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Contributors to this Issue
Patient Power? Medical Perspectives on Patient Use of the Internet
Jennifer Tann , Adrian Platts , Sarah Welch & Judy Allen
Patients and carers now have unprecedented access to health information via specialist journals and the popular media, while the worldwide web has revolutionised public access to clinical information. Levels of patient demand for information about health have grown and there is evidence to suggest that patients wish to receive more information than is sometimes currently provided by clinicians. In secondary care, some specialisms have more readily adopted the use of information communication technologies (ICT) in clinician/patient communication than others. This paper focuses on clinicians’ perceptions of client Internet use for psychiatric conditions and studies the influence this has had on the consultation process in the United Kingdom. The research method consisted of a postal questionnaire distributed to the members of the Women in Psychiatry Group on the register of the Royal College of Psychiatry. Telephone interviews were conducted, employing the critical incident method, as well as a brief additional questionnaire. The data show that psychiatrists who used the Internet discerned client usage more readily. Where the client sought to discuss information acquired electronically with the consultant this tended to extend the consultation period, but a number of psychiatrists reported a greater sense of partnership as a result. The paper explores consultant perceptions of client motivations for Internet use and the perceived advantages and disadvantages for both client and psychiatrist. Overall, the psychiatry profession appears to be following the lead of clients in the use of ICT. Policy recommendations are offered with respect to the provision of profession-validated information on the Internet and psychiatrists’ training in IT.
Sporadic Innovation and Historical Continuity
J. L. Enos
This article argues that, by appealing to technological factors, one can compare different innovations, even different economies, over time. An application is made to the development of steam engines and turbines over their history from 1700 to 2000, for which it is shown that four types of physical variables–temperatures, pressures, thermal efficiencies and power ratings–provide common measures of succeeding devices. Such measures can be incorporated in a technological analogue of an input-output system. In principle, an entire economy could be represented in technological form; and, since scientific variables are invariant through time, its evolution could be depicted in quantitative terms.
Telecommunication Basic Research: An Uncertain Future for the Bell Legacy
A. Michael Noll
The Bell Labs of decades ago was well recognized as a national treasure for its pioneering innovations and its creation of new knowledge. However, the breakup of the Bell System that occurred in 1984 resulted in considerable change for research and development in telecommunication. This paper reviews that history and, in anticipation of continuing uncertainty and a possible impending crisis, examines possible options for the future to assure leadership by the United States in basic research in telecommunication.
The Viagra Files: The Web as Anticipatory Medium
The article introduces the research behind the making of Viagratool.org, the Lay Decision Support System on the World Wide Web. Viagratool.org is a ‘web knowledge instrument’ made to provide realities about a drug, available by searching, form-filling, online prescription, e-commerce and the post. Collaborative filtering, made famous by the disciples of Vannevar Bush, is used to ascertain information about Viagra. As we found with the aid of a group of collaborative filterers, Viagra comes across on the Web as a party drug, with distinct user groups–clubbers, sex tourists and others–not addressed by more official information providers–regulatory bodies, the medical industry or the manufacturer. Presented here are the findings that have led to two versions of the support system, one for the potential Viagra consumer, and another for the often overlooked second and third parties caught up in ‘Viagra situations’. In the first system, the collaborative filters found and kept information about its marketing (and re-selling), its serious harm in cocktail dosages, and insider accounts provided by seasoned aphrodisiac and other lifestyle drug users. The information is displayed in thought trajectories, each asking whether to consume it, from different angles. Importantly, the system is not a consumer-to-consumer information service or pure cohort support service. Rather, it allows a consumer to hear about Viagra from the marketeer, the emergency room medic, the humorist, and the user of Viagra and Viagra substitutes. Each could play a part in the Viagra decision. In the second version, we present Viagra situations, quite remote from the placid beach scenes with loving couples (on the Pfizer website), or a jogging Bob Dole, as seen on TV. Here, we move closer to employing the Web as an anticipatory medium by first resurrecting the second parties in Viagra situations, different from those in ‘normal, loving’ relationships. Finally, we call into existence third party observers, friends, onlookers, anticipating darker Viagra usage scenarios that are unavailable in the more official discourse.
The Hegemony of Microsoft®: An Australian Story
Each Australian state and the Australian Capital Territory has signed a ‘whole of education department’ contract with the Microsoft® Corporation for the provision of operating systems and other software. This contracted use of Microsoft® products is one story where the purchase of specific commodities is directly connected to the provision of public schooling. It is argued that through these contracts Microsoft® exercises a hegemonic relationship with the schooling systems in Australia. The legal relationships that exist between Microsoft® Corporation and the respective Australian states and territories schooling systems seem to mutually maintain and reinforce the monopolistic, or at best, oligopolistic position of Microsoft® Corporation and its hegemony over Australian public schooling. Further, it is argued that Microsoft’s® hegemonic position in part is maintained by both establishing a ‘commonsense’ about its products and by receiving legitimation and authority through the State for its products used in Australian schools.
Phenomenological Turbulence and Innovation in Knowledge Systems
Greg Hearn , David Rooney & Thomas Mandeville
Most considerations of knowledge management focus on corporations and, until recently, considered knowledge to be objective, stable, and asocial. In this paper we wish to move the focus away from corporations, and examine knowledge and national innovation systems. We argue that the knowledge systems in which innovation takes place are phenomenologically turbulent, a state not made explicit in the change, innovation and socio-economic studies of knowledge literature, and that this omission poses a serious limitation to the successful analysis of innovation and knowledge systems. To address this lack we suggest that three evolutionary processes must be considered: self-referencing, self-transformation and self-organisation. These processes, acting simultaneously, enable system cohesion, radical innovation and adaptation. More specifically, we argue that in knowledge-based economies the high levels of phenomenological turbulence drives these processes. Finally, we spell out important policy principles that derive from these processes.
Federalism in the Regulation of Chemical Pollutants in Australia
In response to the growth of the environment movement and increasing citizen concern for the environment, the Commonwealth and the Australian states moved to set up government departments of environment, or Environment Protection Agencies, in the early 1970s. At first the issues which engaged the public were ‘green’ ones, involving land and marine degradation, biodiversity (a term not then in use), and activities such as logging, mining and the generation of hydro-electric power. These were soon joined on the public agenda, however, by concerns over ‘brown’ issues such as chemical pollution and the management of hazardous chemicals and chemical wastes, but these were less well understood by the general public than the more visible ‘green’ issues. At this time, also, Australian governments took significant steps to achieve nationally consistent regulation through the work of ministerial councils, notably the Australian Environment Council (AEC) and subsequently the Australian and New Zealand Environment and Conservation Council (ANZECC). A further wave of environmentalism in the late 1980s and early 1990s, coupled with further development of the federalism model for environmental regulation that flowed from high-level inter-government meetings that were formalised as the Council of Australian Governments (COAG), gave rise to the formation of the National Environment Protection Council (NEPC). This body, while not giving more power to the Commonwealth, achieves national harmonisation of regulations through slightly more coercive processes than are available to the older-style ministerial councils. These continue to exist, however, operating in parallel with NEPC. For chemicals coming into use, there are national schemes under which the Commonwealth, states and territories regulated industrial, agricultural and veterinary chemicals, therapeutic substances, and food additives. Most ‘brown’ issues, however, remain with the successor to ANZECC, the Environment Protection and Heritage Council, as part of which NEPC continues to develop national approaches. In both periods of rapid change, there was a coincidence of environmentalism and federalism, but international developments were also important–in the first phase the United Nations’ first ‘environment’ meeting, held in 1972 in Stockholm, and in the second the developments flowing from the so-called ‘Earth Summit’ held in Rio de Janeiro in 1992. Although public environmentalism continues to be mainly concerned with ‘green’ issues, the ‘brown’ issues remain a focus for governments and some non-government organisations.