Global Diffusion of the Internet VI: The Internet in Togo

The Global Diffusion of the Internet (GDI) framework is used to examine Internet diffusion in Togo along six dimensions: Pervasiveness, Geographical Dispersion, Sectoral Absorption, Connectivity Infrastructure, Organizational Infrastructure, and Sophistication of Use. The Internet in Togo originated in the private sector in 1996. In the years that followed, the Togolese Internet grew at a slower rate than the Internet in many other countries over the same period of time. After examining how each dimension evolved, this study concludes, amongst many suggestions, that the Togolese government should encourage more telecommunication infrastructure development by allowing private companies to utilize Togo Telecom\u27s network

Introducing the Global Diffusion of the Internet Series

While there is no shortage of commentary on the nature and impact of the Internet, a deep understanding of this phenomenon and its diffusion must go beyond the collection of factoids, such as the number of hosts and users, to capture the context within which the Internet evolves. This paper introduces a CAIS series entitled The Global Diffusion of the Internet, which seeks to promote research efforts that contribute to our understanding of the diffusion of the Internet throughout the world, that create and apply analytic frameworks that permit comparative analyses, and that capture the rather perishable history of the Internet as it unfolds. Contributions by scholars from parts of the world that are under-represented among the AIS membership are particularly encouraged

The Internet in Turkey and Pakistan: A Comparative Analysis

The Global Diffusion of the Internet Project was initiated in 1997 to study the diffusion and absorption of the Internet to, and within, many diverse countries. This research has resulted in an ongoing series of reports and articles that have developed an analytic framework for evaluating the Internet within countries and applied it to more than 25 countries. (Seehttp://mosaic.unomaha.edu/gdi.html for links to some of these reports and articles.) The current report applies the analytic framework to compare and contrast the Internet experiences of Turkey and Pakistan, through mid-2000. Although historically these countries have not been closely related, there are significant parallels between the two that make them well suited for a comparative study of the absorption of the Internet. Turkey and Pakistan are among the largest non-Arab Muslim countries in the world. In contrast to most of their Arab counterparts, their governments were founded as secular, parliamentary democracies. Both countries have had stormy political histories, however, with periodic coups and authoritarian governments. Each country has firmly entrenched bureaucracies with closed and, to varying degrees, corrupt processes

Global Sourcing of IT Services and Information Security: Prudence before Playing

This paper calls for awareness of the risks in global sourcing of IT and IT-enabled services. It calls for appropriate assessment and mitigation of these risks. The authors identify ways in which global sourcing (often called offshoring) increases information security exposures and strategies for managing such risks

Global Diffusion of the Internet - I: India: Is the Elephant Learning to Dance?

With his proclamation in 1998 that IT is India\u27s tomorrow , Prime Minister Vajpayee captured a vision of a 21st century India substantially different from that of the previous century, with its high levels of poverty, bloated bureaucracies, and protectionist policies. He envisioned the new India as a major IT power, fully integrated with the global economy, bringing about substantial domestic and international benefit. The Internet is a key to this vision, both as an enabler of technology-based change, and as an indicator of the vision\u27s fulfillment. Using an analytic framework developed by the authors and others, this study documents the growth of the Internet in India, from the pre-Internet networks through the boom of the Internet from 1998 to 2003. The Indian experience provides an example of how fundamental, focused changes in policy and legislation can unleash forces that accelerate Internet diffusion. Private sector initiatives greatly expanded the Internet infrastructure and Internet services market. At the same time, Government initiatives promoted the expansion of the Internet into parts of the country not well served by private ISPs. Poverty and limited telecommunications infrastructure currently limit the rate and extent of Internet expansion. However, time is an ally; the basic elements for continued growth of the Internet are largely in place

Scientific Computing in the Soviet Union

In the last decade, the Soviet Union has placed increased emphasis on the development of high-speed computers and networks for use in scientific, economic, and military applications. When Communist Party General Secretary Mikhail Gorbachev labeled supercomputer development a top priority task for our science and economy in April, 1987, he added new urgency to the production of machines that would both support activities in these applications and also serve as high-profile standard-bearers for perestroika, his program of restructuring and modernization for the nation. The Soviets have also undertaken some major projects in networking, including the creation of a nationwide packet-switched network for the Academy of Sciences, work on network access to databases on scientific literature, and local area networks at a number of institutes

Disproportionate Alterations in the Anterior and Posterior Insular Cortices in Obsessive–Compulsive Disorder

Recent studies have reported that the insular cortex is involved in the pathophysiology of obsessive–compulsive disorder (OCD). However, specific morphometric abnormalities of the insular subregions remain unclear. In this study, we examined insular cortical volume to determine whether the volume of the anterior and posterior insular cortices of unmedicated OCD patients differed according to different symptom dimensions.Using magnetic resonance imaging, we measured the gray matter volumes of the insular cortex and its subregions (anterior and posterior divisions) in 41 patients with OCD (31 drug-naïve and 10 non-medicated) and 53 healthy controls. Volumetric measures of the insular cortex were compared according to different OC symptoms. Enlarged anterior and reduced posterior insular cortices were observed in OCD patients. The insular volumetric alterations were more significant in OCD patients with predominant checking rather than cleaning symptoms when compared with healthy controls.Our results suggest the presence of unbalanced anterior and posterior insular volumetric abnormalities in unmedicated OCD patients and emphasize the distinct role of the insular cortex in different OC symptoms. We propose that the insular morphometric alterations may influence the modulation of interoceptive processing, the insular functional role, in OCD patients with different symptoms

Context, mechanisms and outcomes in end of life care for people with advanced dementia

yesBackground: The majority of people with dementia in the UK die in care homes. The quality of end of life care in these environments is often suboptimal. The aim of the present study was to explore the context, mechanisms and outcomes for providing good palliative care to people with advanced dementia residing in UK care homes from the perspective of health and social care providers. Method: The design of the study was qualitative which involved purposive sampling of health care professionals to undertake interactive interviews within a realist framework. Interviews were completed between September 2012 and October 2013 and were thematically analysed and then conceptualised according to context, mechanisms and outcomes. The settings were private care homes and services provided by the National Health Service including memory clinics, mental health and commissioning services in London, United Kingdom. The participants included 14 health and social care professionals including health care assistants, care home managers, commissioners for older adults’ services and nursing staff. Results: Good palliative care for people with advanced dementia is underpinned by the prioritisation of psychosocial and spiritual care, developing relationships with family carers, addressing physical needs including symptom management and continuous, integrated care provided by a multidisciplinary team. Contextual factors that detract from good end of life care included: an emphasis on financial efficiency over person-centred care; a complex health and social care system, societal and family attitudes towards staff; staff training and experience, governance and bureaucratisation; complexity of dementia; advance care planning and staff characteristics. Mechanisms that influence the quality of end of life care include: level of health care professionals’ confidence, family uncertainty about end of life care, resources for improving end of life care and supporting families, and uncertainty about whether dementia specific palliative care is required. Conclusions: Contextual factors regarding the care home environment may be obdurate and tend to negatively impact on the quality of end of life dementia care. Local level mechanisms may be more amenable to improvement. However, systemic changes to the care home environment are necessary to promote consistent, equitable and sustainable high quality end of life dementia care across the UK care home secto

Heterogeneous treatment effects of therapeutic-dose heparin in patients hospitalized for COVID-19

Importance Randomized clinical trials (RCTs) of therapeutic-dose heparin in patients hospitalized with COVID-19 produced conflicting results, possibly due to heterogeneity of treatment effect (HTE) across individuals. Better understanding of HTE could facilitate individualized clinical decision-making. Objective To evaluate HTE of therapeutic-dose heparin for patients hospitalized for COVID-19 and to compare approaches to assessing HTE. Design, Setting, and Participants Exploratory analysis of a multiplatform adaptive RCT of therapeutic-dose heparin vs usual care pharmacologic thromboprophylaxis in 3320 patients hospitalized for COVID-19 enrolled in North America, South America, Europe, Asia, and Australia between April 2020 and January 2021. Heterogeneity of treatment effect was assessed 3 ways: using (1) conventional subgroup analyses of baseline characteristics, (2) a multivariable outcome prediction model (risk-based approach), and (3) a multivariable causal forest model (effect-based approach). Analyses primarily used bayesian statistics, consistent with the original trial. Exposures Participants were randomized to therapeutic-dose heparin or usual care pharmacologic thromboprophylaxis. Main Outcomes and Measures Organ support–free days, assigning a value of −1 to those who died in the hospital and the number of days free of cardiovascular or respiratory organ support up to day 21 for those who survived to hospital discharge; and hospital survival. Results Baseline demographic characteristics were similar between patients randomized to therapeutic-dose heparin or usual care (median age, 60 years; 38% female; 32% known non-White race; 45% Hispanic). In the overall multiplatform RCT population, therapeutic-dose heparin was not associated with an increase in organ support–free days (median value for the posterior distribution of the OR, 1.05; 95% credible interval, 0.91-1.22). In conventional subgroup analyses, the effect of therapeutic-dose heparin on organ support–free days differed between patients requiring organ support at baseline or not (median OR, 0.85 vs 1.30; posterior probability of difference in OR, 99.8%), between females and males (median OR, 0.87 vs 1.16; posterior probability of difference in OR, 96.4%), and between patients with lower body mass index (BMI 90% for all comparisons). In risk-based analysis, patients at lowest risk of poor outcome had the highest propensity for benefit from heparin (lowest risk decile: posterior probability of OR >1, 92%) while those at highest risk were most likely to be harmed (highest risk decile: posterior probability of OR <1, 87%). In effect-based analysis, a subset of patients identified at high risk of harm (P = .05 for difference in treatment effect) tended to have high BMI and were more likely to require organ support at baseline. Conclusions and Relevance Among patients hospitalized for COVID-19, the effect of therapeutic-dose heparin was heterogeneous. In all 3 approaches to assessing HTE, heparin was more likely to be beneficial in those who were less severely ill at presentation or had lower BMI and more likely to be harmful in sicker patients and those with higher BMI. The findings illustrate the importance of considering HTE in the design and analysis of RCTs. Trial Registration ClinicalTrials.gov Identifiers: NCT02735707, NCT04505774, NCT04359277, NCT0437258