The Telehealth Divide

CYBER NEWS

The development and use of digital technology in everyday life also affects education. Interactive videos are one of the tools to enhance the learning experience by allowing students to participate actively and individually. This paper presents the freely available website Videoslovenščina and the results of a two-part-study on language teaching with interactive videos in 4th grade Slovene Language classes. In the part A of the study, a t-test with independent samples showed, among other things, that students who used the interactive videos in class performed better on a test of writing names than students who did not use the videos. The results of part B of the study showed that the vast majority of fourth graders surveyed preferred the use of interactive videos to traditional instruction, citing a number of benefits of such instruction.

Opioid agonist therapy (OAT) access is restricted by regulatory and allocative treatment policies. Oppressive social conditions inform the creation and implementation of policies and treatment systems that limit access to life-saving care. Jin et al. [1] had the difficult task of summarizing opioid agonist therapy (OAT) delivery practice indicators from around the world (n = 41 countries). They observed variation in OAT eligibility criteria (e.g. age, step-therapy), increased frequency of OAT underdosing, differences in access to unsupervised OAT dosing, variation in urine drug screen practices, and concerningly, the provision of patient information to law enforcement agencies in some jurisdictions [1]. The review, however, did not explicitly explore how broader structural elements inform OAT clinical practice and treatment system design, specifically, policy. Access to OAT is informed through an amalgamation of contemporary and historic social conditions (e.g. racism, classism, capitalism, and moralism/stigma) and how society and decision makers conceptualize addiction (e.g. moral/criminal model versus brain disease model [2]). In turn, these elements are institutionalized through regulatory and allocative treatment policies, dictating the design of treatment systems, which subsequently influences how OAT is delivered (where, when, and by whom) and who receives care. In the United States (US), OAT is regulated unlike any other pharmaceutical product. Methadone and buprenorphine administration and prescribing occur within the context of special regulatory systems. Methadone must be dispensed, often through observed daily dosing, in federally certified opioid treatment programs (OTPs) [3]. To prescribe buprenorphine, physicians must receive a special federal-waiver (i.e. the X-waiver) and are limited in the number of patients they can prescribe to [3]. In contrast, in Canada, methadone and buprenorphine may be prescribed and administered through the pharmacy system without special federal requirements [4]. This special regulatory apparatus is just one of several categories of OAT access barriers (e.g. provider, institutional, and financial among others) [5]. Furthermore, the two-tiered design of the US OAT regulatory system [6-8] propagates OAT access inequities, based on race [9, 10], class [10], and educational-demographics [11]. OTPs across the US are more likely to be located in highly segregated Black and Hispanic/Latinx neighborhoods, compared with buprenorphine, which is more readily available in highly segregated White neighborhoods [9]. In a study of office-based buprenorphine access, Black patients are less likely to receive buprenorphine (adjusted OR = 0.23; 95% CI = 0.13–0.44) as compared with White patients [10]. These findings build on the original evaluation of the buprenorphine waiver system where researchers observed differences among patients who received buprenorphine versus methadone; specifically, buprenorphine patients were more likely to be White, employed, and with some college education [11]. In addition to differences in access by OAT type, racial disparities in OAT access persist. Compared with White women, Black and Hispanic women are significantly less likely to receive any medication for OUD treatment [12]. Similarly, Black veterans receiving care in the Veterans Health Administration have lower odds of starting buprenorphine compared to White patients [13]. In addition to regulatory constraints, allocative policies inform and dictate OAT access. This is of particular importance in societies where the delivery of health care services is commodified and privatized [14]. In the US, a standardized national health insurance program or delivery system does not exist; instead, the US has a fragmented collection of governmental health insurance programs for specific sub-populations (e.g. Medicare, Medicaid, and Tricare), and for-profit and not-for-profit health insurance enterprises. A commodified health services delivery and health insurance market aims to “…optimize the market from their perspective and for their benefit” [15]. Therefore, the US economic production system informs and dictates health care service delivery, which is reflected in payer polices, and, subsequently, access to OAT [16]. Until recently (January 2020), for example, Medicare, the US federally sponsored health insurance plan for patients age 65 and above and those with disabilities, did not cover services received in an OTP [17]. Moreover, private Medicare Part D plans decreased buprenorphine coverage options from 2007 to 2018, as opioid-related overdoses were increasing [18]. Further, many Medicaid programs continue to impose buprenorphine coverage restrictions [19]. Access to OAT, in the US and internationally, is undoubtedly constrained and restricted by federal and local regulatory and allocative treatment policies. Social conditions and oppressive elements inform the creation and implementation of these policies, treatment system design, and subsequently access to care. None. Many thanks to Dr. Dennis McCarty for his comment and review of this commentary. National Institute on Drug Abuse (F30DA044700). The content of this manuscript does not represent the views of the US Government.

ObjectivePatient experience significantly impacts healthcare quality, outcomes, resource utilisation and treatment adherence. Digital technologies offer promising approaches for capturing real-time, multi-faceted patient experiences. This scoping review investigated how digital technologies are used to capture patient experience during healthcare encounters and their potential to improve health service delivery and care.MethodsA scoping review was conducted to determine associations between patients’ use of digital technology and subsequent outcomes. Four electronic databases were searched using six combination search terms in titles and/or abstracts published between 2016 and 2022. Inclusion criteria focused on studies where patients were primary users of digital technology, reporting on their experience during care. Studies had to report on at least one outcome: health service delivery, quality of care or patient experience. Screening, data extraction and analysis were performed systematically.ResultsOf the 377 studies retrieved, 20 were included. Most studies incorporated aspects allowing patients to share experiences with digital technologies. Eighty percent (n = 16) of studies reported improvements in patient experiences, 75% (n = 15) enhancements in service delivery aspects and 50% (n = 10) indicated improved quality of care associated with the use of digital technologies. Real-time journaling and narrative methods alongside treatment were linked to improved communication, healthcare efficiencies and patient agency. Technologies facilitating bidirectional communication were particularly associated with positive effects on patients’ sense of agency.ConclusionDigital technologies facilitating documentation of patient experiences demonstrate potential in enhancing care quality through increased patient voice, collaboration and agency. Technologies designed to map and evaluate patients’ healthcare experiences represent a promising approach to improving healthcare outcomes, service delivery and overall patient experience. Further research is needed to establish standardised methodologies and evaluate long-term impacts across diverse populations. Integrating digital narrative medicine principles may offer valuable insights for future interventions aimed at capturing and enhancing patient experiences in healthcare.

In its June 2011 report to President Barak Obama, the President’s Council of Advisors on Science and Technology (PCAST) noted that: ‘While the United States may not be able to compete in the long run to make goods for which low wage unskilled labor is the key input, this need not be true for sophisticated manufacturing linked to products and processes derived from scientific discovery and technological innovation’. Rather than focusing policy efforts on low technology manufacturing, PCAST argues that ‘advanced manufacturing provides the path forward to revitalizing US leadership in manufacturing and will best support economic productivity and ongoing knowledge production and innovation in the Nation’. In June 2011, President Obama announced the launching of the Advanced Manufacturing Partnership, an effort bringing together industry, universities, and the federal government to invest in such emerging technologies as nano-scale carbon materials, next-generation optoelectronics, flexible electronics, and nanotechnology enabled medical diagnostic devices and therapeutics. PCAST argues for a coherent innovation policy that manifests itself in a recommended ‘Advanced Manufacturing Initiative for America’s Future’ (‘AMI’) – a concerted government effort led by the US Departments of Commerce, Defense, and Energy, and coordinated by the Executive Office of the President. How does an AMI based on an ‘innovation policy’ harmonize with an Administration that has been consistently following an ‘industrial policy’ that financially – as well as through its regulatory policies – supports and influences specific manufacturing companies and industries that it deems as ‘winners’? The short answer is not well. Both ‘tilting the field’ and ‘playing the role of principal actor’ is how the Obama administration has actively supported ‘green’ technology companies, and this industrial policy could be expanded in a second term to other government designated ‘winners’ at the competitive expense of other industry sub-sectors of advanced manufacturing.

E-health (eHealth) is an emerging field of health communication encompassing medical informatics, public health, and business where health information and services are exchanged through electronic processes. The current leading researchers in e-health include: Dr. Gunther Eysenbach from University of Toronto on health information and decision-making; Dr. David Gustafson from University of Wisconsin, Madison on interactive support systems; The Pew Internet and American Life Project on chronicling e-health use; Dr. Neil Coulson from University of Nottingham on online support group communication, and Dr. Elizabeth Murray from University College London, who develops online treatments. This entry summarizes research on e-health behaviors: seeking health information online, the impact of patient-to-patient communication on health, and receiving treatment online. Future directions for research on e-health behaviors include exploring the disadvantages of online support groups, research on minority populations, development of online randomized controlled trial methodology, and longitudinal research examining e-health behaviors over time.

The Internet is often characterized as a disruptive technology, as recently argued by the music industry against Napster and by Sony against PC emulations of its PlayStation. Three questions are raised: 1) How much does the Internet replace traditional media? 2) As another channel, does the Internet supplement traditional media? 3) How much do Internet users navigate the Web in order to download relevant goods (news, music, movies) as part of their consumption and purchase strateg ies? Data from the Pew Internet and American Life Project are used to test two competing hypotheses: 1) Easily copied and distributed digital content encourages consumers to exploit the information wants to be free character of the Internet, thereby hampering the growth of the market for goods and services, and 2) Information consumers practice a sophisticated arbitrage process across different media, by weighing the value of online and offline and thereby reinforcing active participation in the electronic marketplace. The efforts of the music industry to obstruct the downloading of MP3s may represent a serious misunderstanding of consumer arbitrage practices, much as book publishers' characterize library use as a threat to book sales. Policy implications of this work extend into ongoing public and corporate policy debates about digital content and intellectual property. ____________________ John B. Horrigan is the research director of The Pew Internet and American Life

Pew Internet and American Life Project

Exploring Web 2.0 political engagement: Is new technology reducing the biases of political participation?

Click to increase image sizeClick to decrease image size Notes Michael Booth, Many in U.S. Don't Mind Being E-mauled, DENVER POST, Aug. 16, 1998, at A1. http://www.spectorsoft.com/products/SpectorPro_Windows/index.html. [Visited January 7, 2007]. 18 United States Code 2510-2522 (2000). Lisa K. Bruno, 1st Circuit rules company VP can be charged for intercepting e-mail, Rhode Island Lawyers Weekly, August 22, 2005. Steve Wilmsen, Internet Merchant Accused of Intercepting Rival's E-Mail, Boston Globe, Nov. 23, 1999, at A1. Section 2510(4). Jessica Belskis, Article: Applying the Wiretap Act to Online Communications After U.S. v. Councilman, 2 Shidler Journal of Law, Commerce and Technology 18, Spring 2006. U.S. v. Councilman, 373 F.3d 197 (1st Cir. 2004). U.S. v. Councilman, 418 F.3d 67 (1st Cir. 2005) (en banc). Victory in US v. Councilman Case, http://I-newswire.com/pr41879.html. [Visited December 1, 2006]. Pew Internet & American Life Project, Daily Internet Activities, www.pewinternet.org/trends (last visited Aug. 19, 2006). Samantha L. Martin, Note: Interpreting the Wiretap Act: Applying Ordinary Rules of “Transit” To The Internet Context, 28 Cardozo Law Review 441, October 1996. Charles Arthur, Identity Crisis on the Internet, New Scientist, March 11, 1995. A full discussion of remailing can be found at www.andrebacard.com/remail.html. (Visited January 12, 2007). Allison R. Michael and Scott M. Lidman, Monitoring of Employees Still Growing: Employers Seek Greater Productivity and Avoidance of Harassment Liability; Most Workers Have lost on Privacy Claims, National Law Journal, January 29, 2001. Blakely v. Continental Airlines Inc., 751 A.2d 538 (N.J. Sup. Ct. 2000). Meir S. Hornung, Think Before You Type: A Look at Email Privacy in the Workplace, 15 Fordham Journal of Corporate and Financial Law 115, 2005. Ari Schwartz, Deirdre Mulligan and Indrani Mondral, COMMENTARY: Storing Our Lives Online: Expanded Email Storage Raises Complex Policy Issues, 1 I/S: A Journal of Law and Policy for the Information Society 997, Spring/Summer 2005. American Management Association, 2005 Electronic Monitoring Surveillance Survey, www.amanet.org/research/pdfs/EMS-summary05.pdf. [Visited January 7, 2007]. Michael L. Rustad and Thomas H. Koenig, Cybertorts and Legal Lag: An Empirical Analysis, 13 Southern California Interdisciplinary Law Journal 77 (2003). Barbara Kate Repa, Computers and Email on the Job, www.hrlawinfo.com/lawguide/Privacy/computers_and_emai.asp, [Visited January 7, 2007].

Background: Although use of social media is an important part of adolescents’ lives, the mental health impact of this activity is largely unknown to practitioners. Methods: An extensive literature search was conducted regarding social media use among adolescents and the benefits and potential risks associated with that use. A PUBMED search was conducted using various terms including “social media and teens”, “social media and suicide”, “facebook and suicide”, “sexting”, “cyberbullying”, “facebook and teens”, “social media and self-injury”. Relevant articles were examined and used in this review. Also, reports on adolescent social media use from the Pew Internet and American Life Project were examined. Results: This newer form of communication has many benefits to adolescents and plays an important role in their social lives. Despite the numerous benefits of these technologies, there are also several potential risks that can be detrimental to the mental health and well-being of adolescents. Conclusions: It is critical that child psychiatrists and other mental health providers be informed of these potential risks so they can more effectively educate and treat their adolescent patients and their families.

The use of the term “digital natives” has led to a great deal of controversy. Most academics dislike it, for good and sufficient reasons. Among other problems, the term implies that digital skills are innate rather than taught and learned. But the term resonates for many parents, teachers, and policy-makers. In this article, we describe our efforts to reclaim the awkward term “digital natives,” despite its obvious defects, in an attempt to reach a broader audience for the sound social scientific research about youth media practices that is emerging from the academic world. Many—though not all—young people are using digital media in ways that are changing how they learn and how they relate to one another, to information, and to institutions. In this article, we make the case that the sum of these changes in youth media practices can be good for teaching and learning, but that they are not without complications. Along the way we also make the case, in tension with what others in this volume have argued, that the use of the term “Digital Natives” can be a constructive way to reach parents and teachers and that it can be done in such a fashion that is true to sound research about youth practices with respect to digital media. The roadmap to this Article is as follows. First, we explore the awkward term “Digital Natives,”1 explain why we have chosen to use it * Henry N. Ess Professor of Law and Vice Dean for Library and Information Resources, Harvard Law School; Faculty Co-Director, Berkman Center for Internet & Society at Harvard University. The authors wish to thank Momin Malik and Sandra Cortesi for invaluable research assistance on this article. ** Executive Director, Berkman Center for Internet & Society at Harvard University; previously Professor of Law, University of St. Gallen, Switzerland. I/S: A JOURNAL OF LAW AND POLICY FOR THE INFORMATION SOCIETY 34 I/S: A JOURNAL OF LAW AND POLICY [Vol. 6:3 I/S: A JOURNAL OF LAW AND POLICY [Vol. 7:1 in certain contexts, and to describe some of the common attributes of this subset of the world’s young people today. Then, we will address some of the key problems faced by these young people and others in society. Last, we will end with a positive outlook. While there are problems associated with youth media practices, and challenges for large learning institutions in responding to those problems, overall we believe a bright future can lie ahead if we are smart about it and listen to sound research. The goal of our research has been to understand how young people use technology and relate to information in a digital era and to address the implications of lives that are highly mediated by digital technologies. At the same time, we have looked hard at articulated positions about youth and digital media that might be more myth than reality. One related purpose of our work is to examine what the most important implications of these practices are for learning institutions, including universities and libraries. In performing this research, we have built on the shoulders of giants. There are many other people who have studied this topic for a long time, like Mizuko Ito,2 danah boyd,3 and, at the Pew Center for Internet and American Life, Amanda Lenhart.4 While the most extensive empirical work on this topic has been done in the United States and in the United Kingdom, we have grounded our work in the 1 JOHN PALFREY & URS GASSER, BORN DIGITAL: UNDERSTANDING THE FIRST GENERATION OF DIGITAL NATIVES (2008). 2 MIZUKO ITO, SONJA BAUMER, MATTEO BITTANTI, DANAH BOYD, RACHEL CODY, BECKY HERRSTEPHENSON, HEATHER A. HORST, PATRICIA G. LANGE, DILAN MAHENDRAN, KATYNKA Z. MARTINEZ, C. J. PASCOE, DAN PERKEL, LAURA ROBINSON, CHRISTO SIMS, & LISA TRIPP, HANGING OUT, MESSING AROUND, AND GEEKING OUT: KIDS LIVING AND LEARNING WITH NEW MEDIA (2010); MIZUKO ITO, HEATHER A. HORST, MATTEO BITTANTI, DANAH BOYD, BECKY HERR-STEPHENSON, PATRICIA G. LANGE, C. J. PASCOE, & LAURA ROBINSON (WITH SONJA BAUMER, RACHEL CODY, DILAN MAHENDRAN, KATYNKA Z. MARTINEZ, DAN PERKEL, CHRISTO SIMS, & LISA TRIPP), THE JOHN D. AND CATHERINE T. MACARTHUR FOUNDATION REPORTS ON DIGITAL MEDIA AND LEARNING – LIVING AND LEARNING WITH NEW MEDIA: SUMMARY OF FINDINGS FROM THE DIGITAL YOUTH PROJECT (Nov. 2008), available at http://digitalyouth.ischool.berkeley.edu/report. 3 danah boyd, Why Youth ♥ Social Network Sites: The Role of Networked Publics in Teenage Social Life, in MACARTHUR FOUNDATION SERIES ON DIGITAL LEARNING YOUTH, IDENTITY, AND DIGITAL MEDIA VOLUME, 119–42 (David Buckingham ed., 2007), available at http://www.danah.org/papers/WhyYouthHeart.pdf. 4 Amanda Lenhart & Mary Madden, TEEN CONTENT CREATORS AND CONSUMERS, PEW INTERNET & AMERICAN LIFE PROJECT (Nov. 2, 2005), http://www.pewinternet.org/Reports/2005/Teen-Content-Creators-and-Consumers.aspx. 2011] PALFREY AND GASSER 35 I/S: A JOURNAL OF LAW AND POLICY [Vol. 6:3 extensive literature of researchers around the world.5 To the extent that we have relied upon the work of other colleagues, we have documented much of that reading in the form of two extensive literature reviews6 with a forthcoming third literature review led by Urs Gasser related to youth, media, credibility and information quality.7 A related piece, written in partnership with UNICEF, is a review of the literature related to youth media practice and safety around the world.8 Our book, Born Digital, also includes a Selected Bibliography that notes the texts and projects that most influenced our thinking.9 To complement the research work of others, we have also held our own series of focus groups and interviews to try and understand what the key issues are associated with how young people use digital media. 5 E.g., MACARTHUR FOUNDATION SERIES ON DIGITAL LEARNING YOUTH, IDENTITY, AND DIGITAL MEDIA (David Buckingham ed., 2007), available at http://mitpress.mit.edu/catalog/item/default.asp?ttype=2t NICOLA DORING, SOZIALPSYCHOLOGIE DES INTERNET. DIE BEDEUTUNG DES INTERNET FUR KOMMUNIKATIONSPROZESSE, IDENTITATEN, SOZIALE BEZIEHUNGEN UND GRUPPEN (2d ed. 2003); MACARTHUR FOUNDATION SERIES ON DIGITAL LEARNING DIGITAL MEDIA, YOUTH, AND CREDIBILITY (Miriam J. Metzger & Andrew J. Flanagin eds., 2007), available at http://mitpress.mit.edu/catalog/item/default.asp?ttype=2t SONIA LIVINGSTONE, CHILDREN AND THE INTERNET (2009); KIRSTEN DROTNER & SONIA LIVINGSTONE (EDS.), INTERNATIONAL HANDBOOK OF CHILDREN, MEDIA AND CULTURE

First, the establishment of local (provincial, autonomous region, municipal, and county) commercial organs is to be decided by the people's councils of each province, autonomous region, and municipality directly under the central government, in accordance with local conditions. When two or more commercial departments or bureaus are merged, from the financial point of view it is proper for them to abandon their original system of independent calculation and implement a new system of unified calculation. But they must still accept guidance on administrative principles and policies from commercial departments to which they were formerly subordinated. In principle, local commercial administrative organizations and enterprise organizations should be merged. For example, commercial departments and bureaus are to be changed into organizations taking charge of both administrative affairs and enterprise management, and the existing local specialized commercial companies are to be abolished and become a bureau or office within a commercial department or bureau. In certain large cities or districts, merging is not necessary if a careful study shows that it is impracticable.

The impact of the Covid-19 pandemic on the education system has altered from face-to-face learning to online learning. The sudden pandemic made teachers underprepared either psychologically or pedagogically to teach online learning. Many teachers often faced psychological pressure while preparing for online teaching due to the lack of digital literacy. Teachers now have to overcome pressures for understanding digital literacy. Teachers have issues with: 1) the lack of digital literacy mastery and/or the utilization of digital learning platforms, and 2) the lack of teachers’ ability in creating meaningful learning through the use of digital technology and/or interactive multimedia. By providing the 33 teachers with support and training in digital literacy, those issues could be resolved. The assistance is focused on how to use digital learning platforms and produce android learning and interactive multimedia videos to support the learning process in the classroom. The findings showed that teachers are becoming more knowledgeable about digital literacy, particularly as it relates to the utilization of digital learning platforms and the creation of android learning videos and interactive multimedia learning videos to support the learning process in the classroom. Through the use of digital learning platforms in the classroom, teachers can provide meaningful learning experiences to students and students can actively engage in the learning process. In addition, digital literacy helps teachers increase students’ enthusiasm in the classroom, and students’ autonomous learning.

Regulatory and other public policy issues in the future of biomedical engineering, as they relate to the development and use of medical devices, are discussed. At the federal level, agencies that directly influence the application of medical technology include the Food and Drug Administration (FDA), with its clinical trials and premarket and regulatory authority, and the Health Care Financing Administration (HCFA), with its reimbursement policy. The Occupational Safety and Health Administration (OSHA), the Environmental Protection Agency (EPA), and the Department of Commerce can have a considerable impact on corporate profitability, which is a driving force for most new technology and new product introductions. Another area of public policy that has been cited as significantly influencing health care and medical device development, namely, civil litigation, is also considered. To illustrate the issues, the impact of the regulatory environment on the application of computer software to a wide variety of medical products is examined. The humanistic and ethical problems brought about by technological advances are discussed. Ten key technologies that are likely to have the greatest importance in the next few years and ten external influences on the future of the medical device technology industry that have been identified by the Health Industry Manufacturers Association are described.