Information technology, innovation and human development: hospital information systems in an Indian State

This paper addresses the topic of how innovation based on information and communication technologies (ICTs) can contribute to human development. A theoretical framework is developed in two stages. Firstly, ICT-based innovation is conceptualized as involving technological, social and institutional innovations. Secondly, Sen’s capability approach is drawn on to theorize how such innovations can contribute to human development. The theoretical framework is used as a basis to explore a rich case study of the development and use of a hospital information system within the public sector of the State of Himachal Pradesh in India. The paper analyses both the potential that the system has to promote positive development outcomes in the State, but also the challenges which constrain that impact. Three human development themes are identified and discussed: strengthening processes to include the disadvantaged; empowering the patient and making communal voices count. Finally, it is argued that the theoretical approach in the paper may have applicability in other contexts where ICT-based innovations are aiming to support human development outcomes

ICT4D research: reflections on history and future agenda

Research on the use of ICTs for international development, or ICT4D research, has a history going back some thirty years. The purpose of this paper is to take stock of the ICT4D research field at this important juncture in time, when ICTs are increasingly pervasive and when many different disciplines are involved in researching the area. The paper first provides some reflections on the history of the field broken down into three phases from the mid-1980s to the present day. This is followed by a detailed discussion of future research agenda including topic selection, the role of theory, methodological issues and multi-disciplinarity, and research impact. ICT4D research started largely in the academic field of information systems but it is concluded that the future lies in a multi-disciplinary interaction between researchers, practitioners and policy makers

Combatting electoral traces: the Dutch tempest discussion and beyond

In the Dutch e-voting debate, the crucial issue leading to the abandonment of all electronic voting machines was compromising radiation, or tempest. Other countries, however, do not seem to be bothered by this risk. In this paper, we use actor-network theory to analyse the socio-technical origins of the Dutch tempest issue in e-voting, and its consequences for e-voting beyond the Netherlands. We introduce the term electoral traces to denote any physical, digital or social evidence of a voter's choices in an election. From this perspective, we provide guidelines for risk analysis as well as an overview of countermeasures

The golden circle: A way of arguing and acting about technology in the London ambulance service

This paper analyses the way in which the London Ambulance Service recovered from the events of October 1992, when it implemented a computer-aided despatch system (LASCAD) that remained in service for less than two weeks. It examines the enactment of a programme of long-term organizational change, focusing on the implementation of an alternative computer system in 1996. The analysis in this paper is informed by actor-network theory, both by an early statement of this approach developed by Callon in the sociology of translation, and also by concepts and ideas from Latour’s more recent restatement of his own position. The paper examines how alternative interests emerged and were stabilized over time, in a way of arguing and acting among key players in the change programme, christened the Golden Circle. The story traces four years in the history of the London Ambulance Service, from the aftermath of October 1992 through the birth of the Golden Circle to the achievement of National Health Service (NHS) trust status. LASCAD was the beginning of the story, this is the middle, an end lies in the future, when the remaining elements of the change programme are enacted beyond the Golden Circle

Critical Care Cycling Study (CYCLIST) trial protocol: a randomised controlled trial of usual care plus additional in-bed cycling sessions versus usual care in the critically ill

Introduction In-bed cycling with patients with critical illness has been shown to be safe and feasible, and improves physical function outcomes at hospital discharge. The effects of early in-bed cycling on reducing the rate of skeletal muscle atrophy, and associations with physical and cognitive function are unknown. Methods and analysis A single-centre randomised controlled trial in a mixed medical-surgical intensive care unit (ICU) will be conducted. Adult patients (n=68) who are expected to be mechanically ventilated for more than 48 hours and remain in ICU for a further 48 hours from recruitment will be randomly allocated into either (1) a usual care group or (2) a group that receives usual care and additional in-bed cycling sessions. The primary outcome is change in rectus femoris cross-sectional area at day 10 in comparison to baseline measured by blinded assessors. Secondary outcome measures include muscle strength, incidence of ICU-acquired weakness, handgrip strength, time to achieve functional milestones (sitting out of bed, walking), Functional Status Score in ICU, ICU Mobility Scale, 6 min walk test 1week postICU discharge, incidence of delirium and quality of life (EuroQol Five Dimensions questionnaire Five Levels scale). Quality of life assessments will be conducted post-ICU admission at day 10, 3 and 6 months after acute hospital discharge. Participants in the intervention group will complete an acceptability of intervention questionnaire. Ethics and dissemination Appropriate ethical approval from Metro South Health Human Research Ethics Committee has been attained. Results will be published in peer-reviewed publications and presented at scientific conferences to assist planning of future multicentre randomised controlled trials (if indicated) that will test in-bed cycling as an intervention to improve the physical, cognitive and health-related quality of life outcomes of patients with critical illness

A simulation model of the Kenya national economy and its use as a guide to economic policy

This paper describes a simulation model of the Kenya national economy. The aim is to present a novel way of identifying, discussing and analysing a fairly wide spectrum of development problems facing Kenya. The model consists of a nine-sector input/output production component linked to a consumption component composed of four rural and five urban income classes. One of the main features of this model is that it is demand driven. Thus, growth rates in the productive sectors are generated endogenously as a function of demand. The model also deals with questions of income distribution, rural-urban migration and inflation. An overview is presented of the Kenyan economic and planning environment and the development and applications of the Kenya Simulation Model (KENSIM). The structure as well as the computational sequences of the model are described. A more detailed description of the model, including the overall structure (as reported in Slater and Walsham 1975) the set of economic assumptions and equations, the fortran computer programme, and the details of the data sources are reported in a forthcoming book by Slater, Walsham and Shah(l977). The paper goes on to discuss the application of KENSIM as a forecasting tool and for the simulation of alternative policy options, giving the example of rural-urban migration. The scope for further application and development of KENSIM is wide, and some of the major areas of current interest are identified. Some lessons and experiences are also included concerning co-operation between decision-makers and 'model-builders', which is essential if simulation models are to be used effectively for development planning

In-bed Cycling with Critically Ill Patients: Practical Lessons From a Randomised Trial

Introduction: In-bed cycling for critically ill patients is a rehabilitative exercise that may help improve patients’ functional status at hospital discharge. In-bed cycling is not currently implemented early during a patients’ critical illness. Objectives: To identify if early in-bed cycling could be safely implemented following a patients’ admission to ICU and to identify the barriers and facilitators to implementation of in-bed cycling within ICU. Methods: A randomised controlled trial comparing usual care physio-therapy with additional in-bed cycling within a tertiary mixed medical, surgical, trauma ICU was conducted. Number of sessions of in-bed cycling planned, conducted, distance and duration cycled, haemodynamic parameters and occurrence of pre-defined adverse events were recorded. A diary of intervention implementation processes and outcomes was kept to identify barriers and facilitators to implementation of in-bed cycling. Results: Thirty-seven participants completed 276 of 304 (90.8%) planned in-bed cycling interventions. Participants completed a median (IQR) of 6 (4,8) in-bed cycling sessions. Participants commenced in-bed cycling a median (IQR) of 2.3 (1.8,3.1) days following ICU admission. Participants cycled a mean (SD) 27.7 (5.2) minutes per session and mean (SD) 3.23km (1.63km) per session and maintained haemodynamic stability. Two minor adverse events (0.7% of sessions) occurred that required clinician intervention (increased respiratory rate and oxygen desaturation). These events required adjustment to ventilator settings without any long-term consequences. The main barriers to the implementation of in-bed cycling sessions were patient fatigue (n = 9), delirium (n = 5) and haemodynamic instability (n = 4). Timing of initiation of the intervention following morning chest x-ray round with independent implementation by a physiotherapist were identified as the main facilitators to the in-bed cycling intervention. Conclusions: In-bed cycling commencing within 2 to 3 days of a patients’ ICU admission was both safe and feasible. Adverse events were rare and the main barrier to implementation of in-bed cycling sessions was patient fatigue.<br/

Eleanor Davies and the New Jerusalem

Eleanor Davies was a great believer in historical moments. In her first work—A Warning to the Dragon and All His Angels of 1625-she told readers that “The Lord is at the Dore.”1 This immanence of God made her watchful and purposeful, reading the signs in her daily life, counting days, weeks, and years because she believed that Christ would come again. His arrival had been predestined from the beginning of the world: “from the going forth of the Commandement, which is the beginning of the Creation to the building of the New Jerusalem, the second comming of Messiah, the Prince the Sonne of God, it shall be Seaven Weekes or Seaven Moneths.”2 For Davies, time was elastic, but history was absolute. What the biblical prophets (in this case Ezekiel) said would come to pass, really would come to pass, but their promises were oracular; they had complete authority but were also elusive. Davies accepted this. She knew that she was living in the latter days, but when it came to God’s final judgment, “the daye and houre knoweth no man.”3 God could not be known as such and what she called knowledge was a spiritual transformation that took place when “He powreth out his Spirit upon his hand-maidens,” like herself.4 This essay uses A Warning to the Dragon and Davies’ works of the 1630s and 1640s to examine her theology

Room for Silence: Ebola Research, Pluralism and the Pragmatic Study of Sociomaterial Practices

The notion of sociomaterial practices speaks to a view of routine work in which people and materials are always already entangled. This implies that the commonsense tendency to treat concrete materials and social activity as separate analytical categories may actually muddy more than illuminate our understanding of practices. Engaging work from science and technology studies, this broad view of materiality refers not only to the physical properties of machines but also to software and algorithms, electrical grids and other infrastructure, buildings, human bodies, ecological systems etc. Despite remarkable enthusiasm, the conversation about sociomaterial practices occasionally has devolved into philosophical turf wars, engendering pleas for pluralism. All too often, such lofty conceptual debates lose sight of pragmatic concerns such as technology design work or humanitarian action. This essay traces both issues to a tension between adopting a grand philosophical Ontology, versus undertaking detailed empirical studies of particular concrete work practices. I argue that studies exploring the practical specifics of particular sociomaterial practices should be granted room for silence with respect to some theoretical commitments, on the grounds that this will afford a more lively pluralism. For ethnomethodologists, this re-orientation to grand theory is a matter of methodological rigor and theoretical sophistication. For pragmatists, room for silence has to do with the dilemma of rigor or practical relevance. This is not to say that key concepts are unnecessary—they can provoke us to look beyond narrow disciplinary confines and standard assumptions about the scope of field studies. Through an account of the 2013-2016 Ebola outbreak in West Africa, I show how these conceptual debates matter for empirical research and for design practice. In this case, complex technical and biosocial processes made a concrete difference in the course of the outbreak and the humanitarian response to it. For practitioners no less than for researchers, this case throws into sharp relief the real human stakes of grasping how the material world gets caught up in workaday human activity

The molybdenum isotopic composition of the modern ocean

Natural variations in the isotopic composition of molybdenum (Mo) are showing increasing potential as a tool in geochemistry. Although the ocean is an important reservoir of Mo, data on the isotopic composition of Mo in seawater are scarce. We have recently developed a new method for the precise determination of Mo isotope ratios on the basis of preconcentration using a chelating resin and measurement by multiple-collector inductively coupled plasma mass spectrometry (MC-ICP-MS), which allows us to measure every stable Mo isotope. In this study, 172 seawater samples obtained from 9 stations in the Pacific, Atlantic, and Southern Oceans were analyzed, giving global coverage and the first full depth-profiles. The average isotope composition in δA/95Mo (relative to a Johnson Matthey Mo standard solution) was as follows: δ92/95Mo = –2.54 ± 0.16‰ (2SD), δ94/95Mo = –0.73 ± 0.19‰, δ96/95Mo = 0.85 ± 0.07‰, δ97/95Mo = 1.68 ± 0.08‰, δ98/95Mo = 2.48 ± 0.10‰, and δ100/95Mo = 4.07 ± 0.18‰. The δ values showed an excellent linear correlation with atomic mass of AMo (R2 = 0.999). Three-isotope plots for the Mo isotopes were fitted with straight lines whose slopes agreed with theoretical values for mass-dependent isotope fractionation. These results demonstrate that Mo isotopes are both uniformly distributed and follow a mass-dependent fractionation law in the modern oxic ocean. A common Mo standard is urgently required for the precise comparison of Mo isotopic compositions measured in different laboratories. On the other hand, our results strongly support the possibility of seawater as an international reference material for Mo isotopic composition