It produces high-quality research information on the costs, effectiveness and broader impact of health technologies for those who use, manage and provide care in the NHS. 'Health technologies' are broadly defined to include all interventions used to promote health, prevent and treat disease, and improve rehabilitation and long-term care, rather than settings of care. The research findings from the HTA Programme directly influence decision-making bodies such as the National Institute for Health and Clinical Excellence (NICE) and the National Screening Committee (NSC). HTA findings also help to improve the quality of clinical practice in the NHS indirectly in that they form a key component of the 'National Knowledge Service'. The HTA Programme is needs-led in that it fills gaps in the evidence needed by the NHS. There are three routes to the start of projects. First is the commissioned route. Suggestions for research are actively sought from people working in the NHS, the public and consumer groups and professional bodies such as royal colleges and NHS trusts. These suggestions are carefully prioritised by panels of independent experts (including NHS service users). The HTA Programme then commissions the research by competitive tender. Secondly, the HTA Programme provides grants for clinical trials for researchers who identify research questions. These are assessed for importance to patients and the NHS, and scientific rigour. Thirdly, through its Technology Assessment Report (TAR) call-off contract, the HTA Programme commissions bespoke reports, principally for NICE, but also for other policy-makers. TARs bring together evidence on the value of specific technologies. Some HTA research projects, including TARs, may take only months, others need several years. They can cost from as little as £40,000 to over £1 million, and may involve synthesising existing evidence, undertaking a trial, or other research collecting new data to answer a research problem. The final reports from HTA projects are peer-reviewed by a number of independent expert referees before publication in the widely read monograph series Health Technology Assessment. Criteria for inclusion in the HTA monograph seriesReports are published in the HTA monograph series if (1) they have resulted from work for the HTA Programme, and (2) they are of a sufficiently high scientific quality as assessed by the referees and editors. Reviews in Health Technology Assessment are termed 'systematic' when the account of the search, appraisal and synthesis methods (to minimise biases and random errors) would, in theory, permit the replication of the review by others.The research reported in this monograph was commissioned by the HTA Programme as project number 03/67/01. The contractual start date was in April 2005. The draft report began editorial review in October 2006 and was accepted for publication in May 2007. As the funder, by devising a commissioning brief, the HTA Programme specified the research question and study design. The authors have been wholly responsib...
A surprisingly large and ever-growing number of alternative models of primary care service delivery have been developed in Ontario. The models are relatively poorly understood, and it is unclear why there are so many of them. What needs of providers and of government as payer are they attempting to address? Through a literature review and interviews with key informants, we sought to explain why there are so many models.
A set of climate change projections for the United States was developed for use in the 2010 USDA Forest Service RPA Assessment. These climate projections, along with projections for population dynamics, economic growth, and land use change in the United States, comprise the RPA scenarios and are used in the RPA Assessment to project future renewable resource conditions 50 years into the future. This report describes the development of the historical and projected climate data set. The climate variables are monthly total precipitation in millimeters (mm), monthly mean daily maximum air temperature in degrees Celsius (°C), and monthly mean daily minimum air temperature in degrees Celsius (°C). Downscaled climate data were developed for the period 2001-2100 at the 5-arcminute grid scale (approximately 9.3 km by 7.1 km grid size at 40 degree N) for the conterminous United States. These data were also summarized at the U.S. county level. Computed monthly mean daily potential evapotranspiration (mm) and mean grid cell elevation in meters (m) are also included in the data set. The scenarios used here from the IPCC Special Report on Emissions Scenarios are A1B, A2, and B2. The A1B and A2 scenarios were used to drive three climate models: the Third Generation Coupled Global Climate Model, version 3.1, medium resolution; the Climate System Model, Mark 3.5 (T63); and the Model for Interdisciplinary Research on Climate, version 3.2, (T42), all used in the Fourth IPCC Assessment. The B2 scenario was used to drive three earlier generation climate models: the Second Generation Coupled Global Climate Model, version 2, medium resolution; the Climate System Model, Mark 2; and the UKMO Hadley Centre Coupled Model, version 3, all used in the IPCC Third Assessment. Monthly change factors were developed from global climate model output using the delta method. The coarse-resolution change factors were downscaled to a 5-arcminute resolution grid using ANUSPLIN. The 30-year mean historical climatology (1961-1990) was developed using the Parameter-elevation Regressions on Independent Slopes Model (PRISM) data at 2.5-arcminute resolution and aggregated to the 5-arcminute resolution grid. The downscaled change factors were combined with the PRISM observed climatology to develop nine future climate projections for the conterminous United States. These projection data and the change factor data are available through the U.S. Forest Service data archive website (
Projections of future climate were selected for four well-established general circulation models (GCM) forced by each of three greenhouse gas (GHG) emissions scenarios, namely A2, A1B, and B1 from the Intergovernmental Panel on Climate Change (IPCC) Special Report on Emissions Scenarios (SRES). Monthly data for the period 1961-2100 were downloaded mainly from the web portal of Third Coupled Model Intercomparison Project (Phase 3) of the Program for Climate Model Diagnosis and Intercomparison (PCMDI) and subsets of data covering North America were extracted. Climate variables included monthly mean daily maximum and minimum temperatures, precipitation, incident surface solar radiation, wind speed, and specific humidity. All variables were expressed as changes relative to the simulated monthly means for 1961-1990, which corrected for GCM bias in reproducing past climate and allowed future projected trends to be compared directly. The downscaling procedure used the ANUSPLIN software package to fit a two-dimensional spline function to each month's change data for each climate variable at a spatial resolution of 5 arcminutes (0.0833º) longitude and latitude. The A2 emission scenario invariably generated the greatest warming by 2100 and the B1 the least. Alaska is projected to undergo the greatest regional increases in temperature and precipitation. Differences across the projections were generally greater from the different GHG forcings than those resulting from the different GCMs, although the consistency varied spatially. Gridded datasets are publicly available. The downscaled change factors from this study are being used with historical climatology developed from the PRISM climate data set to develop the climate projections for the RPA scenarios in the USDA FS RPA assessment. A companion report and data set will be issued by Natural Resources Canada
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