies in software &amp / development and manufacturing industries which were appraised in or in progress of being appraised in CMMI. The study revealed the benefits and deficiencies of IT use in the company. It also provided information for decision makers about IT value within companies, and demonstrated the effects of best practices and standards over IT use.The reported findings should be valuable assets to researchers studying on IT management and IT use in organizations.

The main purpose of this dissertation is to elucidate the problem of assessing and providing alternative medical technologies. The purpose is divisible into three parts: To investigate the bases of assessment for the acceptance of an alternative medical technology; 2. To investigate the professional and ethical problems connected with the practice of alternative medical technologies and find out whether the views of laymen and physicians differ with regard to the provision of treatments which are not in accordance with science and proven experience; 3. To investigate the interest physicians have shown in alternative medicine and the motives for this interest. These investigations are based partly on a study of the literature on alternative medicine dealing with the effects of the following alternative medical technologies: manipulation therapy, acupuncture, reflexio (zone) therapy, homoeopathy and magnetic therapy, and partly on empirical research into the attitudes expressed by doctors and patients towards non-scientific treatments. The results of these studies show that the acceptance of empirical data cannot be separated from the scientific paradigm within which the investigation has been planned. The documentation of the effect of alternative medical technologies is often empirically insufficient and based, in many instances, on so-called ”personal experience”. The interest shown by accredited physicians in alternative medicine is often motivated by the fact that certain complaints brought to them by their patients cannot be rectified by academic medical methods. The study also shows that physicians have professional interests which the patient is not prepared to respect in the same way as the physician is prepared to respect the right of a patient to refuse to undergo life-saving medical treatment. The main conclusion is that alternative medicine is a heterogeneous field where the interest expressed can be interpreted as a crisis phenomenon and an indication of the need for the assessment of alternative medicine as well as academic medicine. Laymen perceive the ethical and professional problems connected with the practice of alternative medicine relatively differently when compared to physicians. The possibility of scientific co-operation between practitioners of alternative medicine and academic medicine is difficult due to the fact that alternative medicine and academic medicine relate to different scientific paradigms. Clinical co-operation in the case of individual patients, on the other hand, is likely to occur. / <p>Diss. (sammanfattning) Umeå : Umeå universitet, 1991, härtill 6 uppsatser</p> / digitalisering@umu

Diss. (sammanfattning) Linköping : Linköpings universitet, 2010. / Härtill 4 uppsatser.

Systematic reviews - appraisal and synthesis of all primary research - are increasingly being used to inform policy and practice in health care. Therefore, it is important to understand how the key questions in systematic reviews are identified and prioritised and whether they are relevant to policy makers, practitioners and members of the public. Research priority setting (RPS) is usually defined as any interpersonal activity that leads to the selection of topics and/or choices of key questions to investigate . Diverse approaches to setting research priorities are used in different countries, regions and organisations. There is no consensus in the literature on the most effective processes with which to set these priorities. However, these decisions define the quality and implications of the evidence, and syntheses of it, available to patients, public and policy makers to help them make informed decisions. My initial scoping work, was to design and conduct a survey across an influential international systematic review organisation (Cochrane Collaboration ) on how they set priorities for their reviews. We identified 13 structured approaches to setting priorities. As part of the project, we developed an evaluation framework that demonstrated whether the priority setting processes meet the values and principles of the Cochrane Collaboration. Subsequently, we developed an equity lens for research priority setting exercises to inform the design of research priority setting processes to ensure that they consider the priorities of disadvantaged groups along with advantaged groups. We used the equity lens to do a second evaluation on the priority setting processes in the Cochrane Collaboration. Both evaluation frameworks demonstrated that the Cochrane Collaboration requires better designed priority setting approaches and must be more transparent in reporting those processes. The evaluation of research priority setting exercises in the Cochrane Collaboration, along with the wider literature, demonstrates that research priority setting exercises cannot be evaluated in isolation from organisational cultures, values and context. Therefore, the next step of the project focused on a specific stakeholder group (major research funders) with significant influence on research, including support for systematic reviews. We selected 11 national research agencies in the UK, Netherlands, France, Norway, Denmark, Germany, Australia, Canada, and the USA. We devised and used a checklist based on Chalmers and Glasziou’s “avoidable research waste” framework (and evaluated the processes and policies of these agencies using this checklist). As previous evaluations had demonstrated, this second evaluation found a lack of transparency in the process of setting priorities for research and other related organisational and policy issues. Increased funding is needed for methodological research to evaluate research practices and to monitor how funding research projects is done and reported. My evaluation of funding agencies and the Cochrane Collaboration found a similar lack of transparency and accountability in the context of conflicting values among stakeholders that decreases accountability and scrutiny of researchers and their institutions. However, the projects have led to organisational and policy changes in the two key stakeholder groups (the Cochrane Collaboration and selected funding agencies). Officials of national health research funding agencies have approached me to collaborate with them to address the issues raised by my work on reducing research waste. This led to the establishment of Funders Forum - the Ensuring Value in Research (EViR) Funders’ Collaboration and Development Forum - to enable agencies in various countries to exchange their experience in addressing issues and creating work groups to address them. The Forum is chaired by individuals from three major research funders: NIHR (UK), ZonMW (Netherlands) and Patient-Centered Outcomes Research Institute (PCORI; USA). The Forum organises several meetings to establish common principles, standards and work plans to achieve the common objective around reducing research waste and adding value for research for a national research funder.

The value to consider user needs throughout the development of medical devices has been acknowledged in the field of health technology assessment. Yet, user needs are narrowly conceptualised and are mainly examined from an ergonomic perspective. By focusing on the user-device interaction per se with a view to detect use errors and to create design solutions that promote intended use, the dominant approach to user needs research fails to adequately elaborate upon symbolic and practice-related dimensions in the user-technology relationship. Moreover, whilst the examination of user needs from a User standpoint is clearly required, it is also crucial to investigate how the medical device industry understands and addresses this issue, since it is these understandings that will eventually be projected onto the technology. The present research sought to provide a cross-actor account on the issue of user needs by examining the perspectives of two key stakeholders: the users and the medical device manufacturer. Using the example of home blood pressure (BP) monitoring, a qualitative programme of research explored, on the one hand, the process of integrating home blood pressure monitors (HBPMs) into daily life as well as the elements that are conducive to building trust in this technology, and on the other, the practices the medical device manufacturer adopts to capture its users and their needs. The results suggest that people engage with home BP monitoring in an effort to develop an experiential understanding of their health condition reproducing the dominant discourse around the benefits of self-care. Nevertheless, communicating this practice outside the home was not always without tension since concerns around the ascription of undesired identities were expressed. Home measurements were occasionally performed to check the dependability of technology – arguably an unintended device use – indicating the importance of establishing trust in the artefact. Building trust in HBPMs appeared to be a multifaceted phenomenon that was not limited to the perceived trustworthiness of the technology but implicated a network of other trustworthy relationships with humans, institutions and technologies. Medium-to-large medical device manufacturers appear to appreciate the value of a user needs-informed approach to medical device development employing a series of routes, more or less direct and formalised, to reach their user. The challenge for the industry is to synthesise the evidential base deriving from individual user studies to create a higher order knowledge base. The term ‘symbolic’ – also employed in the title of this thesis – signifies people’s representations, reasoning and meanings constructed around the use or production of home medical technology whilst the term ‘practical’ (or practice-related) refers to actions, activities, and routines pertaining to these two aspects.

Made available in DSpace on 2015-07-22T20:49:39Z (GMT). No. of bitstreams: 0 Previous issue date: 2011-02-22. Added 1 bitstream(s) on 2015-08-11T03:26:02Z : No. of bitstreams: 1 Publico-12515.pdf: 978359 bytes, checksum: 3be0798a82267f20204fe25244cbed7d (MD5) / Objetivo: Avaliar a evidência de eficácia e segurança do deferasirox para o tratamento da sobrecarga de ferro relacionada à betatalassemia, doença falciforme e síndrome mielodisplásica, em comparação a outros quelantes de ferro disponíveis no Brasil (desferroxamina e deferiprona). Método: Para síntese da evidência foi realizada busca por relatórios de agências de avaliação de tecnologias em saúde e por revisões sistemáticas no Medline (março 2009). Adicionalmente, foi feita busca por ensaios clínicos para atualização da informação disponível. Das referências identificadas, foi selecionado o trabalho de McLeod (2009), por ser uma revisão sistemática e estudo de avaliação econômica elaborado por uma agência de avaliação de tecnologias em saúde de alta confiabilidade. Considerando o contexto econômico local e a disponibilidade dos medicamentos e insumos laboratoriais, a evidência foi adaptada e avaliada criticamente. Resultados: A evidência encontrada é baseada em três ensaios clínicos, de baixa qualidade metodológica, que avaliaram o uso do deferasirox em relação à desferroxamina. Não foram localizados estudos comparativos entre o deferasirox e a deferiprona. Nos ensaios clínicos identificados, a concentração hepática de ferro (exame não disponível no Brasil) foi considerada como desfecho primário, apesar de na prática clínica a quantidade de ferro ser monitorada pela concentração de ferritina sérica. As mudanças na ferritina sérica revelam-se mais favoráveis em pacientes com betatalassemia e doença falciforme (maior prevalência no Brasil) que receberam desferroxamina, do que aqueles que receberam deferasirox. As informações econômicas levantadas indicam que o deferasirox, em comparação a desferroxamina pode ser uma opção custo-efetiva. Conclusões: Como o deferasirox foi introduzido recentemente no mercado brasileiro e é considerado alternativa de tratamento no sistema público de saúde, informações de farmacovigilância precisam ser monitoradas, principalmente no que se refere ao risco de insuficiência renal, citopenias (agranulocitose e trombocitopenia), além de distúrbios gastrointestinais, hepáticos, renais e sanguíneos. / Objectives: to evaluate the evidence on efficacy and safety regarding deferasirox for treatment of iron overload relating to beta-thalassemia, sickle cell disease and myelodysplastic syndrome, in comparison with other iron chelators available in Brazil (deferoxamine and deferiprone). Methods: to produce a synthesis of the evidence, a search was conducted using reports from HTA agencies and systematic reviews in Medline (March 2009). Additionally, a search for clinical trials was conducted to update the information available. Among the references identified, the study by McLeod (2009) was selected because this was a systematic review and economic evaluation produced by a highly trustworthy HTA agency. Considering the local economic context and the availability of medications and laboratory supplies, the evidence was adapted and critically evaluated. Results: the evidence found was based on three clinical trials of low methodological quality that evaluated the use of deferasirox in relation to deferoxamine. No comparative studies between deferasirox and deferiprone were found. In the clinical trials identified, hepatic iron concentration (a test unavailable in Brazil) was taken to be the primary outcome, although in clinical practice, the iron levels were monitored by means of the serum ferritin concentration. The changes in serum ferritin concentration were more favorable among patients with beta thalassemia and sickle cell disease (highest prevalence in Brazil) who received deferoxamine than among those who received deferasirox. Previous economic evaluation suggests that deferasirox may be a cost-effective strategy. Conclusions: since deferasirox was only recently introduced onto the Brazilian market and is considered to be an alternative for treatment within the public healthcare system, drug surveillance information is required, particularly regarding the risks of kidney failure, cytopenia (agranulocytosis and thrombocytopenia) and gastrointestinal, hepatic, renal and blood disorders. / TEDE / BV UNIFESP: Teses e dissertações