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Public Value Management in Digital Transformation : Emergent technology's impact on public services
(Háskólinn í Reykjavík, 2026-10) Hjaltalín, Illugi Torfason; Sigurðarson, Hallur Þór; Candi, Marina; Department of Business and Economics
This thesis addresses an important knowledge gap by examining the government-as-user role, a perspective that has received limited attention in artificial intelligence and digital governance research. Emergent technology, including artificial intelligence (AI) and algorithmic systems, is reshaping public sector digital transformation, raising important questions about how public value is framed, created, and enacted. This PhD research investigates how governance strategies and mechanisms shape the implementation of digital transformation initiatives in the public sector, and how emergent technology influences the framing and distribution of public value. The research approach is pluralistic, combining content and discourse analysis with theory-driven evaluation of digital transformation policies and service delivery programs to examine the discursive and practical dimensions of digital transformation across four papers. Papers I and II apply discourse analysis to digital policy and strategy documents, analyzing how public values and power dynamics are articulated, how users and public sector AI applications are positioned, and how these framings allocate benefits and responsibilities among stakeholders in digital governance. Papers III and IV draw on a longitudinal case of Digital Iceland (Stafrænt Ísland). Paper III systematically examines the adoption of a digital shared-services center, focusing on the emergence of a “center of excellence” and the functional components — organizational, technical, and governance-related — that support technology-enabled reforms in government. These components inform the contextual conditions used in developing the evaluative framework in Paper IV. Paper IV employs a theory-driven evaluation approach, adopting and adapting a context–mechanism–outcome (CMO) framework to evaluate Digital Iceland, and examines under what contextual conditions governance strategies and arrangements iv — in particular mechanisms such as flexible policy, accountability, and collaboration — are configured to generate or constrain public value outcomes. The originality of this approach lies in combining content and discourse analysis of digital policies with a theory-driven CMO logic to evaluate digital transformation programs, and in developing a PVM in Digital Transformation framework that evaluates digital governance arrangements. The thesis treats digital strategies and initiatives as analytically distinct yet interconnected domains, linking discursive positioning in national digital and AI strategies to the configuration of governance mechanisms in concrete programs. The framework argues that digital transformation outcomes are not determined by technology itself, but by how emergent technology applications are enacted within specific institutional arrangements and governance mechanisms, which in turn shapes whether public value is created, distributed, or destroyed in practice. It serves both analytical and practical purposes: analytically, by synthesizing the main findings into core concepts for evaluating digital governance; and practically, by considering how administrators translate public value framings into practice, how context-dependent mechanisms enable or constrain their efforts, and how these configurations yield public value outcomes such as improved service delivery, transparency, and responsiveness. The research shows both enabling and constraining effects of dominant discourses and organizational routines, identifies key barriers to agile digital transformation, and underscores the importance of inclusive governance strategies that align diverse stakeholder interests. Overall, this thesis advances evaluative e-government and digital governance research by offering a critical and realistic account of PVM that traces under what conditions governance mechanisms contribute to public value and when they become constrained in public sector digital transformation. In doing so, it bridges the longstanding gap between v policy framing and program outcomes, providing both a theoretically grounded evaluation framework and an empirically substantiated model for assessing how digital governance initiatives generate public value.
Verk
Longitudinal investigation of sleep and circadian rest-activity rhythms in non-small cell lung cancer patients during immunotherapy and associations with fatigue, depression, and perceived stress
(2025-10) Strøm, Louise; Zachariae, Robert; Wu, Lisa M.; Meldgaard, Peter; Ancoli-Israel, Sonia; Lekander, Mats; Mroczek, Daniel; Amidi, Ali; Department of Psychology
Background: Patients with advanced non-small cell lung cancer (NSCLC) face poor prognosis. However, new therapies like immune checkpoint inhibitors (ICIs) have improved survival. Nevertheless, ICIs act through immune activation – a proposed underlying mechanism of frequently reported symptoms such as sleep and circadian disturbances. The objective of this study was to longitudinally investigate sleep and circadian rest-activity rhythms and associations with psychological symptoms in NSCLC during ICI treatment. Methods: Newly diagnosed NSCLC patients were included in this prospective study, assessing insomnia severity, total sleep time, circadian rest-activity rhythms, and psychological symptoms (fatigue, depression, and stress) during the first five months of ICI treatment, using validated questionnaires, sleep diaries and actigraphy. Results: Forty-nine patients were included. Prior to treatment, patients slept on average 5.8 hours/night and 49 % reported clinical levels of insomnia. Spontaneous improvements in insomnia severity and total sleep time were observed, along with marginal but non-significant improvements in circadian rest-activity rhythm robustness. Insomnia severity was significantly associated with higher levels of fatigue (p = .004), depression (p = .007), and perceived stress (p = .033). Moreover, lower circadian rest-activity robustness was associated with more fatigue (p = .021). At baseline, mean levels of fatigue, depression, and perceived stress were below clinical levels and declined further over time. Conclusion: Sleep disturbances, circadian disruption, and psychological symptom burden in NSCLC patients were greatest prior to and shortly after initiation of ICI treatment, with gradual improvement over the first five months. However, inter-individual differences in sleep and circadian disturbances were evident and linked to psychological symptoms.
Verk
From Farm to Fork : The Role of AI in Advancing Sustainable Business Practices
(2025-07-31) Sigurjonsson, Throstur Olaf; Wendt, Stefan; Department of Business and Economics
This study examines how artificial intelligence (AI) supports environmental and social sustainability in the Icelandic food industry across the full value chain—from production to retail. Using a qualitative design, five semi-structured interviews were conducted with senior executives from food production, processing, and distribution firms. Thematic analysis revealed that AI is primarily applied for automation, quality control, energy efficiency, and workplace safety. Although not initially adopted for sustainability purposes, AI delivers indirect benefits such as reduced material use, lower energy and water consumption, and minimized food waste. For instance, AI-based quality control improved efficiency in meat and fish processing, while predictive tools enhanced inventory accuracy in retail. Importantly, no evidence was found of rebound effects or increased resource use. Instead, AI contributes to sustainability mainly through operational improvements. Its adoption is largely driven by external factors such as labor shortages, regulatory pressures, and consumer expectations. Despite its promise, challenges remain, particularly in data-sharing, implementation costs, and public trust. The study highlights the importance of embedding AI in broader ethical and sustainability frameworks to ensure its long-term contribution to responsible food system transformation.
Verk
Psychological Intervention for Patients with Biopsychosocial Late Effects Following Surgery for Colorectal Cancer with Peritoneal Metastases—A Feasibility Study
(2025-04) Balachandran, Rogini; Thaysen, Henriette Vind; Christensen, Peter; Nissen, Eva Rames; O’Toole, Mia Skytte; Knutzen, Sofie Møgelberg; Buskbjerg, Cecilie Dorthea Rask; Wu, Lisa Maria; Tauber, Nina; Amidi, Ali; Danielsen, Josefine Tingdal Taube; Zachariae, Robert; Iversen, Lene Hjerrild; Department of Psychology
Background: Up to 80% of patients experience late effects (LE) one year after surgery for peritoneal metastases (PM) from colorectal cancer (CRC). We tested the feasibility and outcome of a treatment strategy to address LEs. Methods: During January 2021–May 2023, patients who had undergone surgery for CRC-PM in Denmark were screened for biopsychosocial LEs (anxiety, depression, fear of cancer recurrence, insomnia, cognitive impairment, pain, fatigue). Patients scoring according to clinical cut-offs were referred to a Multi-Disciplinary Team conference (MDT). The patients, surgeon(s), nurse(s), and psychologists participated in the MDT, identified key concerns and proposed a personalized intervention. Pre- and post-intervention, patients completed a “Measure Yourself Concerns and Wellbeing” (MYCaW) questionnaire, rating the two most distressing LEs and general wellbeing on a 7-point Likert scale. Results: Of 28 eligible patients, 13 (59 years (mean), 85% women) accepted referral, participated in the MDT, and were offered a personalized intervention. The intervention was completed by 11 patients. Improvement in MYCaW score was observed 1 month postintervention for all three items: (1) the primary LE (p = 0.003, Hedges’s g 1.54), (2) the secondary LE (p < 0.001, Hedges’s g 1.65), and (3) general wellbeing (p = 0.005, Hedges’s g 1.09). This improvement was sustained 6 months postintervention. The 15 non-participants were, in general, older (66 years (mean), men 73%). Conclusions: Screening for LEs and conducting an MDT can provide a personalized intervention plan, which patients are able to complete and may benefit from.
Verk
Cognitive impairment in patients with melanoma before adjuvant immune checkpoint inhibitor therapy and associations with brain gray matter, catechol-O-methyltransferase genotype, and psychological factors
(2025-01-15) Danielsen, Josefine T.; Zachariae, Robert; Schmidt, Henrik; Kallehauge, Jesper F.; Thomadsen, Julie K.; Wefel, Jeffrey S.; Wu, Lisa M.; Amidi, Ali; Department of Psychology
Background: Cancer-related cognitive impairment (CRCI) is a significant concern in patients with cancer but understanding its prevalence and risk factors in patients with malignant melanoma (MMPs) remains limited. This study explores CRCI via a multifaceted approach integrating neurobiological, genetic, and psychological assessments. Methods: Cognitive functioning across multiple domains was assessed via neuropsychological tests in 47 MMPs before adjuvant immune checkpoint inhibitor therapy, compared with 53 matched healthy controls (HCs). Self-reported cognitive complaints, brain gray matter (GM) properties, catechol-O-methyltransferase (COMT) genotype, and psychological and behavioral factors were evaluated. Between-group differences were analyzed with t-tests and χ2 tests, and associations were explored with correlation analyses. GM properties were assessed in a subset of 23 MMPs and 47 HCs. Results: MMPs exhibited significantly lower cognitive functioning across multiple tests (all p <.05), with a high CRCI prevalence (68.1% vs. 26.4% in HCs). MMPs reported higher fatigue, anxiety, and insomnia severity and poorer sleep quality and quality of life (all p <.01). Self-reported cognitive complaints in MMPs were associated with some cognitive test scores (all p <.05), fatigue (p <.001), and anxiety (p =.045). GM analyses revealed a smaller left cuneus volume in MMPs and significant associations between MMPs' processing speed and cortical thickness (right precentral and left inferior parietal regions) and between delayed verbal memory and right postcentral GM volume (all p <.01). Conclusions: These findings underscore the need for comprehensive assessments in MMPs to better understand and address CRCI. A multifaceted approach would provide valuable insights that could inform future interventions and improve patient outcomes and quality of life.

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