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T he digital divide has loomed as a public policy issue for over a decade. Yet, a theoretical account for the effects of the digital divide is currently lacking. This study examines three levels of the digital divide. The digital access divide (the first-level digital divide) is the inequality of access to information technology (IT) in homes and schools. The digital capability divide (the second-level digital divide) is the inequality of the capability to exploit IT arising from the first-level digital divide and other contextual factors. The digital outcome divide (the third-level digital divide) is the inequality of outcomes (e.g., learning and productivity) of exploiting IT arising from the second-level digital divide and other contextual factors. Drawing on social cognitive theory and computer self-efficacy literature, we developed a model to show how the digital access divide affects the digital capability divide and the digital outcome divide among students. The digital access divide focuses on computer ownership and usage in homes and schools. The digital capability divide and the digital outcome divide focus on computer self-efficacy and learning outcomes, respectively. This model was tested using data collected from over 4,000 students in Singapore. The results generate insights into the relationships among the three levels of the digital divide and provide a theoretical account for the effects of the digital divide. While school computing environments help to increase computer self-efficacy for all students, these factors do not eliminate knowledge the gap between students with and without home computers. Implications for theory and practice are discussed.

Our aim was to determine the effect of delay to surgery on the time to discharge, in-hospital death, the presence of major and minor medical complications and the incidence of pressure sores in patients with a fracture of the hip. All patients admitted to Vancouver General Hospital with this injury between 1998 and 2001 inclusive were identified from our trauma registry. A review of the case notes was performed to determine the delay in time from admission to surgery, age, gender, type of fracture and medical comorbidities. A time-to-event analysis was performed for length of stay. Additionally, a Cox proportional hazards model was used to determine the effect of delay to surgery on the length of stay while controlling for other pertinent confounding factors. Using logistical regression we determined the effect of delay to surgery on in-hospital death, medical complications and the presence of pressure sores, while controlling for confounding factors. Delay to surgery (p = 0.0255), comorbidity (p < 0.0001), age (p < 0.0001) and type of fracture (p = 0.0004) were all significant in the Cox proportional hazards model for increased time to discharge. Delay to surgery was not a significant predictor of in-hospital mortality. However, a delay of more than 24 hours was a significant predictor of a minor medical complication (odds ratio (OR) 1.53, 95% confidence interval (CI) 1.05 to 2.22), while a delay of more than 48 hours was associated with an increased risk of a major medical complication (OR 2.21, 95% CI 1.01 to 4.34), a minor medical complication (OR 2.27, 95% CI 1.38 to 3.72) and of pressure sores (OR 2.29, 95% CI 1.19 to 4.40). Patients with a fracture of the hip should have surgery early to lessen the time to acute-care hospital discharge and to minimise the risk of complications.

T he sale of digital items, such as avatars and decorative objects, is becoming an important source of revenue for virtual community (VC) websites. However, some websites are unable to leverage this source of revenue, and there is a corresponding lack of understanding about what motivates people to purchase digital items in VCs. To explain the phenomenon, we develop a model based on the theory of self-presentation. The model proposes that the desire for online self-presentation is a key driver for such purchases. We also hypothesize that the social influence factors of online self-presentation norms and VC involvement as well as personal control in the form of online presentation self-efficacy are antecedents of the desire for online self-presentation. The model was validated by using survey data collected from Cyworld (N = 217) and Habbo (N = 197), two online social network communities that have been pioneers in the sale of digital items. This work contributes to our understanding of the purchase of digital items by extending the theory of self-presentation and adds to the broader line of research on online identity. It also lends insights into how VC providers can tap this source of revenue.

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At a median 14 years after tibial nailing of isolated tibial fractures, patients' function is comparable to population norms, but objective and subjective evaluation shows persistent sequelae which are not insignificant. This study is the first to describe the long-term functional outcomes after tibial shaft fractures treated with intramedullary nailing nails. It may allow surgeons to better inform patients on the expected long-term function after intramedullary nailing of a tibia fracture. It may also prove useful when comparing intramedullary nailing nailing to other treatment techniques.

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AimWe conducted a responsibility analysis to determine whether drivers injured in motor vehicle collisions who test positive for Δ‐9‐tetrahydrocannabinol (THC) or other drugs are more likely to have contributed to the crash than those who test negative.DesignProspective case–control study.SettingTrauma centres in British Columbia, Canada.ParticipantsInjured drivers who required blood tests for clinical purposes following a motor vehicle collision.MeasurementsExcess whole blood remaining after clinical use was obtained and broad‐spectrum toxicology testing performed. The analysis quantified alcohol and THC and gave semiquantitative levels of other impairing drugs and medications. Police crash reports were analysed to determine which drivers contributed to the crash (responsible) and which were ‘innocently involved’ (non‐responsible). We used unconditional logistic regression to determine the likelihood (odds ratio: OR) of crash responsibility in drivers with 0 < THC < 2 ng/ml, 2 ng/ml ≤ THC < 5 ng/ml and THC ≥ 5 ng/ml (all versus THC = 0 ng/ml). Risk estimates were adjusted for age, sex and presence of other impairing substances.FindingsWe obtained toxicology results on 3005 injured drivers and police reports on 2318. Alcohol was detected in 14.4% of drivers, THC in 8.3%, other drugs in 8.9% and sedating medications in 19.8%. There was no increased risk of crash responsibility in drivers with THC < 2 ng/ml or 2 ≤ THC < 5 ng/ml. In drivers with THC ≥ 5 ng/ml, the adjusted OR was 1.74 [95% confidence interval (CI) = 0.59–6.36; P = 0.35]. There was significantly increased risk of crash responsibility in drivers with blood alcohol concentration (BAC) ≥ 0.08% (OR = 6.00;95% CI = 3.87–9.75; P < 0.01), other recreational drugs detected (OR = 1.82;95% CI = 1.21–2.80; P < 0.01) or sedating medications detected (OR = 1.45; 95%CI = 1.11–1.91; P < 0.01).ConclusionsIn this sample of non‐fatally injured motor vehicle drivers in British Columbia, Canada, there was no evidence of increased crash risk in drivers with Δ‐9‐tetrahydrocannabinol < 5 ng/ml and a statistically non‐significant increased risk of crash responsibility (odds ratio = 1.74) in drivers with Δ‐9‐tetrahydrocannabinol ≥ 5 ng/ml.