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PubMed1990

EPA's control technology approach to assisting states and regions with air toxics problems: five case studies.

The Environmental Protection Agency (EPA) announced in June 1985 a new strategy to reduce public exposure to toxic air pollutants in the ambient air. Over the next 5-8 years, the strategy called for State and Local authorities to take on more of the lead regulatory role, with the Agency providing technical and financial assistance to their efforts. The shift in emphasis and responsibility from the Federal level to State and Local air toxics programs and the need to transfer expertise from the Federal level to the appropriate State or Local level prompted EPA's Office of Research and Development (ORD) and EPA's Office of Air Quality Planning and Standards (OAQPS) to develop and implement an innovative technical assistance program. This program is called the Control Technology Center (CTC). It has since been expanded to include technical assistance in the area of control of air toxics, particulate matter, and volatile organic compounds (VOCs); emission measurements; and other areas where expertise is available to ORD and OAQPS. During the CTC's first year of operation, operating guidelines were developed and three categories of technical assistance were established. These categories are telephone HOTLINE calls, direct engineering assistance, and technical guidance projects. The CTC HOTLINE is a special telephone number which State and Local Agencies can call for easy access to EPA personnel who can provide prompt assistance in a variety of ways including discussions, references to pertinent literature, and referrals to other EPA personnel. In some cases, a HOTLINE call will require more in-depth engineering analysis indicating a need for direct engineering assistance. These projects tend to be short-term (2 to 3 months) and specific in nature. In some cases, several agencies may indicate a need for information on the same source, or a group of Agencies may make a joint request. In these cases, the CTC Steering Committee, a group who advises the CTC managers, may decide that a technical guidance project is indicated. Technical guidance projects are longer-term and are intended to be of broad interest, useful to many agencies. This paper discusses the development of the CTC, experience to date with its operation, and future plans. In addition, five CTC projects are discussed to illustrate the assistance provided.

Air Pollutants↗
PubMed2005

Building capacity for health promotion--a case study from China.

During the period 1997-2000 a technical assistance project to build capacity for community-based health promotion was implemented in seven cities and one province in China. The technical assistance project formed part of a much larger World Bank supported program to improve disease prevention capabilities in China, commonly known as Health VII. The technical assistance project was funded by the Australian Agency for International Development. It was designed to develop capacity within the Ministry of Health (MOH) and the cities and province in the management of community-based health promotion projects, as well as supporting institutional development and public health policy reform. There are some relatively unique features of this technical assistance which helped shape its implementation and impact. It sought to provide the Chinese MOH and the cities and province with an introduction to comprehensive health promotion strategies, in contrast to the more limited information, education and communication strategies. The project was provided on a continuing basis over 3 years through a single institution, rather than as a series of ad hoc consultancies by individuals. Teaching and learning processes were developmental, leading progressively to a greater degree of local Chinese input and management to ensure sustainability and maintenance of technical support for the project. Based on this experience, this paper presents a model for capacity building projects of this type. It describes the education, training and planning activities that were the key inputs to the project, as well as the limited available evidence on the impact of the project. It describes how the project evolved over time to meet the changing needs of the participants, specifically how the content of the project shifted from a risk-factor orientation to a settings-based focus, and the delivery of the project moved from an expert-led approach to a more participatory, problem based learning approach. In terms of impact, marked differences before and after the implementation of the training activities were identified in key areas for reform, in addition to the self reported positive change in knowledge, and a high level of participant satisfaction. Key lessons are summarized. Technical assistance projects of this kind benefit from continuity and a high level of coordination, the provision of culturally and linguistically appropriate teaching, and a clear understanding of the need to match workforce development with organizational/institutional development.

China↗
PubMed2002

Managing non-technical factors in healthcare IT projects.

The implementation of IT within any healthcare organization is a demanding and intense exercise in the management of both technical (systemic) and non-technical (social) influences and factors, and the project process is often fraught with unforeseen obstacles or impediments to success. Project success depends as much on a specific understanding of the non-technical project impediments such as conflicting personalities and corporate culture as it does on the performance of the applied technology or the viability of the implementation process itself.

Health Care Sector↗
PubMed2003

The VEPSY UPDATED Project: clinical rationale and technical approach.

More than 10 years ago, Tart (1990) described virtual reality (VR) as a technological model of consciousness offering intriguing possibilities for developing diagnostic, inductive, psychotherapeutic, and training techniques that can extend and supplement current ones. To exploit and understand this potential is the overall goal of the "Telemedicine and Portable Virtual Environment in Clinical Psychology"--VEPSY UPDATED--a European Community-funded research project (IST-2000-25323, www.cybertherapy.info). Particularly, its specific goal is the development of different PC-based virtual reality modules to be used in clinical assessment and treatment of social phobia, panic disorders, male sexual disorders, obesity, and eating disorders. The paper describes the clinical and technical rationale behind the clinical applications developed by the project. Moreover, the paper focuses its analysis on the possible role of VR in clinical psychology and how it can be used for therapeutic change.

Computer Simulation↗
PubMed2000

User acceptability--a critical success factor for picture archiving and communication system implementation.

The Department of Diagnostic Imaging at the Hospital for Sick Children (HSC), Toronto, implemented a picture archiving and communication system (PACS) during the last year. This report describes our experience from the point of view of user acceptability. Based on objective data, the following key success factors were identified: user involvement in PACS planning, training, technical support, and rollout of pilot projects. Although technical factors are critical and must be addressed, the main conclusion of our study is that other nontechnical factors need to be recognized and resolved. Recognition of the importance of these factors to user acceptance and clear communication and consultation will help reduce negative user attitudes and increase the chance of a successful PACS implementation.

Academic Medical Centers↗
PubMed1998

Private health insurance and veterans use of Veterans Affairs care. RATE Project Committee. Rate Alternative Technical Evaluation.

OBJECTIVES: This study examined the effect of private health insurance on the use of medical, surgical, psychiatric, and addiction services for patients eligible for publicly supported care. METHODS: The authors assembled administrative databases describing 350,000 noninstitutionalized veterans who had been discharged from a Veterans Affairs (VA) inpatient medicine or surgery bed section during a 1-year period. Patient use of care was followed for 1 year after the index discharge. Patient insurance information came from Medical Care Cost Recovery Billing and Collection files obtained separately from each of 162 VA Medical Centers. Distances between VA and non-VA sources of care were estimated from the Health Care Financing Administration's Hospital Distance File. RESULTS: Insured patients were less likely to seek surgical care but were 12 times (65 years of age and older) and 73 times (63 years of age and younger) more likely to initiate outpatient medical visits than were their counterparts, adjusted for patient demographic, diagnostic, and index facility characteristics. Patients who had private health insurance also were 3.4 (> or = 65) and 2.6 (< or = 64) times less likely to use VA surgical care in response to changes in available surgical staff-to-patient ratios than were their uninsured counterparts. CONCLUSIONS: Private health insurance may substitute (reduce) or complement (increase) the continued use of publicly supported health care services, depending on patient age, care setting, and service type.

Adult↗
PubMed1996

Selling high quality and low cost: market conditions and successful quality improvement projects.

Many potentially useful health care improvement projects fail to achieve much improvement. Even a technically excellent project can fail because, under certain conditions, economic factors in the health care market do not support high quality and low cost. Most health care markets evolve from the traditional fee for service market through a consolidation phase into risk shared market. At each phase, payment mechanisms will support specific quality and productivity improvement projects and discourage others. For example, the implementation of critical paths/clinical protocols is not supported until the majority of payers pay a fixed cost per illness or covered life. Prior to that point, loss of income for the hospital and/or physicians will inhibit successful implementation. Maximum quality and productivity improvements outcomes can be achieved with minimum efforts when project leaders understand the maturity of their organization's market, and strategic needs. This paper will review the types of payment systems (fee for service, discounted fee for service, and risk shared payments) and identify the types of projects that maximize benefit to the stakeholders involved.

Cost-Benefit Analysis↗
PubMed2005

[JICA Leprosy Control and Basic Health Services Project in Myanmar].

Japan International Cooperation Agency (JICA) implemented a 5-year long bilateral technical cooperation project, "Leprosy Control and Basic Health Services Project" in Myanmar. The project was implemented by National Leprosy Control Program, Department of Health with close technical collaboration of JICA experts mainly from International Medical Center of Japan (IMCJ) and National Sanatoriums of leprosy in Japan. It accelerated to achieve the elimination of leprosy at national level, which was declared in January 2003, and at sub-national level onward. It also developed the appropriate technologies for prevention of disability and prevention of worsening of disability (POD/POWD), which were introduced in 9 townships as a pilot service program. The Government stratified the POD/POWD services as a national program since 2005 by taking up the former pilot area to start with. The project also strengthened the function of referral system of leprosy control (Diagnosis and treatment), POD/POWD and physical rehabilitation. Beside leprosy, the project conducted a series of refresher trainings for primary health care givers, Basic Health Service Staff (BHS), of project areas (48 townships) to improve the services on tuberculosis, Malaria, Leprosy, Trachoma and HIV/AIDS for 3 years (2001-2003), which was evaluated in 2004. It contributed to improve the services at township level hospitals in procurement of audio-visual equipments and in conducting microscope training on leprosy, Malaria and tuberculosis at project areas.

Health Services↗
PubMed1995

[A technical evaluation of 5 brands of O2 concentrators. The Asturias Project].

To check the technical specifications of 5 O2 concentrators pertaining to 5 different brands: Mark 4, Zefir, Puritan-Bennet, Drager and MHF prototype. The concentrators worked continuously for 37 days. External filters were cleaned after 400 hours and measurements were taken when theoretical flows were between 1 and 3 l/min. One-way analysis of variance and Scheffe's method were used to compare the different brands. Flow measurements were taken with Costrema and Drager debitmeters. O2 concentrations were measured with Drager, Cepo and Oxidig oximeters. Emitted sound was measured with Cel, Spyri Ag Thun, Bruel Kjaer and General Radio meters. Electrical consumption was determined with a Siemens counter. All the concentrators produced flows that were under theoretical values, though the Zefir and MHF models came the closest. Accuracy and precision of flow varied from 1% to -32%, and from 1.1% to 11.7%, respectively. The value of 4 expressing linearity of flows oscillated between 0.959 and 0.991. When flow was 2 l/min or less, all achieved O2 concentrations greater than 90%, but this level was reached only by the Drager and MHF concentrators when flows were 3 l/min. With the exception of the MHF prototype, all the models emitted noise over 50 dB, the Drager machine being the noisiest. Electrical consumption was similar in all models. O2 concentrators can be recommended as sources of oxygen supply, but they have their limitations. Improvements must be made in accuracy of flow and monitoring of the apparatus ability to concentrate; noise must be reduced as well.

Analysis of Variance↗
PubMed1995

Stereo-videomicrography projection system for use at scientific meetings. A technical note.

A new stereoscopic projection system has been developed for simultaneous viewing of microsurgical procedures by hundreds of participants at neurosurgical meetings. The video images recorded from each eyepiece of an operating microscope were projected onto two wide screens, which were viewed by two converging eyes or by cross-sight. The system was simple and proved to be of great practical use although it yielded minor eyestrain and required some practice.

Equipment Design↗
PubMed1992

"Smoking doesn't work:" a smoking prevention project for women attending a technical institute.

Women attending technical institutes often enroll in training programs for occupations with traditionally high smoking rates. In contrast, more worksites are implementing smoke-free and restricted smoking policies. "Smoking Doesn't Work," a smoking prevention project targeted at young females enrolled in a technical institute in Minnesota, used employability as the central theme in schoolwide events and classroom activities. Project intervention resulted in statistically significant increases in knowledge and awareness of smoking and employability issues. While young women enrolled in the technical institute recognized the negative image and health effects of smoking, they were less aware of the relationship between smoking status and employability. A focus on employability appears to provide a salient approach to smoking prevention with technical institute students.

Adolescent↗
PubMed1996

A prodigious information systems failure.

The article reports a case study in the conception and implementation of a regional information systems project in a Regional Health Authority in England in the 1980s. The project was technically ambitious and involved far-reaching organizational changes throughout the region. The project failed, after considerable expenditure, because support in the region dwindled. With reference to the context of changing management practice in the National Health Service in the 1980s, the project is assessed in the light of its technocratic focus and its effects on the organization, including implicit changes in power relationships.

Equipment Failure↗