This study aims to evaluate the diffusion process of a solar-powered refrigerator system, by implementing a sustainable business model as an approach of assessing key features to facilitate the process. The aspiration of this study is to develop a business perspective that can be utilized by companies when aiming to diffuse sustainable enhancing innovations in developing countries with the aim of improving entrepreneurship.  The conclusion of this study is based on the alignment of a theoretical framework centered on a sustainable business model and the theory for diffusion of innovation, alongside empirical findings obtained during a case study in Linga Linga, Mozambique. Primary data was acquired through active observations and semi-structured interviews of both female fish entrepreneurs and two organizations with ties to Sweden, operating in Linga Linga.  Empirical findings reveled limited availability of new products in Linga Linga, obstructing the diffusion of innovations. Businesses struggles to diffuse innovations in developing countries because of insufficient knowledge of culture differences and the basic needs of the end user. Sustainable development is highlighted as crucial when operating in the Western word but stated as challenging to implement to the same extent in the developing world. The fulfillment of basic needs, rather than operating sustainable and the unfamiliarity with sustainable development as a concept, is found as the reason for the challenge of implementing sustainable development for individuals afflicted by poverty.  The alignment of the theoretical framework and the empirical findings in the discussion chapter underscores the benefits of implementing a sustainable business model. Furthermore, the discussion emphasizes the importance of extending the model with knowledge as an additional key feature to comprehensively understand the end users and their basic need in the developing world.   This study concludes that utilizing a sustainable business model to assess key features is crucial for facilitating diffusion of innovations, with a particular focus on understanding end user´s basic needs. The study emphasizes the significance of circular economy as a key feature in ensuring durable and reliable products and highlights the importance of comprehensive value chain assessments. Empirical finding concluded that providing solar-powered refrigerator system for the female fish entrepreneurs in Linga Linga could potentially expand their business opportunities, ensuring an increased disposable income, and reduce workload.

Transportations role in society is increasingly important and today it has a prominent role in business, citizens lives as well as in the world economy. The increasing globalization and urbanization puts significant pressure on the existing transport system, with increasing demand for high-speed travel. However, this comes with implications on the environment, and the environmental concerns constitutes one of the biggest pressures in transport. And as the contemporary modes are bound by their technologies, enabling marginal rather than radical improvements, a possible window of opportunity for new radical technologies to enter the market can emerge. One new technology emerging within transportation today is called hyperloop, a technology that could prove to meet demand for faster, cheaper, safer and more environmentally efficient transportation. However, the technology is still in an early stage of development and hence surrounded by major uncertainties. Further, the nature of the technology necessitates overcoming several obstacles before it can reach commercial practice. And this together with a limited knowledge of the concept in Sweden makes it difficult to predict if hyperloop can become a viable transport alternative on the Swedish market. Which condensed lays the foundation to the purpose of this paper: "To give an overarching understanding of the Swedish transport market dynamics, together with a comprehensive evaluation of the hyperloop concept. And hence contribute to more inclusive knowledge and understanding of hyperloop’s viability in the Swedish context." Since the phenomenon has not been comprehensively studied previously, the elected research design is that of an exploratory case study, with an inductive, qualitative approach. To address the purpose, a literary review of the theoretical field was conducted. Looking in to previous research on disruptive innovation, diffusion of innovations, technical transitions, transformational pressure as well as window of opportunity. The empirical material gathered during the research process was derived from two main channels. Firstly, an extensive review of scientific articles about the hyperloop technology was conducted, providing insights on the technology and its surroundings. This was complemented by qualitative interviews to obtain material on the dynamics of the Swedish transport market as well as for understanding hyperloop in the Swedish context. The empirical study was further accompanied by a review of news articles and websites to map the most recent progress in the hyperloop development. By analyzing the empirical material through three frameworks; Characteristics of Diffusion, the Multi-Level Perspective (MLP) and Technology Readiness Level (TRL), interesting findings and conclusions were drawn. These together points towards that hyperloop, if the technology reaches its predicted performance, will have significant relative advantages and observable effects in the relation to the contemporary modes of transportation. Further, a noticeable window of opportunity, sprung from capacity shortages and pressure towards environmental sustainability, seems to exist on the Swedish market. A window which could be capitalized upon and justify hyperloop in the Swedish context. The current state of the technology does however come with implications as it so far is insufficient to decrease uncertainty amongst the potential adopters. Factors that likely will prolong the adoption of the technology in Sweden relates to the relative complexity of the system, its limited compatibility with existing practices and the low maturity of the technology. Hence, the hyperloop companies must prove the concept feasible and increase the maturity to gain sufficient acceptance and recognition. This paper contributes to the academic community by assessing the compatibility of hyperloop on the Swedish market, as well as if hyperloop could become a viable alternative transport solution in Sweden. It provides insight to specific perspectives of the Swedish market, its requirements and the demand for alternative transport solutions. Hence, this paper is considered to make both an analytical contribution in terms of evaluating the viability of disruptive technologies. And an empirical contribution by shedding light on new important insights for the potential diffusion of hyperloop. Insights that are significant for hyperloop actors as well as for dominant actors on the Swedish transport market. / Transporters roll i samhället blir allt viktigare och de har idag en framträdande roll inom näringsliv, medborgares liv samt världsekonomin. Den ökande globaliseringen och urbaniseringen sätter dock ett betydande tryck på det existerande transportsystemet, med ökande efterfrågan för höghastighetsalternativ. Detta medför implikationer för miljön, och oron kring transporters miljöpåverkan är ett av de största bekymren för transportsektorn. Eftersom de existerande transportalternativen är bundna av sin teknik, vilket begränsar dem till inkrementella snarare än radikala förbättringar, kan en möjlighet för nya transportsätt att komma in på marknaden öppna sig. En kommande ny teknik som utvecklas inom transport idag kallas hyperloop, en teknik som kan visa sig möta efterfrågan för snabbare, billigare, säkrare och mer miljösmarta transporter. Tekniken är dock i ett tidigt utvecklingsskede och är därav omgärdad av stora osäkerheter. Vidare kräver teknikens natur att flertalet hinder kommer att behöva överkommas innan tekniken kan nå kommersiellt bruk. Detta tillsammans med den begränsade kunskap som finns kring konceptet i Sverige gör det svårt att förutspå om hyperloop kan bli ett möjligt transportalternativ på den svenska marknaden. Kondenserat ligger detta till grund för syftet med den här uppsatsen: "Att ge en övergripande förståelse av dynamiken på den svenska transportmarknaden, tillsammans med en djupgående utvärdering av hyperloop konceptet. Och därav bidra till en mer inkluderande kunskap och förståelse kring hyperloops möjligheter i den svenska kontexten." Eftersom detta fenomen inte tidigare har studerats i större utsträckning valdes en forskningsdesign i form av en undersökande fallstudie med ett induktivt, kvalitativt tillvägagångssätt. För att adressera syftet gjordes en litterär översyn av det teoretiska fältet. Med inblickar i tidigare forskning kring disruptiv teknik, diffusion av innovation, tekniska övergångar, transformationstryck samt möjlighetsfönster. Det empiriska materialet till studien samlades in genom två kanaler i huvudsak. Först, genom en djupdykning i tidigare forskning och vetenskapliga artiklar relaterade till hyperlooptekniken, för att generera insikter kring tekniken och dess omgivning. Detta kompletteras med kvalitativa intervjuer för att erhålla material om dynamiken på den svenska transportmarknaden samt för att ge en förståelse av hyperloop i den svenska kontexten. Den empiriska studien kompletterades ytterligare med en översyn av nyhetsartiklar och webbplatser för att kartlägga de senaste framstegen i hyperlooputvecklingen. Genom att analysera det empiriska materialet med hjälp av tre ramverk; Egenskaper för Spridning av Innovation, Perspektiv i Multipla Nivåer (MLP) och Teknisk Mogenhetsnivå (TRL), kunde flertalet intressanta upptäckter och slutsatser dras. Vilka tillsammans pekar mot att hyperloop, om tekniken lyckas uppnå den predikterade prestandan, kommer att ha betydande relativa fördelar och synliga effekter i förhållande till dagens transportsätt. Vidare kan ett märkbart möjlighetsfönster, sprunget ur kapacitetsbrist och tryck mot miljömässig hållbarhet, identifieras på den svenska marknaden. Detta fönster skulle kunna kapitaliseras på och motivera hyperloop i den svenska kontexten. Teknologins nuvarande tillstånd har emellertid konsekvenser, eftersom den hittills inte är tillräcklig för att minska osäkerheten hos potentiella adopterare. Faktorer som sannolikt kommer att förlänga processen att adoptera tekniken i Sverige härstammar från systemets relativa komplexitet, dess begränsade kompatibilitet med befintliga metoder samt teknikens låga mogenhet. Därav är det essentiellt för hyperloopbolagen att bevisa konceptet möjligt och öka mogenheten för att få tillräcklig acceptans och erkännande. Detta arbete bidrar till det akademiska samhället genom att bedöma kompatibiliteten mellan hyperloop och den svenska marknaden, samt om hyperloop kan bli ett genomförbart transportalternativ i Sverige. Arbetet bidrar med insikter i specifika perspektiv på den svenska marknaden, dess krav samt efterfrågan för alternativa transportlösningar. Därav kan denna uppsats anses utgöra både ett analytiskt bidrag genom dess utvärdering av genomförbarheten av disruptiv teknik. Samt ett empiriskt bidrag genom att belysa viktiga insikter för den potentiella spridningen av hyperloop. Insikter som är viktiga för såväl hyperloopaktörer som de dominanta aktörerna på den svenska transportmarknaden.

As new teaching and learning technologies begin to challenge the boundaries between time and place, distance and elearning are becoming mainstream approaches to increase access and improve quality in post-secondary education. Educators and educational managers are being challenged by the need to manage technology integration within institutions and within education systems. In 2007, the Government of Botswana established a new technical college with the specific mandate to expand technical and vocational education and training (TVET) provision by introducing distance and elearning programme delivery. This thesis reports on the findings of a case study undertaken during the first two years of the life of the college. The study aimed to identify the organisational structures and change processes needed for the successful implementation of distance and elearning and to discover how these structures and processes can be best managed. The field work was carried out within an interpretive paradigm in a longitudinal case study over 30 months. The approach was ethnographic and the data collection methods included documentary analysis and participant observation. Focussed interviews were carried out with a purposive sample of key respondents in order to further explore observations. Different theoretical and practical models of technology integration were investigated and the MIT 90s model was considered to be the most applicable and pragmatic. Theories of organisational change were researched to help understand the process. Lewin’s seminal work on field theory, group dynamics and the 3-step change model with the notion of driving and restraining forces on change gave a framework against which to analyse the process of change. The findings detail a change process which features a lack of preparation, perceived lack of management commitment by staff and poor timing in a top down approach to introducing distance and flexible learning. The findings show how an external group of change agents working as technical experts within clearly defined policy objectives and facilitating extensive staff development, were an insufficient driving force for change against the restraining forces of a bureaucratic organisational culture, strong mental models of traditional teaching and perceived lack of leadership. / Sociology / D. Litt. et Phil. (Sociology)

Introdução: Amplo debate tem associado a incorporação de novas tecnologias para a saúde com os custos crescentes dos sistemas de saúde. Face à dúvidas \"se as novas tecnologias são parte do problema, parte da solução ou as duas coisas\" relativamente à saúde da população e do sistema de saúde, este estudo de caso analisa a incorporação de três inovações no Instituto do Coração, InCor-HC/FMUSP, visando elaborar quais fatores influenciaram a decisão de adoção e exemplificar as metodologias de avaliação de novo medicamento, de procedimento diagnóstico e intervenção cirúrgica. A avaliação das tecnologias para a saúde, ATS, pode auxiliar a constituir algumas propostas de respostas. Metodologia: estudo qualitativo empírico em caso retrospectivo de incorporação de três inovações para assistência de alta complexidade em cardiologia. As metodologias utilizadas consistiram em entrevistas aos tomadores de decisão, revisões sistemáticas da literatura relevante, descritiva ou meta-analítica, e análise de impacto econômico hospitalar. Resultados: O padrão do InCor para a incorporação das inovações funciona como um sistema social criativo, sob uma estratégia prática pluralista, ou seja, utilizam as pesquisas, aprovadas pela Comissão de Ética e Pesquisa do InCor e do HC, que se sucederam e que sucedem em incrementos, verificando e ajustando as informações segundo os resultados obtidos para desenhar novas pesquisas. Os atores construíram conhecimentos e negociaram protocolos de pesquisa, promoveram a capacitação de super-especialistas técnicos, transferindo práticas internacionais e gerando conhecimentos adaptados à realidade do Brasil. A avaliação do medicamento tacrolimus demonstra que se poderia resgatar uma média de 75% das rejeições refratárias às terapias convencionais, proporcionando um custo hospitalar de R$ R$ 102,99 por dia de sobrevida nos 8 adultos e R$ 137,53 nas 13 crianças observadas, comparativamente à R$ 229,00 e R$ 260,00, com ciclosporina, respectivamente. Assim, se evitaria 37% da mortalidade associada à episódios de rejeição nos pacientes com transplante cardíaco e, mesmo no único óbito, o custo hospitalar por dia de sobrevida foi de metade que o custo dos períodos observados nos 32 pacientes sob ciclosporina que foram a óbito. O diagnóstico por angiotomocoronariografia em pacientes com angina atípica e risco moderado permitiria orientar o manejo de até dois terços destes casos evitandose coronariografias invasivas. Isto permitiria aumentar a resolutividade do Departamento de Hemodinâmica de 25% para mais 20% dos casos assim estudados, com economias para o InCor, aumento do acesso e resolutividade, podendo evitar até 2.000 mortes, e com o acréscimo estimado de <10% do valor destas 14% mais angioplastias e 6% mais revascularizações cirúrgicas para o SUS. A ablação cirúrgica tem o potencial de curar >10% das fibrilações atriais refratárias a medicamentos em pacientes com indicação de cirurgia aberta para correção de problemas cardíacos estruturais, evitando morbidade e mortalidade em até 1.000 pacientes por ano, se houver suposição que esta seja utilizada apenas com as cirurgias valvares no âmbito do SUS. Conclusões e discussão: As novas tecnologias estudadas proporcionam benefícios à saúde, mas ainda possuem variados graus de incerteza sobre aspectos de segurança e sobre seu potencial de impacto econômico para os programas assistenciais para o InCor e para o SUS. O InCor e os demais hospitais universitários possuem alta capacidade técnica instalada, onde a estruturação de pesquisas facilita e permite a incorporação de inovações de alta complexidade, sem contudo haver planejamento econômico para os programas de assistência à saúde. O isolamento destes atores, em relação às instâncias gestoras do SUS, permite construções sob visões parciais e imediatistas, permite desenvolvimento de interesses externos e diversos, e, por outro lado, pressiona de maneira desordenada a organização e o sistema de saúde. A integração da capacidade profissional, instalada nos hospitais universitários, dentro do circuito de planejamento de médio e longo prazo para o SUS, avaliando as tecnologias inovadoras comparativamente às estabelecidas para a saúde, com base na epidemiologia local observada, pode permitir uma atualização planejada e contínua dos serviços de saúde, construída sobre bases sólidas de conhecimento científico adaptado à nossa realidade e com o responsável equilíbrio orçamentário. / Introduction: There is an ongoing international debate associating the increasing health care costs with adoption of new health technologies. To aid to ascertain whether new health technologies are part of the problem, part of the solution or both in relation to the health of the population and of the health care system, this case study analyses retrospectively three recent decisions to adopt innovations at the Heart Institute, InCor-HC/FMUSP. In order to provide examples of the application of methods for health technologies assessment, the InCor Board of Directors indicated one innovative drug, a new diagnostic procedure and a recent surgery. Methods: Qualitative, retrospective field evaluation of the three decisions for the highest complexity of care in cardiology. Decision-makers survey, systematic reviews (descriptive or meta-analytic) and hospital economic impact analysis were the methodologies applied to this case. Results: A pattern of new technologies incorporation through incremental research, a strategic and pluralist practice emerged within a creative social system. Approved by the InCor and HC Research Ethics Boards and based on previous research results, successive investigations verified and adjusted the informations and generated additional research. Thus, the decision-makers do build knowledge, negotiate research protocols, promote very technical specialists formation and transfer international practice, inter- and up-grading it to the Brazilian reality. Evaluation of these three innovative technologies results are: - The drug tacrolimus may rescue and resolve an average of 75% of the episodes of rejection refractory to conventional medications. The average hospital cost observed (since conversion from CSA, censored at March the 30th, 2006) was of US$45 or R$102.99 per day of survival in 8 adults and of US$61 or R$137.53 for the 13 children (<18 years of age), compared with R$ 229.00 and R$ 260.00, respectively, in those who remained under cyclosporine treatment. Thus, it could prevent 37% rejection related mortality and bring some economy (even in the single child death observed, the hospital cost per day until death was the half of the cost observed for the 32 cyclosporine treated). - The tomoangiocoronariography diagnosis for patients presenting atypical angina and moderate to low risk of stenosis may orient and modify up to 66% clinical decisions preventing requirement of an invasive procedure. This would increase 20% to the Haemodynamic Department 25% resolutivity, may prevent up to 2000 deaths with an estimated additional 10% of the costs of 14% more angioplasties and 6% increase in surgical coronary bypasses for the health care system. - Surgical ablation has the potential to cure more than 10% of medications refractory atrial fibrillation in patients undergoing open heart surgery for structural corrections. Supposing it is restricted only to the group of patients undergoing valve surgery in the health care system, it could prevent morbidity and mortality for up to 1000 patients. Conclusions and discussion: The new technologies evaluated bring benefits to the health of the patients. Safety concerns and economic impact for the InCor and for the health care system assistance programs require further investigation. InCor and the other university hospitals have enhanced technical capacity installed. The structured research facilitates and allows incorporation of highly complex innovations without planning future programs for care. The isolation of these decision makers from the health care system decision planners allows partial views and immediacies. Such a distance facilitates development of external and diverse interests. These facts, consequently, pressures on the organization and the health care system. The integration of the university hospitals installed professional capacities, within an average and long term health care system plans, making evaluations of the innovative health technologies in comparison with the established ones based on local epidemiology, may permit a planned and continuous actualization of the health services on solid scientific basis adapted to the Brazilian reality and with a responsible financial balance.

本研究架構以Wixom & Todd(2005)提出的使用者滿意與科技接受整合模式為基礎，以資訊系統成功模式中「系統品質」、「資訊品質」、「服務品質」構面以及Roger(1995)提出的創新擴散中「相對好處」、「相容性」作為研究架構的探討構面，針對雲端遊戲平台的使用者進行實證研究，探討使用者參與雲端遊戲平台之影響因素。 研究中，得知資訊系統成功模式「系統品質」、「資訊品質」、「服務品質」與「資訊系統滿意度」存在正向影響關係，創新擴散「相對好處」、「相容性」也與「資訊系統滿意度」呈現正向的影響關係；而資訊系統成功模式「資訊系統滿意度」與科技接受模式的「知覺有用性」、「知覺易用性」確實有著密切關連；另外，研究發現創新擴散構面對於「知覺有用性」存在影響關係，但對於「知覺易用性」證實不存在顯著的影響關係，而科技接受模式「知覺有用性」、「知覺易用性」、「態度」、「使用意圖」彼此皆存在影響關係。 / This study bases its structure on Theoretical Integration of User Satisfaction and Technology Acceptance Wixom & Todd (2005) proposed, in which “System Quality”, “Information Quality”, “Service Quality” dimensions in Information System Success Model, and “Relatively Advantage” & “Compatibility” in Innovation Diffusion that Roger (1995) proposed constitute discussion dimension. For discussing factors that influence users to take part in cloud gaming platform, the empirical research targets at those users. From the research, we found “System Quality”, “Information Quality”, “Service Quality” and “IS Satisfaction” in Information System Success Model have positive correlation, and “Relatively Advantage” & “Compatibility” and “IS Satisfaction” present a positive correlation as well while “IS Satisfaction” in Information System Success Model and “Perceived Usefulness”, “Perceived Ease of Use” in Technology Acceptance Model are closely related; besides, this study discovered Innovation Diffusion dimension has effect on “Perceived Usefulness”, but doesn’t have significant effect on “Perceived Ease of Use” while “Perceived Usefulness”, “Perceived Ease of Use”, “Attitude” and “Intention to Use” in Technology Acceptance Model are related.

As new teaching and learning technologies begin to challenge the boundaries between time and place, distance and elearning are becoming mainstream approaches to increase access and improve quality in post-secondary education. Educators and educational managers are being challenged by the need to manage technology integration within institutions and within education systems. In 2007, the Government of Botswana established a new technical college with the specific mandate to expand technical and vocational education and training (TVET) provision by introducing distance and elearning programme delivery. This thesis reports on the findings of a case study undertaken during the first two years of the life of the college. The study aimed to identify the organisational structures and change processes needed for the successful implementation of distance and elearning and to discover how these structures and processes can be best managed. The field work was carried out within an interpretive paradigm in a longitudinal case study over 30 months. The approach was ethnographic and the data collection methods included documentary analysis and participant observation. Focussed interviews were carried out with a purposive sample of key respondents in order to further explore observations. Different theoretical and practical models of technology integration were investigated and the MIT 90s model was considered to be the most applicable and pragmatic. Theories of organisational change were researched to help understand the process. Lewin’s seminal work on field theory, group dynamics and the 3-step change model with the notion of driving and restraining forces on change gave a framework against which to analyse the process of change. The findings detail a change process which features a lack of preparation, perceived lack of management commitment by staff and poor timing in a top down approach to introducing distance and flexible learning. The findings show how an external group of change agents working as technical experts within clearly defined policy objectives and facilitating extensive staff development, were an insufficient driving force for change against the restraining forces of a bureaucratic organisational culture, strong mental models of traditional teaching and perceived lack of leadership. / Sociology / D. Litt. et Phil. (Sociology)

Thesis submitted in fulfilment of the requirements for the degree Master of Technology: in Information Technology in the Faculty of Informatics and Design at the Cape Peninsula University of Technology Supervisor: Dr Ephias Ruhode Cape Town campus December 2013 / The use of ICTs such as computers, electronic databases and other technologies have been in use for a number of years within the public sector to organise, manage and disseminate information to the public as well as to facilitate day-to-day communication in government offices. In this context, the value of the use of ICTs has been to assist and streamline government operations. The technological development in South Africa has opened up the possibilities of the use of ICTs in the democratic and governance process. E-democracy has been defined as a tool for abandoning the representative system for one with more direct citizen engagement. This study sets out to explore the challenges of the current electoral process, and also determine the factors that could influence the adoption and diffusion of e-voting technologies within the South African context. Literature has shown that countries such as Brazil and India have successfully implemented electronic voting systems and other countries are at various piloting stages to address many challenges and problems associated with manual paper based system such as costs of physical ballot paper and other overheads, electoral delays, distribution of electoral materials, and general lack of confidence in the electoral process. It is in this context that the study also seeks to determine whether the South African electoral management body can leverage on the opportunities that e-voting presents. However, with all the benefits that e-voting presents, there are countries such Germany, the Netherlands etc. that have tried and tested e-voting systems and decided to abandon these system to go back to the manual paper ballot voting systems because of various reasons ranging from cost, security and verifiability. This research is exploratory in nature and adopts qualitative research approach and it is within the interpretivism paradigm. Survey and interview strategies were used to collect data. A purposive sampling method was used to select the participants for the survey. To gain an understanding of the views of voters and electoral management body (IEC) about the current electoral process and e-voting technologies, literature was explored, a questionnaire was distributed online to voters and an in-depth semi-structured interview was conducted with the IEC. The study targeted voters who had access to the internet since the survey questionnaire was distributed online. The analysis is based on thematic analysis and diffusion of innovation (DoI) theory was also used to provide an analytical framework for the study. Through this framework the aims and objectives of the study were conceptualized around three constructs from the theory (relative advantage, compatibility and complexity). The findings of the study revealed that the three constructs from the DoI framework are important factors that may influence the adoption process of e-voting technologies. The findings also revealed other factors such as availability of ICT enable infrastructure and resources, digital divide, trust in technology, awareness of the technology and environment could that also influence the adoption process. The contributions of this research are anticipated to be a better understanding of the adoption of e-voting technologies in South Africa. For the electoral management bodies, the contribution of this research is that the research to some extent portrays factors that could influence the adoption of e-voting technologies in South Africa. Therefore, findings such as availability of ICT infrastructure and accessibility of these infrastructures should be taken into consideration before introducing e-voting technologies. Keywords: DoI (diffusion of Innovation), e-voting (electronic voting) technologies, E-governance, e-participation.

Introdução: Amplo debate tem associado a incorporação de novas tecnologias para a saúde com os custos crescentes dos sistemas de saúde. Face à dúvidas \"se as novas tecnologias são parte do problema, parte da solução ou as duas coisas\" relativamente à saúde da população e do sistema de saúde, este estudo de caso analisa a incorporação de três inovações no Instituto do Coração, InCor-HC/FMUSP, visando elaborar quais fatores influenciaram a decisão de adoção e exemplificar as metodologias de avaliação de novo medicamento, de procedimento diagnóstico e intervenção cirúrgica. A avaliação das tecnologias para a saúde, ATS, pode auxiliar a constituir algumas propostas de respostas. Metodologia: estudo qualitativo empírico em caso retrospectivo de incorporação de três inovações para assistência de alta complexidade em cardiologia. As metodologias utilizadas consistiram em entrevistas aos tomadores de decisão, revisões sistemáticas da literatura relevante, descritiva ou meta-analítica, e análise de impacto econômico hospitalar. Resultados: O padrão do InCor para a incorporação das inovações funciona como um sistema social criativo, sob uma estratégia prática pluralista, ou seja, utilizam as pesquisas, aprovadas pela Comissão de Ética e Pesquisa do InCor e do HC, que se sucederam e que sucedem em incrementos, verificando e ajustando as informações segundo os resultados obtidos para desenhar novas pesquisas. Os atores construíram conhecimentos e negociaram protocolos de pesquisa, promoveram a capacitação de super-especialistas técnicos, transferindo práticas internacionais e gerando conhecimentos adaptados à realidade do Brasil. A avaliação do medicamento tacrolimus demonstra que se poderia resgatar uma média de 75% das rejeições refratárias às terapias convencionais, proporcionando um custo hospitalar de R$ R$ 102,99 por dia de sobrevida nos 8 adultos e R$ 137,53 nas 13 crianças observadas, comparativamente à R$ 229,00 e R$ 260,00, com ciclosporina, respectivamente. Assim, se evitaria 37% da mortalidade associada à episódios de rejeição nos pacientes com transplante cardíaco e, mesmo no único óbito, o custo hospitalar por dia de sobrevida foi de metade que o custo dos períodos observados nos 32 pacientes sob ciclosporina que foram a óbito. O diagnóstico por angiotomocoronariografia em pacientes com angina atípica e risco moderado permitiria orientar o manejo de até dois terços destes casos evitandose coronariografias invasivas. Isto permitiria aumentar a resolutividade do Departamento de Hemodinâmica de 25% para mais 20% dos casos assim estudados, com economias para o InCor, aumento do acesso e resolutividade, podendo evitar até 2.000 mortes, e com o acréscimo estimado de <10% do valor destas 14% mais angioplastias e 6% mais revascularizações cirúrgicas para o SUS. A ablação cirúrgica tem o potencial de curar >10% das fibrilações atriais refratárias a medicamentos em pacientes com indicação de cirurgia aberta para correção de problemas cardíacos estruturais, evitando morbidade e mortalidade em até 1.000 pacientes por ano, se houver suposição que esta seja utilizada apenas com as cirurgias valvares no âmbito do SUS. Conclusões e discussão: As novas tecnologias estudadas proporcionam benefícios à saúde, mas ainda possuem variados graus de incerteza sobre aspectos de segurança e sobre seu potencial de impacto econômico para os programas assistenciais para o InCor e para o SUS. O InCor e os demais hospitais universitários possuem alta capacidade técnica instalada, onde a estruturação de pesquisas facilita e permite a incorporação de inovações de alta complexidade, sem contudo haver planejamento econômico para os programas de assistência à saúde. O isolamento destes atores, em relação às instâncias gestoras do SUS, permite construções sob visões parciais e imediatistas, permite desenvolvimento de interesses externos e diversos, e, por outro lado, pressiona de maneira desordenada a organização e o sistema de saúde. A integração da capacidade profissional, instalada nos hospitais universitários, dentro do circuito de planejamento de médio e longo prazo para o SUS, avaliando as tecnologias inovadoras comparativamente às estabelecidas para a saúde, com base na epidemiologia local observada, pode permitir uma atualização planejada e contínua dos serviços de saúde, construída sobre bases sólidas de conhecimento científico adaptado à nossa realidade e com o responsável equilíbrio orçamentário. / Introduction: There is an ongoing international debate associating the increasing health care costs with adoption of new health technologies. To aid to ascertain whether new health technologies are part of the problem, part of the solution or both in relation to the health of the population and of the health care system, this case study analyses retrospectively three recent decisions to adopt innovations at the Heart Institute, InCor-HC/FMUSP. In order to provide examples of the application of methods for health technologies assessment, the InCor Board of Directors indicated one innovative drug, a new diagnostic procedure and a recent surgery. Methods: Qualitative, retrospective field evaluation of the three decisions for the highest complexity of care in cardiology. Decision-makers survey, systematic reviews (descriptive or meta-analytic) and hospital economic impact analysis were the methodologies applied to this case. Results: A pattern of new technologies incorporation through incremental research, a strategic and pluralist practice emerged within a creative social system. Approved by the InCor and HC Research Ethics Boards and based on previous research results, successive investigations verified and adjusted the informations and generated additional research. Thus, the decision-makers do build knowledge, negotiate research protocols, promote very technical specialists formation and transfer international practice, inter- and up-grading it to the Brazilian reality. Evaluation of these three innovative technologies results are: - The drug tacrolimus may rescue and resolve an average of 75% of the episodes of rejection refractory to conventional medications. The average hospital cost observed (since conversion from CSA, censored at March the 30th, 2006) was of US$45 or R$102.99 per day of survival in 8 adults and of US$61 or R$137.53 for the 13 children (<18 years of age), compared with R$ 229.00 and R$ 260.00, respectively, in those who remained under cyclosporine treatment. Thus, it could prevent 37% rejection related mortality and bring some economy (even in the single child death observed, the hospital cost per day until death was the half of the cost observed for the 32 cyclosporine treated). - The tomoangiocoronariography diagnosis for patients presenting atypical angina and moderate to low risk of stenosis may orient and modify up to 66% clinical decisions preventing requirement of an invasive procedure. This would increase 20% to the Haemodynamic Department 25% resolutivity, may prevent up to 2000 deaths with an estimated additional 10% of the costs of 14% more angioplasties and 6% increase in surgical coronary bypasses for the health care system. - Surgical ablation has the potential to cure more than 10% of medications refractory atrial fibrillation in patients undergoing open heart surgery for structural corrections. Supposing it is restricted only to the group of patients undergoing valve surgery in the health care system, it could prevent morbidity and mortality for up to 1000 patients. Conclusions and discussion: The new technologies evaluated bring benefits to the health of the patients. Safety concerns and economic impact for the InCor and for the health care system assistance programs require further investigation. InCor and the other university hospitals have enhanced technical capacity installed. The structured research facilitates and allows incorporation of highly complex innovations without planning future programs for care. The isolation of these decision makers from the health care system decision planners allows partial views and immediacies. Such a distance facilitates development of external and diverse interests. These facts, consequently, pressures on the organization and the health care system. The integration of the university hospitals installed professional capacities, within an average and long term health care system plans, making evaluations of the innovative health technologies in comparison with the established ones based on local epidemiology, may permit a planned and continuous actualization of the health services on solid scientific basis adapted to the Brazilian reality and with a responsible financial balance.

This study aims to understand and assess the diffusion and adoption of RES forenhanced societal wellbeing in developing countries. Furthermore, the purpose is tocontribute to a deeper understanding of the drivers and barriers (D&amp;B) to the diffusionand adoption of RES among smallholders in rural Tanzania. The study onlyinvestigated solar energy lamps and not all products within the scope of RE. This wasto draw a more accurate and relevant conclusion from the empirical study. The study took place in Handeni, Tanzania, from March to May 2022. The primarydata for the study was collected through observations and twenty semi-structuredinterviews in four different villages in Handeni's Rural district. The data sets wereanalyzed through a thematic analysis to identify which D&amp;B the smallholders werefacing regarding the adoption of solar energy lamps. These D&amp;B were later furtheranalyzed with the help of the secondary data from literature studies, where theDiffusion of innovations theory and the Sustainable livelihoods approach were themain theories used. Barriers to adopting solar energy lamps were identified as; knowledge, trust, economy,and accessibility. Driving forces for wanting a solar energy lamp were; the reduced riskof health problems, reduced risk for accidents, portability, facilitating householdactivities, no variable costs, and the possibility to study and work at night. Otherfindings were the need for payment plans, charging on cloudy days, and batteriesthrown in nature. By connecting the drivers with elements from DOI, it was concluded that adoptiononly occurred in households where the driving forces were stronger than the barriers.Furthermore, an assessment of smallholders' wellbeing through the five capitals ofSLA discovered that financial, human, and physical capital were considered low in thestudied area. By bridging the gap between barriers and end-user, an increased diffusionand adoption of RES could occur, raising the capital assets identified as low. This risein the smallholders' low capital assets could push the transformation towardsustainability and enhance societal wellbeing in developing countries. The contribution from this study can hopefully be used for future research on howorganizations in practice can implement presented solutions. Furthermore, the study'sfindings can also provide guidelines on how the diffusion and adoption of RES can beincreased in rural areas of other developing countries. / Minor field studies

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