Institute of Technology Assessment

Abstract The development of new batteries has historically been achieved through discovery and development cycles based on the intuition of the researcher, followed by experimental trial and error—often helped along by serendipitous breakthroughs. Meanwhile, it is evident that new strategies are needed to master the ever‐growing complexity in the development of battery systems, and to fast‐track the transfer of findings from the laboratory into commercially viable products. This review gives an overview over the future needs and the current state‐of‐the art of five research pillars of the European Large‐Scale Research Initiative BATTERY 2030+, namely 1) Battery Interface Genome in combination with a Materials Acceleration Platform (BIG‐MAP), progress toward the development of 2) self‐healing battery materials, and methods for operando, 3) sensing to monitor battery health. These subjects are complemented by an overview over current and up‐coming strategies to optimize 4) manufacturability of batteries and efforts toward development of a circular battery economy through implementation of 5) recyclability aspects in the design of the battery.

Nutrition and metabolism have been the topic of extensive scientific research in chronic obstructive pulmonary disease (COPD) but clinical awareness of the impact dietary habits, nutritional status and nutritional interventions may have on COPD incidence, progression and outcome is limited. A multidisciplinary Task Force was created by the European Respiratory Society to deliver a summary of the evidence and description of current practice in nutritional assessment and therapy in COPD, and to provide directions for future research. Task Force members conducted focused reviews of the literature on relevant topics, advised by a methodologist. It is well established that nutritional status, and in particular abnormal body composition, is an important independent determinant of COPD outcome. The Task Force identified different metabolic phenotypes of COPD as a basis for nutritional risk profile assessment that is useful in clinical trial design and patient counselling. Nutritional intervention is probably effective in undernourished patients and probably most when combined with an exercise programme. Providing evidence of cost-effectiveness of nutritional intervention is required to support reimbursement and thus increase access to nutritional intervention. Overall, the evidence indicates that a well-balanced diet is beneficial to all COPD patients, not only for its potential pulmonary benefits, but also for its proven benefits in metabolic and cardiovascular risk.

Abstract On the basis of a review of existing life cycle assessment studies on lithium‐ion battery recycling, we parametrize process models of state‐of‐the‐art pyrometallurgical and hydrometallurgical recycling, enabling their application to different cell chemistries, including beyond‐lithium batteries such as sodium‐ion batteries. These processes are used as benchmark for evaluating an advanced hydrometallurgical recycling process, which is modeled on the basis of primary data obtained from a recycling company, quantifying the potential reduction of environmental impacts that can be achieved by the recycling of different cell chemistries. Depending on the cell chemistry, recycling can reduce significantly the potential environmental impacts of battery production. The highest benefit is obtained via advanced hydrometallurgical treatment for lithium nickel manganese cobalt oxide and lithium nickel cobalt aluminum oxide‐type batteries, mainly because of the recovery of cobalt and nickel. Especially under resource depletion aspects, recycling of these cells can reduce their impact to an extent that even leads to a lower “net impact” than that of cells made from majorly abundant and cheap materials like lithium iron phosphate, which shows a more favorable performance when recycling is disregarded. For these cells, recycling does not necessarily provide benefits but can rather cause additional environmental impacts. This indicates that maximum material recovery might not always be favorable under environmental aspects and that, especially for the final hydrometallurgical treatment, the process would need to be adapted to the specific cell chemistry, if one wants to obtain maximum environmental benefit.

Erkki Huhtamo & Jussi Parikka, Media Archaeology. Approaches, Applications, and Implications (Berkeley: University of California Press, 2011), 368 pp., ISBN: 9780520262744 (pbk), £18.95. Media Arch...

Importance: Deaths due to opioid overdose have tripled in the last decade. Efforts to curb this trend have focused on restricting the prescription opioid supply; however, the near-term effects of such efforts are unknown. Objective: To project effects of interventions to lower prescription opioid misuse on opioid overdose deaths from 2016 to 2025. Design, Setting, and Participants: This system dynamics (mathematical) model of the US opioid epidemic projected outcomes of simulated individuals who engage in nonmedical prescription or illicit opioid use from 2016 to 2025. The analysis was performed in 2018 by retrospectively calibrating the model from 2002 to 2015 data from the National Survey on Drug Use and Health and the Centers for Disease Control and Prevention. Interventions: Comparison of interventions that would lower the incidence of prescription opioid misuse from 2016 to 2025 based on historical trends (a 7.5% reduction per year) and 50% faster than historical trends (an 11.3% reduction per year), vs a circumstance in which the incidence of misuse remained constant after 2015. Main Outcomes and Measures: Opioid overdose deaths from prescription and illicit opioids from 2016 to 2025 under each intervention. Results: Under the status quo, the annual number of opioid overdose deaths is projected to increase from 33 100 in 2015 to 81 700 (95% uncertainty interval [UI], 63 600-101 700) in 2025 (a 147% increase from 2015). From 2016 to 2025, 700 400 (95% UI, 590 200-817 100) individuals in the United States are projected to die from opioid overdose, with 80% of the deaths attributable to illicit opioids. The number of individuals using illicit opioids is projected to increase by 61%-from 0.93 million (95% UI, 0.83-1.03 million) in 2015 to 1.50 million (95% UI, 0.98-2.22 million) by 2025. Across all interventions tested, further lowering the incidence of prescription opioid misuse from 2015 levels is projected to decrease overdose deaths by only 3.0% to 5.3%. Conclusions and Relevance: This study's findings suggest that interventions targeting prescription opioid misuse such as prescription monitoring programs may have a modest effect, at best, on the number of opioid overdose deaths in the near future. Additional policy interventions are urgently needed to change the course of the epidemic.

Abstract System dynamics models, as causal models, are much like scientific theories. Hence, in evaluating such models, we assume certain norms of scientific inquiry. Most critics hold that the system dynamics approach does not employ formal, objective, quantitative model validation tests. This article argues that this type of criticism presupposes the traditional logical empiricist philosophy of science, which assumes that knowledge is an objective representation of reality and that theory justification can be an objective, formal process. According to the more recent relativist philosophy of science, knowledge is relative to a given society, epoch, and scientific world view. Theory justification is therefore a semiformal, relative social process. We show that relativist philosophy is consistent with the system dynamics paradigm and discuss the practical implications of the two philosophies of science for system dynamics modelers and their critics.

CONTEXT: In the United States, 192,000 men were diagnosed as having prostate cancer in 2009, the majority with low-risk, clinically localized disease. Treatment of these cancers is associated with substantial morbidity. Active surveillance is an alternative to initial treatment, but long-term outcomes and effect on quality of life have not been well characterized. OBJECTIVE: To examine the quality-of-life benefits and risks of active surveillance compared with initial treatment for men with low-risk, clinically localized prostate cancer. DESIGN AND SETTING: Decision analysis using a simulation model was performed: men were treated at diagnosis with brachytherapy, intensity-modulated radiation therapy (IMRT), or radical prostatectomy or followed up by active surveillance (a strategy of close monitoring of newly diagnosed patients with serial prostate-specific antigen measurements, digital rectal examinations, and biopsies, with treatment at disease progression or patient choice). Probabilities and utilities were derived from previous studies and literature review. In the base case, the relative risk of prostate cancer-specific death for initial treatment vs active surveillance was assumed to be 0.83. Men incurred short- and long-term adverse effects of treatment. PATIENTS: Hypothetical cohorts of 65-year-old men newly diagnosed as having clinically localized, low-risk prostate cancer (prostate-specific antigen level <10 ng/mL, stage ≤T2a disease, and Gleason score ≤6). MAIN OUTCOME MEASURE: Quality-adjusted life expectancy (QALE). RESULTS: Active surveillance was associated with the greatest QALE (11.07 quality-adjusted life-years [QALYs]), followed by brachytherapy (10.57 QALYs), IMRT (10.51 QALYs), and radical prostatectomy (10.23 QALYs). Active surveillance remained associated with the highest QALE even if the relative risk of prostate cancer-specific death for initial treatment vs active surveillance was as low as 0.6. However, the QALE gains and the optimal strategy were highly dependent on individual preferences for living under active surveillance and for having been treated. CONCLUSIONS: Under a wide range of assumptions, for a 65-year-old man, active surveillance is a reasonable approach to low-risk prostate cancer based on QALE compared with initial treatment. However, individual preferences play a central role in the decision whether to treat or to pursue active surveillance.

This article investigates how the new spirit of capitalism gets inscribed in the fabric of search algorithms by way of social practices. Drawing on the tradition of the social construction of technology (SCOT) and 17 qualitative expert interviews it discusses how search engines and their revenue models are negotiated and stabilized in a network of actors and interests, website providers and users first and foremost. It further shows how corporate search engines and their capitalist ideology are solidified in a socio-political context characterized by a techno-euphoric climate of innovation and a politics of privatization. This analysis provides a valuable contribution to contemporary search engine critique mainly focusing on search engines' business models and societal implications. It shows that a shift of perspective is needed from impacts search engines have on society towards social practices and power relations involved in the construction of search engines to renegotiate search engines and their algorithmic ideology in the future.

What should training for teachers look like? Do our assessment practices align well with what we would like our students to do? How can you self‐assess assessment training at your institution?

Batteries are one of the key technologies for flexible energy systems in the future. In particular, vanadium redox flow batteries (VRFB) are well suited to provide modular and scalable energy storage due to favorable characteristics such as long cycle life, easy scale-up, and good recyclability. However, there is a lack of detailed original studies on the potential environmental impacts of their production and operation. The present study fills this gap by providing a comprehensive life cycle assessment of a representative VRFB. Transparent and comprehensive inventory data are disclosed as a basis for further environmental studies. VRFBs are found to be promising regarding the assessed impact categories, especially at high energy-to-power (E/P) ratios. On the other hand, significant impacts are associated with the vanadium pentoxide production, which is why the origin and processing of the vanadium bearing ores are a key for further reducing the environmental impacts associated with the VRFB manufacturing. While the lower efficiency of the VRFB is a disadvantage in comparison to e.g. lithium-ion batteries (LIB), its recyclability is significantly higher. In this sense, the importance of taking a cradle-to-cradle life cycle perspective when comparing very different battery systems can be highlighted for further research on this topic.

Emerging technologies present both challenges and opportunities for national technology strategies. National governments may therefore want to monitor the technological horizon on a systematic basis. This article outlines the quantitative approaches available for such monitoring. Among the standard types of bibliometric data, proposals and publications are most likely to be useful for this purpose since they capture information earlier in the cycle of technology development. Patents, in contrast, trail behind. Analysis can proceed with keywords or citations, and algorithms are available to use the information structure inherent in these kinds of data to identify and measure emerging areas. There are limitations, however, in all the available approaches and the authors therefore recommend using them in conjunction with expert methods by focusing the qualitative assessment in particular areas.

This article critically reviews current European trends on smart cities in the context of open innovation. It draws from analyses of key European Union (EU) programmes, four international projects and related activities. These initiatives are framed by the EU's strategic policies on Competitiveness and Innovation, Smart Cities, the Future Internet and Living Labs with the aims to foster smarter, sustainable and inclusive cities. The article probes similarities and differences in the programmes and projects examined and their challenges towards EU strategies, including the i2020 agenda. The analysis shows that a new approach to open innovation is emerging, which links technologies with people, urban territory and other cities and that this approach is likely to be increasingly influential over the next period of time. It is suggested that this approach of using open innovation for sharing visions, knowledge, skills, experience and strategies for designing the delivery of services, goods and policies in cities is effective, efficient and sustainable. However, consistent frameworks, principles and strategic agendas are necessary to optimally bind these elements together.

OBJECTIVE: Although the clinical relevance of minor depression has been demonstrated in many studies, the economic costs are not well explored. In this study, we examine the economic costs of minor depression. METHOD: In a large-scale, population-based study in the Netherlands (n = 5504) the costs of minor depression were compared with the costs of major depression and dysthymia. Excess costs, i.e. the costs of a disorder over and above the costs attributable to other illnesses, were estimated with help of regression analysis. The direct medical costs, the direct non-medical costs and the indirect non-medical costs were calculated. The year 2003 was used as the reference year. RESULTS: The annual per capita excess costs of minor depression were US$ 2141 (95% CI = 753-3529) higher than the base rate costs of US$ 1023, while the costs of major depression were US$ 3313 (95% CI = 1234-5390) higher than the base rate. The costs of minor depression per 1 million inhabitants were 160 million dollars per year, which is somewhat less than the costs of major depression (192 million dollars per year). CONCLUSION: The economic costs associated with minor depression are considerable and approach those of major depression.

Experteninterviews sind ein anschauliches Beispiel dafür, dass die Alltagspraxis empirischer Sozialforschung und deren methodische Reflexion nicht immer parallel verlaufen. Manchmal ist die Anwendung bestimmter Methoden ihrer theoretischen Durchdringung voraus. Oder mit anderen Worten: Experteninterviews werden oft gemacht, aber selten durchdacht Obwohl die Bedeutung von Expertenwissen beider reflexiven Umgestaltung moderner Industriegesellschaften kaum umstritten ist (vgl. Beck 1986; Giddens 1995; Bauman 1995: 239ff.), die Literatur zu Expertenbegriff und Expertenstatus in den verschiedenen Teilarenen sozialwissenschaftlicher Forschung stetig anwächst1 und das Experteninterview als Methode der Datenproduktion ohnehin längst eine prominente Rolle spielt, etwa im Rahmen industrie- und bildungssoziologischer, aber auch politologischer und padagogischer Fragestellungen2, wird die methodische Reflexion auch heute nicht züden vordringlichen Aufgaben gerechnet. Keineswegs soll bestritten werden, dass in den letzten Jahren einzelne aus der jeweiligen Forschungspraxis angeregte Aufsätze mit unterschiedlichen Stoßrichtungen und Systematisierungsinteressen publiziert wurden.3Eingang in Methodenlehrbücher haben derartige Überlegungen bisher jedoch nicht gefunden.4

CONTEXT: The use of systemic corticosteroids is a known risk factor for the development of cataracts. OBJECTIVE: To determine whether treatment with inhaled corticosteroids is associated with cataract extraction in the elderly. DESIGN: Case-control study. SETTING: Quebec universal health insurance program for all elderly (provincial health insurance plan database [RAMQ database]). PATIENTS: RAMQ enrollees 70 years and older. The 3677 cases were patients with a cataract extraction between 1992 and 1994. The 21868 controls were randomly selected from patients who did not have a diagnosis of cataract and matched to cases on the index date of the case. MAIN OUTCOME MEASURES: Odds ratio of cataract extraction in patients with prolonged cumulative exposure to inhaled corticosteroids compared with nonusers. RESULTS: Excluding patients with systemic steroid treatment and after adjusting for age, sex, diabetes, systemic hypertension, glaucoma, ophthalmic steroids, and the number of physician claims for services, use of inhaled corticosteroids for more than 3 years was associated with undergoing cataract extraction (odds ratio [OR], 3.06; 95% confidence interval [CI], 1.53-6.13). For high average daily doses of beclomethasone or budesonide (>1 mg), the OR was elevated after more than 2 years of treatment (OR, 3.40; 95% CI, 1.49-7.76), whereas for low to medium doses (< or =1 mg) of these drugs, the OR was 1.63 (95% CI, 0.85-3.13) after 2 years. CONCLUSION: Prolonged administration of high doses of inhaled corticosteroids increases the likelihood of undergoing cataract extraction in elderly patients. Further studies are needed to investigate the risk of developing cataracts for low to medium doses over longer periods.

Phosphatidylinositol 4-kinase type IIIα (PI4KA) is a host factor essential for hepatitis C virus replication and hence is a target for drug development. PI4KA has also been linked to endoplasmic reticulum exit sites and generation of plasma membrane phosphoinositides. Here, we developed highly specific and potent inhibitors of PI4KA and conditional knock-out mice to study the importance of this enzyme in vitro and in vivo. Our studies showed that PI4KA is essential for the maintenance of plasma membrane phosphatidylinositol 4,5-bisphosphate pools but only during strong stimulation of receptors coupled to phospholipase C activation. Pharmacological blockade of PI4KA in adult animals leads to sudden death closely correlating with the drug's ability to induce phosphatidylinositol 4,5-bisphosphate depletion after agonist stimulation. Genetic inactivation of PI4KA also leads to death; however, the cause in this case is due to severe intestinal necrosis. These studies highlight the risks of targeting PI4KA as an anti-hepatitis C virus strategy and also point to important distinctions between genetic and pharmacological studies when selecting host factors as putative therapeutic targets.

Lung cancer remains the leading cause of cancer mortality in the United States. Lung cancer screening (LCS) with low-dose CT reduces mortality among high-risk current and former smokers and has been covered by public and private insurers without cost sharing since 2015. Patients and referring providers confront numerous barriers to participation in screening. To best serve in multidisciplinary efforts to expand LCS nationwide, radiologists must be knowledgeable of these challenges. A better understanding of the difficulties confronted by other stakeholders will help radiologists continue to collaboratively guide the growth of LCS programs in their communities. This article reviews barriers to participation in LCS for patients and referring providers, as well as possible solutions and interventions currently underway.

As of 2020, the Public Employment Service Austria (AMS) makes use of algorithmic profiling of job seekers to increase the efficiency of its counseling process and the effectiveness of active labor market programs. Based on a statistical model of job seekers' prospects on the labor market, the system-that has become known as the AMS algorithm-is designed to classify clients of the AMS into three categories: those with high chances to find a job within half a year, those with mediocre prospects on the job market, and those clients with a bad outlook of employment in the next 2 years. Depending on the category a particular job seeker is classified under, they will be offered differing support in (re)entering the labor market. Based in science and technology studies, critical data studies and research on fairness, accountability and transparency of algorithmic systems, this paper examines the inherent politics of the AMS algorithm. An in-depth analysis of relevant technical documentation and policy documents investigates crucial conceptual, technical, and social implications of the system. The analysis shows how the design of the algorithm is influenced by technical affordances, but also by social values, norms, and goals. A discussion of the tensions, challenges and possible biases that the system entails calls into question the objectivity and neutrality of data claims and of high hopes pinned on evidence-based decision-making. In this way, the paper sheds light on the coproduction of (semi)automated managerial practices in employment agencies and the framing of unemployment under austerity politics.

BACKGROUND: Untreated anxiety may be particularly difficult for primary care physicians to recognize and diagnose because there are no reliable demographic or medical profiles for patients with this condition and because these patients present with a high rate of comorbid psychological conditions that complicate selection of treatment. METHOD: A prospective assessment of untreated anxiety symptoms and disorders among primary care patients. RESULTS: Approximately 10% of eligible patients screened in clinic waiting rooms of a mixed-model health maintenance organization reported elevated symptoms and/or disorders of anxiety that were unrecognized and untreated. These patients with untreated anxiety reported significantly worse functioning on both physical and emotional measures than "not anxious" comparison patients; in fact these patients reported reduced functioning levels within ranges that would be expected for patients with chronic physical diseases, such as diabetes and congestive heart failure. The most severe reductions in functioning were reported by untreated patients whose anxiety was mixed with depression symptoms or disorders. CONCLUSION: Primary care physicians may benefit from screening tools and consultations by mental health specialists to assist in recognition and diagnosis of anxiety symptoms and disorders alone and mixed with depression.

There are certain concerns regarding the safety for the environment and human health from the use of engineered nanoparticles (ENPs) which leads to unintended exposures, as opposed to the use of ENPs for medical purposes. This review focuses on the unintended human exposure of ENPs. In particular, possible effects in the brain are discussed and an attempt to assess risks is performed.Animal experiments have shown that investigated ENPs (metallic nanoparticles, quantum dots, carbon nanotubes) can translocate to the brain from different entry points (skin, blood, respiratory pathways). After inhalation or instillation into parts of the respiratory tract a very small fraction of the inhaled or instilled ENPs reaches the blood and subsequently secondary organs, including the CNS, at a low translocation rate. Experimental in vivo and in vitro studies have shown that several types of ENPs can have various biological effects in the nervous system. Some of these effects could also imply that ENPs can cause hazards, both acutely and in the long term. The relevance of these data for risk assessment is far from clear. There are at present very few data on exposure of the general public to either acute high dose exposure or on chronic exposure to low levels of air-borne ENPs. It is furthermore unlikely that acute high dose exposures would occur. The risk from such exposures for damaging CNS effects is thus probably very low, irrespective of any biological hazard associated with ENPs.The situation is more complicated regarding chronic exposures, at low doses. The long term accumulation of ENPs can not be excluded. However, we do not have exposure data for the general public regarding ENPs. Although translocation to the brain via respiratory organs and the circulation appears to be very low, there remains a possibility that chronic exposures, and/or biopersistent ENPs, can influence processes within the brain that are triggering or aggravating pathological processes.In general, the present state of knowledge is unsatisfactory for a proper risk assessment in this area. Crucial deficits include lack of exposure data, the absence of a proper dose concept, and that studies often fail in adequate description of the investigated ENPs.