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The primary objective was to analyze the impact of the national cyberattack in May 2021 on patient flow and data quality in the Paediatric Emergency Department (ED), amid the SARS-CoV-2 (COVID-19) pandemic.
Methods:
A single site retrospective time series analysis was conducted of three 6-week periods: before, during, and after the cyberattack outage. Initial emergent workflows are described. Analysis includes diagnoses, demographic context, key performance indicators, and the gradual return of information technology capability on ED performance. Data quality was compared using 10 data quality dimensions.
Results:
Patient visits totaled 13 390. During the system outage, patient experience times decreased significantly, from a median of 188 minutes (pre-cyberattack) down to 166 minutes, most notable for the period from registration to triage, and from clinician review to discharge (excluding admitted patients). Following system restoration, most timings increased. Data quality was significantly impacted, with data imperfections noted in 19.7% of data recorded during the system outage compared to 4.7% before and 5.1% after.
Conclusions:
There was a reduction in patient experience time, but data quality suffered greatly. A hospital’s major emergency plan should include provisions for digital disasters that address essential data requirements and quality as well as maintaining patient flow.
The exponential development of information technologies (IT) which has been described as the digital revolution has led to different IT outcomes at individual, organizational and societal levels. The chapter theorizes these different IT outcomes as digitally led emancipation and digitally led exploitation. The chapter postulates that the attainment of the outcomes depends on different power mechanisms and their associated fault lines. Power mechanisms and IT are theorized to create a framework explicating these dynamics. Power mechanisms are outlined as episodic power and digitally led emancipation (collective action, participation), episodic power and digitally led exploitation (manipulation, information asymmetries), systemic power and digitally led emancipation (empowerment, inclusion) and systemic power and digitally led exploitation (surveillance/monitoring, automation/algorithmification). The chapter concludes with a research agenda to understand these power mechanisms, which may enable digitally led emancipation and digitally led exploitation.
This chapter discusses how to grow an outcome measurement team in a single clinical practice and covers how outcome measurement can look at scale within larger organizations that have built capabilities to leverage their electronic health records for data collection and analytics. The key steps of data management functions are referenced again to illustrate how these functions can be deployed at scale to measure outcomes. Key personnel needed to support outcome measurement at scale are also explained. Considerations for sharing data with broad audiences is described, specifically the stages of data acceptance are reviewed. Governance and leadership considerations are briefly referenced. The primary audience for this chapter is health care administrators who want to start measuring outcomes in their organization or support existing efforts.
During the coronavirus disease (COVID-19) pandemic, mass vaccination centers became an essential element of the public health response. This drive-through mass vaccination operation was conducted in a rural, medically underserved area of the United States, employing a civilian–military partnership. Operations were conducted without traditional electronic medical record systems or Internet at the point of vaccination. Nevertheless, the mass vaccination center (MVC) achieved throughput of 500 vaccinations per hour (7200 vaccinations in 2 days), which is comparable with the performance of other models in more ideal conditions. Here, the study describes the minimum necessary resources and operational practicalities in detail required to implement a successful mass vaccination event. This has significant implications for the generalizability of our model to other rural, underserved, and international settings.
This article explores the role of interoperability in the development of digital public services in Europe, analyzing the effects of an European Union (EU)-level initiative (the European interoperability framework, EIF) and the development of e-Government services on how citizens interact online with public administrations. The EIF is a common EU framework providing guidance on public sector interoperability. EU countries are not mandated to follow the EIF, but they are encouraged to take up its guidance in their respective national interoperability frameworks (NIFs). Against this background, this article tests two hypotheses: (a) the introduction of NIFs facilitates the online interaction between citizens and public administrations and (b) better e-Government services encourage citizens to interact online with public administrations. Both hypotheses are confirmed by a panel data analysis covering 26 European countries over the period 2012–2019. The analysis relies on a dummy variable reflecting the adoption of NIFs, built by carefully examining official documents of the countries in the scope of the analysis. Based on the empirical results, this article puts forward two main policy recommendations. First, efforts to improve e-Government services across Europe should be intensified in order to support the overarching digital agenda of the EU and increase benefits for European citizens. Second, interoperability should become a central element when designing new digital public services. Therefore, the European Commission could foster a common approach to interoperability of digital public services across the EU by strengthening the governance of interoperability initiatives and encouraging the adoption of specific interoperability requirements.
Histories of semiconductor and computing technology in the United States have emphasized the supporting role of the U.S. state, especially the military, in answer to libertarian denials of state aid that are influential in Silicon Valley today. Somewhat implicit in that historiography, though, is the leading role of actors and organizations that blur any distinction between public and private. Some industries of this sort—telecommunications, aerospace, auto manufacturing—do figure in the historiography, but the class should be expanded further. One such industry—oil—has been exceptionally but almost invisibly influential in the development of computing and semiconductor manufacturing in the United States. Oil firms invested heavily in semiconductors and computing. There was also an “oil spillover” of personnel and technology from oil firms to computing and semiconductor manufacturing. Oil shows up in the biographies of many prominent individuals and organizations in the history of those technologies, from Fairchild Semiconductor to Edsger Dijkstra. These ties potentially hold important implications for the much-needed transition to a more sustainable energy regime.
The rate of innovation in Information Technology (IT) has slowed down over time. The slowdown is evident both in the data on quality-adjusted prices of computers, and performance of microprocessors used in computers. The model in this paper shows that an IT–labor elasticity of substitution that is greater than 1 can explain the slowdown. With an elasticity of substitution greater than 1, however, slowing innovation can result in sustained labor productivity and output growth. Sustained growth is possible because an IT–labor elasticity of substitution greater than 1 results in a continuously increasing share of IT in production costs, which counteracts the effect of slowing innovation on labor productivity and output growth. In this environment of slowing innovation, increasing IT share and sustained growth, employment can increase or decrease, depending on the values of the IT–labor elasticity of substitution and the price elasticity of demand for IT-enabled consumption goods.
Organizations increasingly rely upon algorithms to change their routines—with positive, negative, or messy outcomes. In this chapter, we argue that conceptualizing algorithms as an integral part of an assemblage provides scholars with the ability to generate novel theories about how algorithms influence routine dynamics. First, we review existing research that shows how algorithms operate as an actant making decisions; encode the intentions of designers; are entangled in broader assemblages of theories, artifacts, actors, and practices; and generate performative effects. Second, we elucidate five analytical approaches that can help management scholars to identify new connections between routine assemblages, their elements, and organizational outcomes. Finally, we outline directions for future research to explore how studying algorithms can advance our understanding of routine dynamics and how a routine dynamics perspective can contribute to the understanding of algorithms in strategy and organizational theory more broadly .
Health information has been a major instrument in the assessment of health status in Malaysia, the planning and implementation of health services and the evaluation of health outcomes. Earlier, population censuses and estimates, plus the registration of births and deaths, were complemented by surveys of living conditions. Registration of notifiable diseases added to the assessment of the incidence of infectious diseases and progress made in their management; this was later extended to some non-communicable diseases. Health services research and household surveys have become regular features to support health intervention planning and possible changes. Registration of health professionals and inventories of health facilities give an indication of their availability. Initially, health financing information related mostly to the public sector. More recently, the compilation of national health accounts has given annual health expenditure estimates for both the public and private sectors. Progressively, information technology enhanced the collection, analysis and dissemination of health information and the provision of clinical services, such as in the case of telehealth.
The regulation of technology is an important and topical area of law, relevant to almost all aspects of society. Technology Law: Australian and International Perspectives presents a thorough exploration of the new legal challenges created by evolving technologies, from the use of facial recognition technology in criminal investigations to the rise and regulation of cryptocurrencies. A well-written and fascinating introduction to technology law in Australia and internationally, Technology Law provides thorough coverage of the theoretical perspectives, legislation, cases and developing issues where technology and the law interact. The text covers data protection and privacy, healthcare technology, criminal justice technology, commercial transactions, cybercrime, social media and intellectual property, and canvasses the future of technology and technology law. Written by leading experts in the field, Technology Law is an excellent resource for law students and legal professionals with an interest in the area.
In recent decades, the regulation of technology and associated information has become an important and topical area of law, relevant to almost all aspects of society. Issues in technology law typically extend beyond specific jurisdictions and have state, national and international implications. Developments in one jurisdiction rapidly have international ramifications, due to the connectedness facilitated by the internet and modern communications technology. The areas of the law that are evolving due to technological developments are diverse: a preliminary list would include finance law, criminal law, medical law, media law and privacy law. New technology creates challenges, because when it becomes available, new regulatory gaps arise. For example, the emergence of cryptocurrencies such as Bitcoin has required public agencies to issue guidelines as to whether they constitute forms of currency, and whether dealings using them are subject to taxation laws.1 Another example is the legislation enacted in the early 2000s to regulate the use of DNA evidence in criminal investigations. When these laws were enacted, the use of commercial ancestry databases and other modern techniques in genetic analysis to identify suspects in some high-profile contemporary cases was not envisaged.2
To review Emergency Department internet connectivity, cyber risk factors, perception of risks and preparedness, security policies, training and mitigation strategies.
Methods:
A validated targeted survey was sent to Canadian ED physicians and nurses between March 5, 2019 and April 28, 2019.
Results:
There were 349 responses, with physicians making up 84% of the respondents (59% urban teaching, 35% community teaching, 6% community non-teaching hospitals). All had multiple passwords, 93% had more than 1 user account, over 90% had to log repeatedly each workday, 52% had to change their passwords every 3 months, 75% had multiple methods of authentication and 53% reported using a terminal where someone else was already logged in. Passwords were used to review laboratory and radiology data, access medical records and manage patient flow. Majority of the respondents (51%) did not know if they worked with internet linked devices. Only 7% identified an ‘air gapped’ computer in their facility and 76% used personal devices for patient care, with less than a third of those allowing the IT department to review their device. A total of 26 respondents received no cyber security training.
Conclusion:
This paper revealed significant computer-human interface dysfunctionality and readiness gaps in the event of an IT failure. These stemmed from poor system design, poor planning and lack of training. The paper identified areas with technical or training solutions and suggested mitigation strategies.
When the ticker tape was first invented in the 1860s, it promised a revolution in financial markets. Pricing information was now no longer solely the domain of the trading floor but was relayed continuously and simultaneously to ticker tapes long distances away from the stock exchange. Both nineteenth-century financiers, and the modern scholars who study them, have been enamored with the ticker tape and how it changed the way financial markets were perceived and experienced. However, a focus on how nineteenth-century financiers read and responded to the ticker tape has missed the real reordering of power that the ticker helped usher in. This article argues that between the 1860s and 1890s the London Stock Exchange and the Exchange Telegraph Company powerfully centralized their control over the distribution and transmission of financial information through the mundane infrastructures that underpinned the ticker tape system. Seeming technicalities, like the placement of batteries, the construction of electrical circuits, and the laying of wires and cables, were leveraged by these institutions to create a ticker tape system that distributed financial information unequally to financiers and investors throughout Britain. By the end of the nineteenth century, social and political questions about who should have access to financial information and markets, and on what terms, became helplessly intertwined with the mundane technicalities of the material infrastructures of modern finance.
How will advances in digital technology affect the future of human rights and authoritarian rule? Media figures, public intellectuals, and scholars have debated this relationship for decades, with some arguing that new technologies facilitate mobilization against the state and others countering that the same technologies allow authoritarians to strengthen their grip on power. We address this issue by analyzing the first game-theoretic model that accounts for the dual effects of technology within the strategic context of preventive repression. Our game-theoretical analysis suggests that technological developments may not be detrimental to authoritarian control and may, in fact, strengthen authoritarian control by facilitating a wide range of human rights abuses. We show that technological innovation leads to greater levels of abuses to prevent opposition groups from mobilizing and increases the likelihood that authoritarians will succeed in preventing such mobilization. These results have broad implications for the human rights regime, democratization efforts, and the interpretation of recent declines in violent human rights abuses.
Scholars and policymakers long believed that norms of global information openness and private-sector governance helped to sustain and promote liberalism. These norms are being increasingly contested within liberal democracies. In this article, we argue that a key source of debate over the Liberal International Information Order (LIIO), a sub-order of the Liberal International Order (LIO), is generated internally by “self-undermining feedback effects,” that is, mechanisms through which institutional arrangements undermine their own political conditions of survival over time. Empirically, we demonstrate how global governance of the Internet, transnational disinformation campaigns, and domestic information governance interact to sow the seeds of this contention. In particular, illiberal states converted norms of openness into a vector of attack, unsettling political bargains in liberal states concerning the LIIO. More generally, we set out a broader research agenda to show how the international relations discipline might better understand institutional change as well as the informational aspects of the current crisis in the LIO.
Medication management is challenging for persons with Alzheimer’s disease (AD) and their caregivers. Electronic medication management devices (eMMDs) are specifically designed to support this task. However, theory-driven interventions for eMMD training with this population are rarely described. This study aimed to develop and assess the appropriateness of an intervention protocol to train persons with early-stage AD how to use an eMMD.
Methods:
Interviews with three categories of participants [persons with early-stage AD (n = 3), caregivers (n = 3), and clinicians (n = 3)] were conducted to understand medication management needs, perceived usefulness of an eMMD, and to explore training strategies. Subsequently, this knowledge was integrated in an intervention protocol which was validated with the three clinicians. A content analysis led to iterative modifications to maximize the acceptability and coherence of the intervention protocol in a homecare context.
Results:
The final intervention protocol specifies the expertise required to provide the training intervention and the target population, followed by an extensive presentation of eMMD features. Specific learning strategies tailored to the cognitive profile of persons with AD with step-by-step instructions for clinicians are included. Finally, it presents theoretical information on cognitive impairment in AD and how eMMDs can support them.
Conclusions:
This intervention protocol with its theoretical and pragmatic foundation is an important starting point to enable persons with early-stage AD to become active users of eMMDs. Next steps should evaluate the immediate and long-term impacts of its implementation on medication management in the daily lives of persons with AD and their caregivers.
Given the paucity of data on the use of internet and quality of life (QoL), this literature review aimed to identify the motivations and barriers for internet use and the impact on QoL on older adults using the internet.
Background:
Even though older adults are increasingly using information technology, the numbers remain quite small globally. Currently published research primarily focuses on the various ways and methods of information technology use by older adults and the factors influencing use rather than on the impact of information technology on QoL of older adults.
Methods:
The studies included in this literature review were searched in three databases: WEB of Science, GoogleScholar and PubMed. English language articles were searched using the terms ‘older’, ‘elderly’, ‘senior’, ‘well-being’, ‘life satisfaction’, ‘quality of life’, ‘internet’ and “computer”.
Findings:
The review demonstrated the association of internet use on QoL in older adults. The majority of the studies substantiate the advantages of internet use by older adults including the ability to communicate with family and friends, maintain a wide social network, have access to information and participate in online leisure activities. There are some studies, though less in number, which did not find a relationship between well-being and use of internet by older adults. The policy implications of this review advocate a multidimensional strategy to support internet use by the older people incorporating internet training and education, financial issues, technical support and access needs to be developed.
For more than a decade, the United States military has conceptualized and discussed the Internet and related systems as “cyberspace,” understood as a “domain” of conflict like land, sea, air, and outer space. How and why did this concept become entrenched in US doctrine? What are its effects? Focusing on the emergence and consolidation of this terminology, I make three arguments about the role of language in cybersecurity policy. First, I propose a new, politically consequential category of metaphor: foundational metaphors, implied by using particular labels rather than stated outright. These metaphors support specific ways to understand complex issues, provide discursive resources to some arguments over others, and shape policy contestation and outcomes. Second, I present a detailed empirical study of US military strategy and doctrine that traces the emergence and consolidation of terminology built on the “cyberspace domain.” This concept supported implicit metaphorical correspondences between the Internet and physical space, yielding specific analogies and arguments for understanding the Internet and its effects. Third, I focus on the rhetorical effects of this terminology to reveal two important institutional consequences: this language has been essential to expanding the military's role in cybersecurity, and specific interests within the Department of Defense have used this framework to support the creation of US Cyber Command. These linguistic effects in the United States also have implications for how other states approach cybersecurity, for how international law is applied to cyber operations, and for how International Relations understands language and technological change.
A preconception Virtual Patient Advocate (VPA) called “Gabby” supported African-American women to decrease their preconception health risks and may be a scalable resource to increase women’s access to preconception care. Aims were to assess the acceptability of a preconception VPA in women living in Australia and document the changes required to adapt Gabby to suit an Australian context. Taking a descriptive qualitative approach, nonpregnant female participants (n = 31), aged 18–45 years, living in metropolitan and regional Victoria, Australia interacted with Gabby. Focus groups (n = 7) that gathered participants’ perspectives of their experience with Gabby ran in July–August 2019 before being transcribed verbatim and thematically analyzed. Six interrelated themes and 12 subthemes were identified. Participants found VPAs to be an acceptable provider of health information with potential to increase women’s access preconception health advice. Gabby was considered to be trustworthy and was able to develop rapport with participants in a relatively short time. Context-specific, relevant, tailored and trustworthy information and advice were considered more important that Gabby’s physical appearance. Participants had strong opinions about potential technological advancements (e.g., reminders and rewards) and addressing navigation issues to increase Gabby’s acceptability. Participants envisaged that they would use Gabby for readily available and evidence-based information before seeking advice from a health professional if required. Overall, the concept VPAs to provide preconception advice and Gabby were acceptable to participants. Future development of VPAs, Gabby, and other online technology-based resources should consider women’s high expectations of the online health information they choose to interact with.