Technical Support Center Research Articles

Supporting evidence-based judicial decisions on health care in Brazil: an experience report

Objective: The main objective of this study is to report on the implementation and results of the “Supporting Health-Related Judicial Decisions in Brazil” project conducted at the Health Technology Assessment Center, Hospital Sírio-Libanês through the “Programa de Apoio ao Desenvolvimento Institucional do Sistema Único de Saúde”, in Brazil. Methods: This study is an experience report of a project conducted at the Health Technology Assessment Center, Hospital Sírio-Libanês. Results: The activities of the project occurred in 2023 and included two online training courses on primary studies and systematic reviews, 11 one-day workshops with technical-scientific content for members of the Technical Support Centers for the Judiciary (NATJus), 40 online technical-scientific consultations for magistrates on a digital platform, 11 technical-scientific reports addressing the most legally claimed technologies in Brazil; two methodological tools, a national forum (hybrid event), 10 chat-based mentorships for NATJus members; and the maintenance of an open-access blog, by publishing news on relevant topics on law and health. Discussion and conclusion: This project has contributed to the improvement of the judicial decision-making process by providing a range of activities aimed at aiding the prioritization of health technologies that are clearly effective and safe over those that are ineffective, harmful, or have uncertain effects. Submission: 04/09/24| Review: 06/29/24| Approval: 08/18/24

Use of supporting software tool for decision-making during low-probability severe accident management at nuclear power plants

In the project NARSIS – New Approach to Reactor Safety ImprovementS – possible advances in safety assessment of nuclear power plants (NPPs) were considered, which also included possible improvements in the field of management of low probability accident scenarios. As a part of it, a supporting software tool for making decisions under severe accident management was developed.
 The mentioned tool, named Severa, is a prototype demonstration-level decision supporting system, aimed for the use by the technical support center (TSC) while managing a severe accident, or for the training purposes. Severa interprets, stores and monitors key physical measurements during accident sequence progression. It assesses the current state of physical barriers: core, reactor coolant system, reactor pressure vessel and containment. The tool gives predictions regarding accident progression in the case that no action is taken by the TSC. It provides a list of possible recovery strategies and courses of action. The applicability and feasibility of possible action courses in the given situation are addressed. For each action course, Severa assesses consequences in terms of probability of the containment failure and estimated time window for failure. At the end, Severa evaluates and ranks the feasible actions, providing recommendations for the TSC. The verification and validation of Severa has been performed in the project and is also described in this paper. Although largely simplified in its current state, Severa successfully demonstrated its potential for supporting accident management and pointed toward the next steps needed with regard to further advancements in this field.

Remote Field Support by the Technical Assistance and Support Center

Remote Field Support by the Technical Assistance and Support Center

Multi-scale hydrological system-of-systems realized through WHOS: the brokering framework

ABSTRACT Global Change challenges are now systematically recognized and tackled in a growingly coordinated manner by intergovernmental organizations such as the United Nations. Heterogeneous observing networks provide the founded data sources to assess the Earth environmental status and take sound decisions to achieve a sustainable development. WMO Hydrological Observing System (WHOS) allows to discover and access historical and near real time hydrological observations. WHOS represents the hydrological contribution to the wider WIGOS-WIS system of WMO. It is a digital ecosystems framework contributed by a set of data providers and technical support centers. In this framework, three regional pilots were successfully completed. The WHOS architecture applies the services brokering style, implemented through the Discovery and Access Broker technology. A brokering approach makes a global system of systems possible and sustainable, where the different enterprise systems are enabled to interoperate, despite they implement heterogeneous communication interfaces and data models. In this manuscript, the WHOS brokering solution is detailed by recurring to the definition of a set of transversal viewpoints to describe the important aspects of the complex ecosystem –namely: enterprise, information, computational, engineering, and technological views. Finally, the three regional pilot ecosystems are described as successful cases of WHOS implementation.

Potential Impact of Reactor Core Damage on Severe Accident Management Actions in Vicinity of Spent Fuel Pool

Fukushima Daiichi NPP accident showed that plant technical support center (TSC) in an extreme and rare external event (design extended condition (DEC)) can have a problem in the case of coincident loss of decay heat removal from the core (possibly resulting in significant core damage) and loss of decay heat removal from spent fuel pool. From the point of view of prioritizing severe accident management strategies it looks like the priority mitigation action should be to reestablish the emergency core cooling in the reactor pressure vessel. The reason is the longer time window available before the water inventory in the spent fuel pool would be evaporated and spent fuel exposed to overheating. However, if such actions would not be successful and reactor core would, consequently, be damaged, potential design basis leakage (or even greater leakage) from the containment to the fuel handling building (FHB) can affect already established TSC measures or operator accessibility to FHB, or it can jeopardize functioning of the systems, structures and components due to radioactive releases and presence of hydrogen (independently of the fact that containment atmosphere can be inerted by steam or that containment may be equipped with passive autolytic recombiners (PARs)). Paper describes an engineering evaluation of possible hydrogen presence in the containment annulus, its flammability and leakages through the penetrations toward FHB in the case of long term station blackout (SBO) without successful restoration of the core cooling in the reactor pressure vessel. SBO accident sequence progression and amount of produced hydrogen is evaluated by MAAP code.

Identifikacija i ublažavanje poremećaja globalnih lanaca snabdevanja u uslovima neizvesnosti

Organizations face a number of decisions in designing their supply chains, which include the number, type and location of production facilities, distribution centers, retail facilities, service or technical support centers, supplier selection, supply chain information management and integration of all parts. into an efficient and effective system. Improper supply chain design can undermine an organization's strategy, lead to lower revenues, less competitiveness, market share and profits. As product lines and markets change or expand, the design or redesign of supply chains becomes an even more critical issue. The risks to which supply chains are exposed are different, and their functioning can be disrupted by a number of situations, which have had serious global consequences in the past. In addition to wars, nuclear accidents, cataclysmic earthquakes, volcanic eruptions, explosions, fires and tsunamis, epidemics of SARS, MERS, HIV, Ebola and Zika viruses, as well as the latest Covid-19 pandemic, have led to the knowledge that humanity is powerless in the face of such catastrophes. Regardless of the achievements in science, extensive and long-term medical research, epidemics (pandemics) have taken millions of lives and had negative effects on society as a whole, but also on the efficiency of business and supply chains. Past epidemics have attracted the attention of scientists and industry experts, resulting in the need to reengineer organizations and adjust supply chains to future challenges. In the context of the current pandemic, serious disturbances have been reported, so a large number of industries have had unprecedented consequences. Responses to such epidemics suggest that global supply chains need to be more integrated and digitally ready. Digitization of supply chains could improve the quality of responses to epidemic-related disorders by increasing their flexibility in such circumstances. This paper identifies the most important disruptions and measures to mitigate the consequences of these disruptions in global supply chains, as well as risk management in conditions of uncertainty.

Legal claims to obtain hip replacement surgery in the State of Rio de Janeiro, Brazil, 2016-2018

This study analyzed the court proceedings, health characteristics of the patients, and plaintiffs' characteristics in lawsuits for hip replacement surgery from public health services in the state of Rio de Janeiro, Brazil. The data employed was from the Technical Support Center for the Judiciary of the Rio de Janeiro Court of Justice (NAT-JUS) database, from January 2016 to December 2018. Data were analyzed according to tiers in the court system. There were 89 lawsuits filed for hip replacement surgery and most of them were tried in the Court of Justice of the State of Rio de Janeiro (TJRJ), with joint plaintiffs, represented by the Public Defender's Office. They had advance relief granted, and were ruled in favor of the plaintiffs, with no appeals filed. More than half of the cases were referred to NAT-JUS. The osteoarthritis group waited approximately seven months, while the emergency conditions group waited nearly two months from the date of filing to obtain the procedure. The lawsuits for hip replacement surgery showed similarities and differences in relation to other claims, object of others studies, which means that the strategies for their qualification. The study found that access to hip replacement surgery related to lawsuits in the Brazilian Unified National Health System (SUS) in the State of Rio de Janeiro is jeopardized, with the claims considered as an indicator of unmet needs.

Development of a decision-making support system for the technical support center based on analysis of human performance under severe accident situation

After the Fukushima accident, hardship of group decision making under severe accident situation is one of human factor issues emerged by Fukushima accident. After core damage, the responsibility for plant control is shifted from main control room (MCR) operators to technical support center (TSC) members who need to follow severe accident management guideline (SAMG). Decision making is necessarily required from this time to establish a suitable strategy because SAMG is not a procedure but it is a broad guideline so it cannot give a precise correct answer to TSC members for mitigating accident sequence like EOP.The developed DM support system can shorten the group DM time through a semi automatic algorithm. In addition, it is possible to gather the opinions of all members of TSC by excluding unnecessary obstructive human factors under uncertain situations like lack of information.

Moving from community-based to health centre-based management: impact on urban community health worker performance in Ethiopia.

Community health worker (CHW) performance is influenced by the way in which management arrangements are configured vis-a-vis the community and health services. While low-/middle-income contexts are changing, the literature provides few examples of country efforts to strategically modify management arrangements to support evolving CHW roles (e.g. chronic disease care) and operating environments (e.g. urbanization). This paper aims to understand the performance implications of changing from community-based to health centre-based management, on Ethiopia's Urban Health Extension Professionals (UHEPs), and the tensions/trade-offs associated with the respective arrangements. We conducted semi-structured interviews/focus groups to gather perspectives and preferences from those involved with the transition (13 managers/administrators, 5 facility-based health workers and 20 UHEPs). Using qualitative content analysis, we deductively coded data to four programme elements impacted by changed management arrangements and known to affect CHW performance (work scope; community legitimacy; supervision/oversight/ownership and facility linkages) and inductively identified tensions/trade-offs. Community-based management was associated with wider work scope, stronger ownership/regular monitoring, weak technical support and weak health centre linkages, with opposite patterns observed for health centre-led management. Practical trade-offs included: heavy UHEP involvement in political/administrative activities under Kebele-based management; resistance to working with UHEPs by facility-based workers and health centre capacity constraints in managing UHEPs. Whereas the Ministry of Health/UHEPs favoured the health centre-led management to capitalize on UHEPs' technical skills, Kebele officials were vested in managing UHEPs and argued for community interests over UHEPs' professional interests; health facility managers/administrators held divided opinions. Management arrangements influence the nature of CHW contributions towards the achievement of health, development and political goals. Decisions about appropriate management arrangements should align with the nature of CHW roles and consider implementation setting, including urbanization, political decentralization and relative capacity of managing institutions.

New safety strategies for nuclear power plants: A review

The Extensive Damage Mitigation Guideline (EDMG), which was developed by the U.S. Nuclear Energy Institute (NEI) owing to the motivation of 911 terrorist attacks and not allowed to spread before the Fukushima nuclear accident, was publicly available after Fukushima nuclear accident and paid attention to worldwide. Many countries have adopted the U.S. EDMG methodology and developed their strategies (some are not called EDMG but have similar functions), planning to introduce it into the emergency plans of their domestic nuclear power plants (NPPs). Based on the defense-in-depth (DID) concept of nuclear safety, the experience of the Fukushima nuclear accident, and the state-of-the-art of EDMGs research, this paper will give a comprehensive review of EDMG. To illustrate the reason for the introduction of EDMG into the traditional NPP procedures/guidelines, the review work started from the perspective of DID in nuclear safety and the reason for the Fukushima nuclear accident from the viewpoint of DID, which showed the weaknesses of DID implementation strategy - underestimation of the damage during a beyond-design-basis external event (BDBEE). EDMG is crucial complementary for the old framework of procedures/guidelines to enhance the concept of DID. The research progress of EDMG in different countries has been reviewed and a rough comparison has been made among them according to the present state-of-the-art from literature. The methodology of EDMG is summarized as follows: (a) Loss of Large Area (LOLA) - the originally designed scenario for EDMG; (b) elements of EDMG - the summarized contents for EDMG implementation; (c) classification of EDMG - initial response EDMGs and Technical Support Center (TSC) response EDMGs; (d) implementation of EDMG-introduction of three phases of EDMG implementation step by step. Furthermore, three typical methods to integrate EDMG into the traditional procedures/guidelines are reviewed. Finally, this paper gives some concluding remarks for EDMG-related critical issues and recommended future work, which may be challenges for the development and application of EDMG and useful for the related researchers. Novelty Statement The studies of the extensive damage mitigation guideline (EDMG), its methodology, and the progress in different countries have been reviewed. Three typical methods to integrate EDMG into the traditional procedures/guidelines are summarized and reviewed. Concluding remarks for EDMG-related critical issues and recommended future work are summarized.

Embedding research into health services in Latin America and the Caribbean: experiences and challenges of the Technical Support CenterExperiências e desafios do Centro de Apoio Técnico na pesquisa integrada aos serviços na América Latina e Caribe

RESUMENEn este artículo se describen los principales modelos de integración, las experiencias de éxito y los retos del trabajo conjunto de los investigadores y los tomadores de decisiones participantes en la iniciativa Incorporación de la Investigación para Avanzar en el Cumplimiento de los Objetivos de Desarrollo Sostenible (ER-SDG), y la experiencia del Centro de Apoyo Técnico (CAT). En junio de 2018 se otorgó financiamiento, previa selección, a 13 proyectos de investigación de 11 países de ingresos medios y bajos de América Latina y el Caribe (Argentina, Bolivia, Brasil, Colombia, Ecuador, Guatemala, Guyana, Haití, Paraguay, Perú y República Dominicana). Los proyectos debían estar centrados en los cambios que se requieren a nivel de sistema, políticas o programas para mejorar la salud y basarse en el trabajo conjunto de investigadores y tomadores de decisiones, a fin de acercar la generación de evidencias a la toma de decisiones en los sistemas y servicios de salud. El CAT apoyó y orientó la producción de resultados de calidad y de utilidad para la toma de decisiones. La experiencia confirmó el valor de iniciativas como ER-SDG en la consolidación de puentes entre el mundo de la investigación sobre implementación de políticas, programas y sistemas de salud, y el mundo de los funcionarios encargados de operar esos programas, servicios e intervenciones relacionadas con la salud. Se resalta la necesidad de respetar y aprovechar cada contexto, y los arreglos y patrones específicos de relación entre investigadores y tomadores de decisiones, mediante incentivos para la integración.

Embedding research into health services in Latin America and the Caribbean: experiences and challenges of the Technical Support Center.

ABSTRACTThis article describes the main models for embedding research and the successful experiences and challenges faced in joint work by researchers and decisionmakers who participated in the Embedding Research for the Sustainable Development Goals (ER-SDG) initiative, and the experience of the Technical Support Center. In June 2018, funding was granted to 13 pre-selected research projects from 11 middle- and low-income countries in Latin America and the Caribbean (Argentina, Bolivia, Brazil, Colombia, Dominican Republic, Ecuador, Guatemala, Guyana, Haiti, Paraguay, and Peru). The projects focused on the system-, policy-, or program-level changes required to improve health and build on the joint work of researchers and decisionmakers, with a view to bringing together evidence production and decision-making in health systems and services. The Technical Support Center supported and guided the production of quality results useful for decision-making. This experience confirmed the value of initiatives such as ER-SDG in consolidating bridges between research on the implementation of health policies, programs, and systems, and the officials responsible for operating health-related programs, services, and interventions. It highlighted the importance of both respecting and taking advantage of each context—and the specific arrangements and patterns in the relationships between researchers and decisionmakers—through incentives for embedded research.

ВИЯВЛЕННЯ ФАКТОРІВ ВПЛИВУ НА ЕФЕКТИВНІСТЬ ІНВЕСТИЦІЙ В АВТОМАТИЗАЦІЮ УПРАВЛІННЯ ПРОМИСЛОВИМИ ПІДПРИЄМСТВАМИ У КОНТЕКСТІ ФОРМУВАННЯ БІЗНЕС-КЛАСТЕРІВ

The formation of the ERP is a complex and time-consuming process, and therefore for the successful completion of the project it is necessary to develop a strategic plan for management automation and the use of modern approaches to assess its effectiveness. An important aspect of the formation of an effective ERP is to identify, analyze and assess the impact of external and internal factors that affect the satisfaction of future users of the implemented system – staff and managers at all levels. The article analyzes common approaches to identifying factors influencing the effectiveness of projects for automation of industrial enterprise management. The application of common approaches to assessing the effectiveness of an automated enterprise management system at different levels of maturity of its IT infrastructure, indicating their main advantages and disadvantages, and gives priority to the total cost of ownership as a key. It is proved that to increase the productivity and efficiency of ERP-system enterprises should take into account the factors that affect user satisfaction. At present, it is actually possible to determine the effectiveness of IT investments for Ukrainian enterprises is the analysis of whether it is possible to achieve the set goals at the expense of funds allocated for automation, formulated not in the form of their return coefficient, but in terms characterizing the parameters of automated processes. In general, for most modern enterprises before the implementation of AMS it is necessary to conduct an audit and reorganization of their activities to create rational technologies and business processes. Reorganization in this case does not necessarily mean a change in the organizational structure of the enterprise, but the optimization of processes to achieve greater productivity at lower cost. Prospects for the development and maintenance of the system are important for domestic enterprises, which are mainly determined by the developer (supplier) of the automated system, as well as a set of standards that is embedded in the system and its components. In addition, an important role in choosing a supplier is the form of its presence in the domestic market, which is formed by the presence of a network of certified technical support centers, authorized training centers, “hotlines” for consultations and more.

静岡県工業技術研究所浜松工業技術支援センター ―静岡県の「次世代自動車研究開発支援拠点」としての活動―

静岡県工業技術研究所浜松工業技術支援センター ―静岡県の「次世代自動車研究開発支援拠点」としての活動―

Time uncertainty analysis method for level 2 human reliability analysis of severe accident management strategies

This paper proposes an extended time uncertainty analysis approach in Level 2 human reliability analysis (HRA) considering severe accident management (SAM) strategies. The method is a time-based model that classifies two time distribution functions—time required and time available—to calculate human failure probabilities from delayed action when implementing SAM strategies. The time required function can be obtained by the combination of four time factors: 1) time for diagnosis and decision by the technical support center (TSC) for a given strategy, 2) time for strategy implementation mainly by the local emergency response organization (ERO), 3) time to verify the effectiveness of the strategy and 4) time for portable equipment transport and installation. This function can vary depending on the given scenario and includes a summation of lognormal distributions and a choice regarding shifting the distribution. The time available function can be obtained via thermal-hydraulic code simulation (MAAP 5.03). The proposed approach was applied to assess SAM strategies that use portable equipment and safety depressurization system valves in a total loss of component cooling water event that could cause reactor vessel failure. The results from the proposed method are more realistic (i.e., not conservative) than other existing methods in evaluating SAM strategies involving the use of portable equipment.

No evidence supports the use of ether and chloroform inhalation for treating COVID-19.

This article describes the main models for embedding research and the successful experiences and challenges faced in joint work by researchers and decisionmakers who participated in the Embedding Research for the Sustainable Development Goals (ER-SDG) initiative, and the experience of the Technical Support Center. In June 2018, funding was granted to 13 pre-selected research projects from 11 middle- and low-income countries in Latin America and the Caribbean (Argentina, Bolivia, Brazil, Colombia, Dominican Republic, Ecuador, Guatemala, Guyana, Haiti, Paraguay, and Peru). The projects focused on the system-, policy-, or program-level changes required to improve health and build on the joint work of researchers and decisionmakers, with a view to bringing together evidence production and decision-making in health systems and services. The Technical Support Center supported and guided the production of quality results useful for decision-making. This experience confirmed the value of initiatives such as ER-SDG in consolidating bridges between research on the implementation of health policies, programs, and systems, and the officials responsible for operating health-related programs, services, and interventions. It highlighted the importance of both respecting and taking advantage of each context—and the specific arrangements and patterns in the relationships between researchers and decisionmakers—through incentives for embedded research.

Life Cycle Assessment of Municipal Solid Waste Management in Kathmandu, Nepal

The study is focused on the life cycle assessment of municipal solid waste management of Kathmandu city. Total waste generated in a year was taken as a functional unit (FU) in the study to compare three different scenarios: 1.) Business as usual (BAU) consisting of collection, transport, and landfilling; 2.) Energy recovery along with recycling; and 3.) Conjunctive disposal system comprising of composting and landfilling. The primary and secondary data were collected from Environment Department and Solid Waste Management Section of Kathmandu city and Solid Waste Management Technical Support Center of Government of Nepal. The life cycle inventory was developed with detail unit process by quantifying values of various resources and emissions. Life cycle impact assessment was performed to compute impacts on the environment. The contribution of this process to the environment was calculated as global warming potential (GWP), acidification potential (AP), eutrophication potential (EP), and fuel energy consumption (FEC). The results obtained from the quantification of environmental impacts were compared. It was found that the Scenario 3 is more eco-friendly than Scenario 1 and Scenario 2. The findings were fundamentally based on the environmental burden of waste managed in landfill regardless of recycling and composting. At the end, GWP, AP, EP, and FEC were calculated for each scenario and compared in kg equivalents per metric ton of waste managed in landfill (Table 1). The comparative study of environmental impacts was performed and we calculated GWP, AP and EP for the total waste managed in a year. Table 1 also includes emission for annual waste management. The results obtained warrant a need for sustainable waste management methods for Kathmandu considering the conjunctive disposal system with composting and landfilling that reduces all four environmental impacts excluding the inefficient collection system, low public participation, landfill location, and operational improvements. As indicated above, Scenario 3 was found to be an option with minimum environmental impacts (less GWP, AP, and EP) and cheaper fuel cost. At the same time, the results are influenced by higher composition of organic waste that can be composted and the GWP, which can be controlled. The results of this study can be applied for an integrated solid waste management system as an environmental tool.

A DESJUDICIALIZAÇÃO DAS DEMANDAS POR MEDICAMENTOS: UMA ANÁLISE SOBRE A EFETIVIDADE DO NÚCLEO DE APOIO TÉCNICO – NAT APÓS A SUA INSTALAÇÃO NO MUNICÍPIO DE JOINVILLE

O presente estudo visa avaliar se o Núcleo de Apoio Técnico - NAT do Município de Joinville é dotado de efetividade, a qual, entende-se, é a capacidade de produzir um resultado para transformar a situação existente, respondendo adequadamente às necessidades da comunidade. Para tanto, faz-se um breve resgate histórico da judicialização da saúde no Brasil, com a análise da evolução da jurisprudência sobre o tema e das medidas adotadas pelo Poder Público para conter o crescimento exponencial do número de processos judiciais e dos gastos públicos correspondentes. No Estado de Santa Catarina, destaca-se o julgamento do Incidente de Resolução de Demandas Repetitivas (Tema 1), a instalação do Comitê Estadual de Monitoramento e Resolução das Demandas de Assistência da Saúde de Santa Catarina – COMESC e a criação do Núcleo de Apoio Técnico – NAT, com a finalidade de assessorar o Poder Judiciário, com informações técnicas e esclarecedoras sobre o atendimento no SUS, bem como de otimizar o atendimento do usuário, mediante a indicação do tratamento preconizado no SUS, quando existir, e, na sua ausência, da alternativa terapêutica existente. Em arremate, há uma análise dos indicadores apresentados no Relatório Anual de Monitoramento da Judicialização – 2017 da Secretaria Municipal de Saúde de Joinville e dos serviços prestados à população local pelo NAT instalado naquela cidade.

New-vision of Shizuoka Prefecture and Fuji Technical Support Center’s Approach

New-vision of Shizuoka Prefecture and Fuji Technical Support Center’s Approach

Mesure de la performance des politiques européennes de développement rural par l’estimation de leur « valeur ajoutée territoriale »

Dans quelle mesure le programme européen Leader contribue-t-il encore à répondre aux objectifs initiaux d’un développement local ascendant et innovant ? Nous proposons une méthode pluridisciplinaire, basée sur une analyse d’évaluation de l’efficacité des projets comme de leur gouvernance à partir d’une grille originale d’analyse de la valeur ajoutée territoriale. Celle-ci est structurée autour de quatre composantes : ancrage territorial, intersectorialité, coordinations entre acteurs et caractère transversal du projet de développement territorial. L’application de cette méthode aux projets Leader mis en œuvre dans le pays d’Aurillac met en exergue la valeur ajoutée la plus importante pour les projets relatifs à l’accueil de populations et d’entreprises. Par ailleurs, le couplage de cette analyse quantitative avec une analyse qualitative de science politique permet de tenir compte du contexte local et de pointer d’autres aspects freinant la performance de Leader (rigidité administrative, stratégies notabiliaires) ou l’améliorant (création d’un pôle d’accueil et d’appui). Classification JEL : Q18, H50, R58