Sample records for proposed telehealth system
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Proposal for a telehealth concept in the translational research model.
Silva, Angélica Baptista; Morel, Carlos Médicis; Moraes, Ilara Hämmerli Sozzi de
2014-04-01
To review the conceptual relationship between telehealth and translational research. Bibliographical search on telehealth was conducted in the Scopus, Cochrane BVS, LILACS and MEDLINE databases to find experiences of telehealth in conjunction with discussion of translational research in health. The search retrieved eight studies based on analysis of models of the five stages of translational research and the multiple strands of public health policy in the context of telehealth in Brazil. The models were applied to telehealth activities concerning the Network of Human Milk Banks, in the Telemedicine University Network. The translational research cycle of human milk collected, stored and distributed presents several integrated telehealth initiatives, such as video conferencing, and software and portals for synthesizing knowledge, composing elements of an information ecosystem, mediated by information and communication technologies in the health system. Telehealth should be composed of a set of activities in a computer mediated network promoting the translation of knowledge between research and health services.
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A framework for telehealth program evaluation.
Nepal, Surya; Li, Jane; Jang-Jaccard, Julian; Alem, Leila
2014-04-01
Evaluating telehealth programs is a challenging task, yet it is the most sensible first step when embarking on a telehealth study. How can we frame and report on telehealth studies? What are the health services elements to select based on the application needs? What are the appropriate terms to use to refer to such elements? Various frameworks have been proposed in the literature to answer these questions, and each framework is defined by a set of properties covering different aspects of telehealth systems. The most common properties include application, technology, and functionality. With the proliferation of telehealth, it is important not only to understand these properties, but also to define new properties to account for a wider range of context of use and evaluation outcomes. This article presents a comprehensive framework for delivery design, implementation, and evaluation of telehealth services. We first survey existing frameworks proposed in the literature and then present our proposed comprehensive multidimensional framework for telehealth. Six key dimensions of the proposed framework include health domains, health services, delivery technologies, communication infrastructure, environment setting, and socioeconomic analysis. We define a set of example properties for each dimension. We then demonstrate how we have used our framework to evaluate telehealth programs in rural and remote Australia. A few major international studies have been also mapped to demonstrate the feasibility of the framework. The key characteristics of the framework are as follows: (a) loosely coupled and hence easy to use, (b) provides a basis for describing a wide range of telehealth programs, and (c) extensible to future developments and needs.
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A product-service system approach to telehealth application design.
Flores-Vaquero, Paul; Tiwari, Ashutosh; Alcock, Jeffrey; Hutabarat, Windo; Turner, Chris
2016-06-01
A considerable proportion of current point-of-care devices do not offer a wide enough set of capabilities if they are to function in any telehealth system. There is a need for intermediate devices that lie between healthcare devices and service networks. The development of an application is suggested that allows for a smartphone to take the role of an intermediate device. This research seeks to identify the telehealth service requirements for long-term condition management using a product-service system approach. The use of product-service system has proven to be a suitable methodology for the design and development of telehealth smartphone applications. © The Author(s) 2014.
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Telehealth coordinators in hospital based telehealth services: Who are they and what do they do?
Edirippulige, Sisira; Armfield, Nigel R; Greenup, Phil; Bryett, Andrew
2016-12-01
Many studies have identified the importance of 'telehealth coordinators' for successful telehealth implementation and operation. However, little is known about the telehealth coordinators' functions, the skills and competencies required and the reasons for their influence. This study aimed to examine the key functions of telehealth coordinators in the Queensland public health system, their perceptions about their role, and the level of competencies to support this role. All telehealth coordinators within Queensland Health Telehealth Services were invited to complete a questionnaire. We collected: (i) demographic information; (ii) details of their telehealth work; and (iii) information about knowledge and skills relevant to their telehealth coordinator role. Eighteen of 20 (90%) participants completed and submitted the survey. Telehealth coordinators were responsible for a range of tasks relating to telehealth consultations, technical assistance, administration, research, promotion and marketing. Nearly all telehealth coordinators (n = 17, 94%) were confident in carrying out the tasks of their job. The majority of telehealth coordinators (n = 13, 72%) thought education and training relating to telehealth would help improve their job. The top three topics that telehealth coordinators were keen to learn about were: (i) examples of clinical use of telehealth; (ii) types of technologies used; and (iii) telehealth clinical and business models. Our participants were all hospital-based; as the use of telehealth is growing outside of the traditional hospital settings, the role of telehealth coordinators is likely to change. © The Author(s) 2016.
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Tsai, Chung-Hung
2014-05-07
Telehealth has become an increasingly applied solution to delivering health care to rural and underserved areas by remote health care professionals. This study integrated social capital theory, social cognitive theory, and the technology acceptance model (TAM) to develop a comprehensive behavioral model for analyzing the relationships among social capital factors (social capital theory), technological factors (TAM), and system self-efficacy (social cognitive theory) in telehealth. The proposed framework was validated with 365 respondents from Nantou County, located in Central Taiwan. Structural equation modeling (SEM) was used to assess the causal relationships that were hypothesized in the proposed model. The finding indicates that elderly residents generally reported positive perceptions toward the telehealth system. Generally, the findings show that social capital factors (social trust, institutional trust, and social participation) significantly positively affect the technological factors (perceived ease of use and perceived usefulness respectively), which influenced usage intention. This study also confirmed that system self-efficacy was the salient antecedent of perceived ease of use. In addition, regarding the samples, the proposed model fitted considerably well. The proposed integrative psychosocial-technological model may serve as a theoretical basis for future research and can also offer empirical foresight to practitioners and researchers in the health departments of governments, hospitals, and rural communities.
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Directory of Open Access Journals (Sweden)
Chung-Hung Tsai
2014-05-01
Full Text Available Telehealth has become an increasingly applied solution to delivering health care to rural and underserved areas by remote health care professionals. This study integrated social capital theory, social cognitive theory, and the technology acceptance model (TAM to develop a comprehensive behavioral model for analyzing the relationships among social capital factors (social capital theory, technological factors (TAM, and system self-efficacy (social cognitive theory in telehealth. The proposed framework was validated with 365 respondents from Nantou County, located in Central Taiwan. Structural equation modeling (SEM was used to assess the causal relationships that were hypothesized in the proposed model. The finding indicates that elderly residents generally reported positive perceptions toward the telehealth system. Generally, the findings show that social capital factors (social trust, institutional trust, and social participation significantly positively affect the technological factors (perceived ease of use and perceived usefulness respectively, which influenced usage intention. This study also confirmed that system self-efficacy was the salient antecedent of perceived ease of use. In addition, regarding the samples, the proposed model fitted considerably well. The proposed integrative psychosocial-technological model may serve as a theoretical basis for future research and can also offer empirical foresight to practitioners and researchers in the health departments of governments, hospitals, and rural communities.
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2013-08-29
... Coordination Home Telehealth (CCHT) Patient Satisfaction Survey, VA Form 10-0481); Activity: Comment Request... required to obtain patient perspective on satisfaction with the CCHT program and messaging devices. DATES.... Titles: Care Coordination Home Telehealth (CCHT) Patient Satisfaction Survey, VA Form 10-0481. OMB...
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Ackerman, Michael J; Filart, Rosemarie; Burgess, Lawrence P; Lee, Insup; Poropatich, Ronald K
2010-01-01
The major goals of telemedicine today are to develop next-generation telehealth tools and technologies to enhance healthcare delivery to medically underserved populations using telecommunication technology, to increase access to medical specialty services while decreasing healthcare costs, and to provide training of healthcare providers, clinical trainees, and students in health-related fields. Key drivers for these tools and technologies are the need and interest to collaborate among telehealth stakeholders, including patients, patient communities, research funders, researchers, healthcare services providers, professional societies, industry, healthcare management/economists, and healthcare policy makers. In the development, marketing, adoption, and implementation of these tools and technologies, communication, training, cultural sensitivity, and end-user customization are critical pieces to the process. Next-generation tools and technologies are vehicles toward personalized medicine, extending the telemedicine model to include cell phones and Internet-based telecommunications tools for remote and home health management with video assessment, remote bedside monitoring, and patient-specific care tools with event logs, patient electronic profile, and physician note-writing capability. Telehealth is ultimately a system of systems in scale and complexity. To cover the full spectrum of dynamic and evolving needs of end-users, we must appreciate system complexity as telehealth moves toward increasing functionality, integration, interoperability, outreach, and quality of service. Toward that end, our group addressed three overarching questions: (1) What are the high-impact topics? (2) What are the barriers to progress? and (3) What roles can the National Institutes of Health and its various institutes and centers play in fostering the future development of telehealth?
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Visioning technology for the future of telehealth.
Brennan, David M; Holtz, Bree E; Chumbler, Neale R; Kobb, Rita; Rabinowitz, Terry
2008-11-01
By its very nature, telehealth relies on technology. Throughout history, as new technologies emerged and afforded people the ability to send information across distances, it was not long before this capability was applied to the most basic need of all: maintaining health. While much of the early work in telehealth was driven by technology (e.g., making opportunistic use of the systems and devices that were available at the time), recent trends are beginning to push the demand for and the development of new technologies specific to the individual needs of telehealth applications. The future of telehealth will benefit greatly from this technology innovation, in particular, in areas such as home telehealth and remote monitoring, e-health and patient portal applications, personal health records, interactive Internet technologies, and robotics. Telehealth, while not a panacea for all of the challenges facing modern healthcare systems, has a substantial and ever-expanding potential to revolutionize the ways in which people receive medical care while offering the possibility to contain costs, manage chronic diseases, and prevent secondary complications. By demanding innovative solutions and speaking out in support of the field, the telehealth community can and should be leading the charge for greater attention to human factors in technology development, interoperable medical records, staff training and competencies, standards and guidelines, and support for expanded telehealth coverage at the national, state, and local levels.
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Directory of Open Access Journals (Sweden)
Woodbridge Peter A
2007-05-01
Full Text Available Abstract Background Monitoring and Messaging Devices (MMDs are telehealth systems used by patients in their homes, and are designed to promote patient self-management, patient education, and clinical monitoring and follow-up activities. Although these systems have been widely promoted by health care systems, including the Veterans Health Administration, very little information is available on factors that facilitate use of the MMD system, or on barriers to use. Methods We conducted in-depth qualitative interviews with clinicians using MMD-based telehealth programs at two Veterans Affairs Medical Centers in the Midwestern United States. Results Findings suggest that MMD program enrollment is limited by both clinical and non-clinical factors, and that patients have varying levels of program participation and system use. Telehealth providers see MMDs as a useful tool for monitoring patients who are interested in working on management of their disease, but are concerned with technical challenges and the time commitment required to use MMDs. Conclusion Telehealth includes a rapidly evolving and potentially promising range of technologies for meeting the growing number of patients and clinicians who face the challenges of diabetes care, and future research should explore the most effective means of ensuring successful program implementation.
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Tablet PC Enabled Body Sensor System for Rural Telehealth Applications
Directory of Open Access Journals (Sweden)
Nitha V. Panicker
2016-01-01
Full Text Available Telehealth systems benefit from the rapid growth of mobile communication technology for measuring physiological signals. Development and validation of a tablet PC enabled noninvasive body sensor system for rural telehealth application are discussed in this paper. This system includes real time continuous collection of physiological parameters (blood pressure, pulse rate, and temperature and fall detection of a patient with the help of a body sensor unit and wireless transmission of the acquired information to a tablet PC handled by the medical staff in a Primary Health Center (PHC. Abnormal conditions are automatically identified and alert messages are given to the medical officer in real time. Clinical validation is performed in a real environment and found to be successful. Bland-Altman analysis is carried out to validate the wrist blood pressure sensor used. The system works well for all measurements.
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Telehealth Education in Nursing Curricula.
Ali, Nagia S; Carlton, Kay Hodson; Ali, Omar S
2015-01-01
Telehealth care is a fast-growing avenue of providing health care services at a distance. A descriptive study was conducted to identify trends of telehealth education in 43 schools of nursing. Findings reflected inadequate integration of telehealth in classroom content, simulation, and clinical experiences. Interviews with 4 nursing leaders of telehealth provided some recommendations on how to integrate telehealth education in nursing curricula.
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Varghese, Shainy B; Phillips, Carolyn A
2009-12-01
The overall goal of this study was to explore and describe the perceptions of advanced practice nurses (APNs) about caring while providing primary care using telehealth technology. This study used naturalistic inquiry methodology to elicit the subjective perceptions and reflections of a sample of APNs about how they convey caring in the context of telehealth. Thirteen APNs, selected by purposive and snowball sampling, participated in the study. The data for the study consisted of interviews conducted by e-mail using a semistructured interview guide. Data analysis used the constant comparison method; rigor and trustworthiness of the study procedures were established using the criteria of credibility, confirmability, dependability, and transferability. The findings of this study revealed that the APNs conveyed caring to their telehealth patients by (1) being with them, (2) personifying the images, and (3) possessing certain attributes. The major constructs that emerged from the data together formed a model of how APNs conveyed caring in telehealth. The findings provide insights and increase the understanding of how caring in telehealth was perceived by APNs. The findings of the study can make important contributions in improving our profession's preparation of future telehealth APNs. The study findings also can lend themselves to developing an instrument to measure caring in telehealth. The study findings also contribute to the nursing literature in a number of ways.
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Varghese, Sunil; Scott, Richard E
2004-01-01
Developing countries are exploring the role of telehealth to overcome the challenges of providing adequate health care services. However, this process faces disparities, and no complementarity in telehealth policy development. Telehealth has the potential to transcend geopolitical boundaries, yet telehealth policy developed in one jurisdiction may hamper applications in another. Understanding such policy complexities is essential for telehealth to realize its full global potential. This study investigated 12 East Asian countries that may represent a microcosm of the world, to determine if the telehealth policy response of countries could be categorized, and whether any implications could be identified for the development of complementary telehealth policy. The countries were Cambodia, China, Hong Kong, Indonesia, Japan, Malaysia, Myanmar, Singapore, South Korea, Taiwan, Thailand, and Vietnam. Three categories of country response were identified in regard to national policy support and development. The first category was "None" (Cambodia, Myanmar, and Vietnam) where international partners, driven by humanitarian concerns, lead telehealth activity. The second category was "Proactive" (China, Indonesia, Malaysia, Singapore, South Korea, Taiwan, and Thailand) where national policies were designed with the view that telehealth initiatives are a component of larger development objectives. The third was "Reactive" (Hong Kong and Japan), where policies were only proffered after telehealth activities were sustainable. It is concluded that although complementarity of telehealth policy development is not occurring, increased interjurisdictional telehealth activity, regional clusters, and concerted and coordinated effort amongst researchers, practitioners, and policy makers may alter this trend.
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Electrocardiogram signal quality measures for unsupervised telehealth environments
International Nuclear Information System (INIS)
Redmond, S J; Xie, Y; Chang, D; Lovell, N H; Basilakis, J
2012-01-01
The use of telehealth paradigms for the remote management of patients suffering from chronic conditions has become more commonplace with the advancement of Internet connectivity and enterprise software systems. To facilitate clinicians in managing large numbers of telehealth patients, and in digesting the vast array of data returned from the remote monitoring environment, decision support systems in various guises are often utilized. The success of decision support systems in interpreting patient conditions from physiological data is dependent largely on the quality of these recorded data. This paper outlines an algorithm to determine the quality of single-lead electrocardiogram (ECG) recordings obtained from telehealth patients. Three hundred short ECG recordings were manually annotated to identify movement artifact, QRS locations and signal quality (discrete quality levels) by a panel of three experts, who then reconciled the annotation as a group to resolve any discrepancies. After applying a published algorithm to remove gross movement artifact, the proposed method was then applied to estimate the remaining ECG signal quality, using a Parzen window supervised statistical classifier model. The three-class classifier model, using a number of time-domain features and evaluated using cross validation, gave an accuracy in classifying signal quality of 78.7% (κ = 0.67) when using fully automated preprocessing algorithms to remove gross motion artifact and detect QRS locations. This is a similar level of accuracy to the reported human inter-scorer agreement when generating the gold standard annotation (accuracy = 70–89.3%, κ = 0.54–0.84). These results indicate that the assessment of the quality of single-lead ECG recordings, acquired in unsupervised telehealth environments, is entirely feasible and may help to promote the acceptance and utility of future decision support systems for remotely managing chronic disease conditions. (paper)
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Embedded DSP-based telehealth radar system for remote in-door fall detection.
Garripoli, Carmine; Mercuri, Marco; Karsmakers, Peter; Jack Soh, Ping; Crupi, Giovanni; Vandenbosch, Guy A E; Pace, Calogero; Leroux, Paul; Schreurs, Dominique
2015-01-01
Telehealth systems and applications are extensively investigated nowadays to enhance the quality-of-care and, in particular, to detect emergency situations and to monitor the well-being of elderly people, allowing them to stay at home independently as long as possible. In this paper, an embedded telehealth system for continuous, automatic, and remote monitoring of real-time fall emergencies is presented and discussed. The system, consisting of a radar sensor and base station, represents a cost-effective and efficient healthcare solution. The implementation of the fall detection data processing technique, based on the least-square support vector machines, through a digital signal processor and the management of the communication between radar sensor and base station are detailed. Experimental tests, for a total of 65 mimicked fall incidents, recorded with 16 human subjects (14 men and two women) that have been monitored for 320 min, have been used to validate the proposed system under real circumstances. The subjects' weight is between 55 and 90 kg with heights between 1.65 and 1.82 m, while their age is between 25 and 39 years. The experimental results have shown a sensitivity to detect the fall events in real time of 100% without reporting false positives. The tests have been performed in an area where the radar's operation was not limited by practical situations, namely, signal power, coverage of the antennas, and presence of obstacles between the subject and the antennas.
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End-to-End Security for Personal Telehealth
Koster, R.P.; Asim, M.; Petkovic, M.
2011-01-01
Personal telehealth is in rapid development with innovative emerging applications like disease management. With personal telehealth people participate in their own care supported by an open distributed system with health services. This poses new end-to-end security and privacy challenges. In this
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Towards Patient-Centric Telehealth: a Journey into ICT Infrastructures and User Modeling
DEFF Research Database (Denmark)
Jørgensen, Daniel Bjerring
Problem setting: The problem setting for this thesis is the telehealth domain. Telehealth is addressed from two perspectives: ICT infrastructures and personalized telehealth. ICT infrastructures are addressed on both the local level concerning the systems that are deployed in patients’ homes......, and on the national level concerning the transmission of data in end-to-end infrastructural scenarios. Personalized telehealth concerns the design of telehealth systems that are able to fit the everyday life of their patients. Problem and Research questions: The problem setting was formalized in a principal research...... events in the CASAS datasets. New ideas for research directions have been spawned by the ICT infrastructure: tools to strengthen and supporting telehealth patients’ motivation and identification of patterns, if such exist, indicating correlations between changes to a telehealth patient’s behavioral...
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Extent of telehealth use in rural and urban hospitals.
Ward, Marcia M; Ullrich, Fred; Mueller, Keith
2014-01-01
Key Findings. Data from 4,727 hospitals in the 2013 HIMSS Analytics database yielded these findings: (1) Two-thirds (66.0% of rural defined as nonmetropolitan and 68.0% of urban) had no telehealth services or were only in the process of implementing a telehealth application. One-third (34.0%rural and 32.0% urban) had at least one telehealth application currently in use. (2) Among hospitals with "live and operational" telehealth services, 61.4% indicated only a single department/program with an operational telehealth service, and 38.6% indicated two or more departments/programs with operational telehealth services. Rural hospitals were significantly less likely to have multiple services (35.2%) than were urban hospitals (42.1%) (3) Hospitals that were more likely to have implemented at least one telehealth service were academic medical centers, not-for-profit institutions, hospitals belonging to integrated delivery systems, and larger institutions (in terms of FTEs but not licensed beds). Rural and urban hospitals did not differ significantly in overall telehealth implementation rates. (4) Urban and rural hospitals did differ in the department where telehealth was implemented. Urban hospitals were more likely than rural hospitals to have operational telehealth implementations in cardiology/stroke/heart attack programs (7.4% vs. 6.2%), neurology (4.4% vs. 2.1%), and obstetrics/gynecology/NICU/pediatrics (3.8% vs. 2.5%). In contrast, rural hospitals were more likely than urban hospital to have operational telehealth implementations in radiology departments (17.7% vs. 13.9%) and in emergency/trauma care (8.8% vs. 6.3%).
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Preparing for success: Readiness models for rural telehealth
Directory of Open Access Journals (Sweden)
Jennett P
2005-01-01
Full Text Available Background: Readiness is an integral and preliminary step in the successful implementation of telehealth services into existing health systems within rural communities. Methods and Materials: This paper details and critiques published international peer-reviewed studies that have focused on assessing telehealth readiness for rural and remote health. Background specific to readiness and change theories is provided, followed by a critique of identified telehealth readiness models, including a commentary on their readiness assessment tools. Results: Four current readiness models resulted from the search process. The four models varied across settings, such as rural outpatient practices, hospice programs, rural communities, as well as government agencies, national associations, and organizations. All models provided frameworks for readiness tools. Two specifically provided a mechanism by which communities could be categorized by their level of telehealth readiness. Discussion: Common themes across models included: an appreciation of practice context, strong leadership, and a perceived need to improve practice. Broad dissemination of these telehealth readiness models and tools is necessary to promote awareness and assessment of readiness. This will significantly aid organizations to facilitate the implementation of telehealth.
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The Ottawa telehealth project.
Cheung, S T; Davies, R F; Smith, K; Marsh, R; Sherrard, H; Keon, W J
1998-01-01
To examine the telehealth system as a means of improving access to cardiac consultations and specialized health services in remote areas of Ontario. The University of Ottawa Heart Institute has set up a telehealth test program, Healthcare and Education Access for Remote Residents by Telecommunications (HEARRT), in collaboration with industry and the provincial and federal government, as well as several remote clinical test sites. The program makes off-site cardiology consultations possible. History taking and physical examinations are conducted by video and electronic stethoscope. Laboratory results and echocardiograms are transmitted by document camera and VCR. The technology is being tested in both stable outpatient and emergency situations. Various telecommunications bandwidths and encoding systems are being evaluated, including satellite and terrestrial-based asynchronous transfer-mode circuits. Patient satisfaction and cost-effectiveness are also being assessed. Bandwidths from as low as 384 kbps using H.320 encoders to 40 Mbps using digital transport of NTSC video signals have been evaluated. Although lower bandwidths are sufficient for sending echocardiographic and electrocardiogram data, bandwidths with transport speeds of 4 to 6 Mbps appear necessary to capture the nuances of the cardiac physical examination. A preliminary satisfaction survey of 19 patients noted that all felt that they could communicate effectively with the cardiologist by video, and each had confidence in the advice offered. None reported that he or she would rather have traveled to the doctor in person. Initial and projected examination of the costs suggested that telehealth will effectively reduce overall health care spending while decreasing travel expenses for rural patients. Telehealth technology is sufficiently sophisticated to allow off-site cardiology assessments. Preliminary results suggest there is a sound business case for the implementation of telehealth technology to meet
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A Proposed Information Architecture for Telehealth System Interoperability
Energy Technology Data Exchange (ETDEWEB)
Craft, R.L.; Funkhouser, D.R.; Gallagher, L.K.; Garica, R.J.; Parks, R.C.; Warren, S.
1999-04-20
We propose an object-oriented information architecture for telemedicine systems that promotes secure `plug-and-play' interaction between system components through standardized interfaces, communication protocols, messaging formats, and data definitions. In this architecture, each component functions as a black box, and components plug together in a ''lego-like'' fashion to achieve the desired device or system functionality. Introduction Telemedicine systems today rely increasingly on distributed, collaborative information technology during the care delivery process. While these leading-edge systems are bellwethers for highly advanced telemedicine, most are custom-designed and do not interoperate with other commercial offerings. Users are limited to a set of functionality that a single vendor provides and must often pay high prices to obtain this functionality, since vendors in this marketplace must deliver en- tire systems in order to compete. Besides increasing corporate research and development costs, this inhibits the ability of the user to make intelligent purchasing decisions regarding best-of-breed technologies. This paper proposes a reference architecture for plug-and-play telemedicine systems that addresses these issues.
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Testing telehealth using technology-enhanced nurse monitoring.
Grant, Leslie A; Rockwood, Todd; Stennes, Leif
2014-10-01
Technology-enhanced nurse monitoring is a telehealth solution that helps nurses with assessment, diagnosis, and triage of older adults living in community-based settings. This technology links biometric and nonbiometric sensors to a data management system that is monitored remotely by RNs and unlicensed support staff. Nurses faced a number of challenges related to data interpretation, including making clinical inferences from nonbiometric data, integrating data generated by three different telehealth applications into a clinically meaningful cognitive framework, and figuring out how best to use nursing judgment to make valid inferences from online reporting systems. Nurses developed expertise over the course of the current study. The sponsoring organization achieved a high degree of organizational knowledge about how to use these systems more effectively. Nurses saw tremendous value in the telehealth applications. The challenges, learning curve, and organizational improvements are described. Copyright 2014, SLACK Incorporated.
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Home telehealth in older patients with heart failure – costs, adherence, and outcomes
Directory of Open Access Journals (Sweden)
Spinsante S
2014-09-01
Full Text Available Susanna Spinsante Dipartimento di Ingegneria dell'Informazione, Università Politecnica delle Marche, Ancona, Italy Abstract: This short review discusses the role of telehealth technologies in the management of older patients with heart failure, from different perspectives. Instead of providing a systematic overview of existing literature in the field, this paper provides evidence for a simple, but effective, paradigm upon which a telehealth system may be built, and highlights how such a model may successfully apply to heart failure management, to improve patients' quality of life after discharge, increase independency, and reduce readmissions and costs for the public health institutions. A few examples are discussed, to show the real applicability of the proposed model and further confirm the effectiveness of telehealth, when properly designed and tailored to users' needs. Keywords: remote health care, workflow, requirements
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Personalized telehealth in the future
DEFF Research Database (Denmark)
Dinesen, Birthe Irene; Nonnecke, Brandie; Lindeman, David
2016-01-01
As telehealth plays an even greater role in global health care delivery, it will be increasingly important to develop a strong evidence base of successful, innovative telehealth solutions that can lead to scalable and sustainable telehealth programs. This paper has two aims: (1) to describe the c...
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Alverson, Dale C; Krupinski, Elizabeth A; Erps, Kristine A; Rowe, Nancy S; Weinstein, Ronald S
2018-05-31
As telemedicine and telehealth services are experiencing increasing rates of adoption, industry leaders and healthcare service providers are becoming increasingly focused on human resource issues encountered in the delivery of a broad range of telehealth services. To create a forum for the discussion of many interrelated elements of telehealth service industry, a national conference entitled "Telemedicine & Telehealth Service Provider Showcase" (SPS) Conference was established in 2014, and repeated in 2016 and 2017, in Arizona. These SPS Conferences include thought leaders, telehealth service providers, government administrators, and academicians from leading programs addressing service provider workforce issues. This report summarizes the content of SPS 2017 conference, held in Phoenix, AZ, October 2-3, 2017. The topics covered at SPS 2017 include using telehealth services as a strategic asset; development of appropriate effective partnerships; direct-to-consumer initiatives; important reimbursement, legislative, and regulatory issues (i.e., Centers for Medicare & Medicaid Services [CMS] approaches, financial models, and return on investment [ROI]); marketing; evaluation and applied metrics; remote monitoring and sensors; integration with electronic health records; and overall lessons learned. The content of SPS 2017 is summarized in the body of this report. The SPS 2017 program evaluators included attendees, speakers, and exhibitors. The knowledge attendees gained at SPS 2017 was characterized, by all three groups, as forward-looking and practical. SPS 2017 succeeded in identifying, and focusing on, solutions for issues, challenges, and barriers impacting the rapidly expanding telehealth service segment of the healthcare industry. The growing interest in this annual SPS Conference series apparently reflects, in part, the program committee's successes in identifying practical issues and their potential solutions.
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Personalized telehealth in the future
DEFF Research Database (Denmark)
Dinesen, B.; Nonnecke, B.; Lindeman, David
2016-01-01
of telehealth services and benefits, presents fundamental principles that must be addressed to advance the status quo, and provides a framework for current and future research initiatives within telehealth for personalized care, treatment, and prevention. A broad, multinational research agenda can provide...... research agenda for future telehealth applications within chronic disease management....
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2014 Mid-Atlantic Telehealth Resource Center Annual Summit
Directory of Open Access Journals (Sweden)
Katharine Hsu Wibberly
2013-12-01
Full Text Available The Mid-Atlantic Resource Center (MATRC; http://www.matrc.org/ advances the adoption and utilization of telehealth within the MATRC region and works collaboratively with the other federally funded Telehealth Resource Centers to accomplish the same nationally. MATRC offers technical assistance and other resources within the following mid-Atlantic states: Delaware, District of Columbia, Kentucky, Maryland, North Carolina, Pennsylvania, Virginia and West Virginia. The 2014 MATRC Summit “Adding Value through Sustainable Telehealth” will be held March 30-April 1, 2014, at the Fredericksburg Expo & Conference Center, Fredericksburg, VA. The Summit will explore how telehealth adds value to patients, practitioners, hospitals, health systems, and other facilities. Participants will experience a highly interactive program built around the case history of “Mr. Doe” as he progresses through the primary care, inpatient hospitalization, and post-discharge environments. The Summit will conclude with a session on financial and business models for providing sustainable telehealth services. For further information and registration, visit: http://matrc.org/component/content/article/2-uncategorised/80-mid-atlantic-telehealth-resource-summit-2014
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Extending Agent Based Telehealth Platform with Activities of Daily Living Reasoning Capabilities
DEFF Research Database (Denmark)
Jørgensen, Daniel Bjerring; Hallenborg, Kasper; Demazeau, Yves
2016-01-01
it will influence his or her everyday live. Therefore we believe that a telehealth system shall adapt its behavior so that it will not be a burden for the patient/resident to use. To this aim we have extended an existing telehealth platform to reason about activities of daily living in a smart home scenario......In the future patients will have a more active role in strengthening and maintaining their own health. Telehealth can empower and motivate patients by giving them the chance to stay in their own homes instead of going to the hospital. A telehealth system is deployed in a patient’s home hence...
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Environment for Telehealth Applications on Top of BDI4JADE
DEFF Research Database (Denmark)
Jørgensen, Daniel Bjerring; Hallenborg, Kasper; Demazeau, Yves
2015-01-01
Patients using telehealth systems have different needs and hence their treatments must differ accordingly. Different compositions of smart home sensors, telehealth devices, and services are used depending on the needs of the individual. This paper presents an open and flexible infrastructure...
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Business models for telehealth in the US: analyses and insights
Directory of Open Access Journals (Sweden)
Pereira F
2017-02-01
Full Text Available Francis Pereira Data Sciences and Operations, Marshall School of Business, University of Southern, Los Angeles, CA, USAAbstract: A growing shortage of medical doctors and nurses, globally, coupled with increasing life expectancy, is generating greater cost pressures on health care, in the US and globally. In this respect, telehealth can help alleviate these pressures, as well as extend medical services to underserved or unserved areas. However, its relatively slow adoption in the US, as well as in other markets, suggests the presence of barriers and challenges. The use of a business model framework helps identify the value proposition of telehealth as well as these challenges, which include identifying the right revenue model, organizational structure, and, perhaps more importantly, the stakeholders in the telehealth ecosystem. Successful and cost-effective deployment of telehealth require a redefinition of the ecosystem and a comprehensive review of all benefits and beneficiaries of such a system; hence a reassessment of all the stakeholders that could benefit from such a system, beyond the traditional patient–health provider–insurer model, and thus “who should pay” for such a system, and the driving efforts of a “keystone” player in developing this initiative would help. Keywords: telehealth, business model framework, stakeholders, ecosystem, VISOR business Model
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Practical aspects of telehealth: financial considerations.
Loh, P K; Sabesan, S; Allen, D; Caldwell, P; Mozer, R; Komesaroff, P A; Talman, P; Williams, M; Shaheen, N; Grabinski, O; Withnall, D
2013-07-01
The second in a series of articles about the practical aspects of telehealth, this paper includes information and a case history on the cost-benefits for patients and practitioners using telehealth. The case history demonstrates that telehealth can save travel time for patients, carers and specialists, and can reduce out-of-pocket expenses. The practical aspects of telehealth article series considers the contextual, clinical, technical and ethical components of online video consultations. © 2013 The Authors; Internal Medicine Journal © 2013 Royal Australasian College of Physicians.
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Directory of Open Access Journals (Sweden)
Durl
2014-11-01
Full Text Available Logan Durland,1 Alejandro Interian,1,2 Ingrid Pretzer-Aboff,3 Roseanne D Dobkin11Rutgers, The State University of New Jersey, Robert Wood Johnson Medical School, Department of Psychiatry, Piscataway, NJ, 2The New Jersey Healthcare System, Veteran Affairs Medical Center, Lyons, NJ, 3University of Delaware, School of Nursing and Biomechanics and Movement Sciences Program, Newark, DE, USAAbstract: Although millions of individuals suffer from mental health problems worldwide, only a small fraction receives adequate treatment. The high prevalence of depression and anxiety observed worldwide, in conjunction with very low rates of treatment utilization, are of great clinical significance, as these psychiatric conditions are two of the most important determinants of quality of life (QoL. Telehealth interventions have been touted as potential solutions to these mental health care disparities, with great interest and utility demonstrated across a diverse array of medical and psychiatric populations. Telehealth interventions may be clinic-based or home-based. The primary objective of this paper is to highlight the extent to which telehealth-to-home interventions positively impact multiple facets of QoL for individuals with depression and anxiety disorders, including those with comorbid medical conditions. While QoL outcomes are important to consider in any assessment of treatment effectiveness, QoL enhancement has received limited attention in the telemental health literature to date. All studies included in the present review evaluate telehealth-to-home treatments, assess QoL outcomes, and incorporate some degree of live, synchronous therapist-patient contact. Recommendations to advance the application of telehealth-to-home approaches are proposed and include: additional research on video-to-home telehealth platforms, strategies to increase the adoption of telehealth-to-home interventions amongst mental health treatment providers, national legislative
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Integrating telemedicine and telehealth: putting it all together.
Weinstein, Ronald S; Lopez, Ana Maria; Krupinski, Elizabeth A; Beinar, Sandra J; Holcomb, Michael; McNeely, Richard A; Latifi, Rifat; Barker, Gail
2008-01-01
Telemedicine and telehealth programs are inherently complex compared with their traditional on-site health care delivery counterparts. Relatively few organizations have developed sustainable, multi-specialty telemedicine programs, although single service programs, such as teleradiology and telepsychiatry programs, are common. A number of factors are barriers to the development of sustainable telemedicine and telehealth programs. First, starting programs is often challenging since relatively few organizations have, in house, a critical mass of individuals with the skill sets required to organize and manage a telemedicine program. Therefore, it is necessary to "boot strap" many of the start-up activities using available personnel. Another challenge is to assemble a management team that has time to champion telemedicine and telehealth while dealing with the broad range of issues that often confront telemedicine programs. Telemedicine programs housed within a single health care delivery system have advantages over programs that serve as umbrella telehealth organizations for multiple health care systems. Planning a telemedicine program can involve developing a shared vision among the participants, including the parent organizations, management, customers and the public. Developing shared visions can be a time-consuming, iterative process. Part of planning includes having the partnering organizations and their management teams reach a consensus on the initial program goals, priorities, strategies, and implementation plans. Staffing requirements of telemedicine and telehealth programs may be met by sharing existent resources, hiring additional personnel, or outsourcing activities. Business models, such as the Application Service Provider (ASP) model used by the Arizona Telemedicine Program, are designed to provide staffing flexibility by offering a combination of in-house and out-sourced services, depending on the needs of the individual participating health care
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Personalized Telehealth in the Future: A Global Research Agenda.
Dinesen, Birthe; Nonnecke, Brandie; Lindeman, David; Toft, Egon; Kidholm, Kristian; Jethwani, Kamal; Young, Heather M; Spindler, Helle; Oestergaard, Claus Ugilt; Southard, Jeffrey A; Gutierrez, Mario; Anderson, Nick; Albert, Nancy M; Han, Jay J; Nesbitt, Thomas
2016-03-01
As telehealth plays an even greater role in global health care delivery, it will be increasingly important to develop a strong evidence base of successful, innovative telehealth solutions that can lead to scalable and sustainable telehealth programs. This paper has two aims: (1) to describe the challenges of promoting telehealth implementation to advance adoption and (2) to present a global research agenda for personalized telehealth within chronic disease management. Using evidence from the United States and the European Union, this paper provides a global overview of the current state of telehealth services and benefits, presents fundamental principles that must be addressed to advance the status quo, and provides a framework for current and future research initiatives within telehealth for personalized care, treatment, and prevention. A broad, multinational research agenda can provide a uniform framework for identifying and rapidly replicating best practices, while concurrently fostering global collaboration in the development and rigorous testing of new and emerging telehealth technologies. In this paper, the members of the Transatlantic Telehealth Research Network offer a 12-point research agenda for future telehealth applications within chronic disease management.
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... role of telehealth in an evolving health care environment. Washington DC: The National Academies Press; 2012. Review ... M. is also a founding member of Hi-Ethics and subscribes to the principles of the Health ...
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Telehealth in the developing world: current status and future prospects
Directory of Open Access Journals (Sweden)
Scott RE
2015-02-01
Full Text Available Richard E Scott,1,2 Maurice Mars11Department of TeleHealth, University of KwaZulu-Natal, Durban, KwaZulu-Natal, South Africa; 2NT Consulting - Global e-Health Inc., Calgary, AB, CanadaAbstract: In a setting of constant change and confusing terminology, telehealth continues to gain ground in both developed and developing countries within the overarching milieu of e-health. Evidence shows telehealth has been used in essentially all countries of the world, but is embedded in few. Uses and needs of telehealth vary between the developed and developing world; the latter struggles with both communicable diseases and noncommunicable diseases, and with very few resources. Common clinical applications include teleconsultation, telecardiology (transmission of ECGs, teleradiology, and teledermatology. Many telehealth projects exist throughout Latin America and the Caribbean, Asia, and Africa, but there is little published evidence and only isolated examples of sustained programs, although several sustained humanitarian networks exist. Application of mobile solutions (m-health is on the rise in many developing countries. Telehealth is still not integrated into existing health care systems globally. Reasons vary: lack of proven large-scale operations, poor evidence base, inadequate implementation, lack of attention to the “soft side” of implementation (readiness, change management, and many others. For the developing world, reasons can be more pragmatic, including limited resources, unreliable power, poor connectivity, and high cost for the poverty stricken – those most in need. Telehealth is poised to improve health and health care in the developing world, driven by both altruistic and profit motives. But to have the desired effect, telehealth must address very specific and evidence-based health “needs” of each facility, region, or country; the shortage of health workers and specialist services; and the required skills upgrading and training
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For telehealth to succeed, privacy and security risks must be identified and addressed.
Hall, Joseph L; McGraw, Deven
2014-02-01
The success of telehealth could be undermined if serious privacy and security risks are not addressed. For example, sensors that are located in a patient's home or that interface with the patient's body to detect safety issues or medical emergencies may inadvertently transmit sensitive information about household activities. Similarly, routine data transmissions from an app or medical device, such as an insulin pump, may be shared with third-party advertisers. Without adequate security and privacy protections for underlying telehealth data and systems, providers and patients will lack trust in the use of telehealth solutions. Although some federal and state guidelines for telehealth security and privacy have been established, many gaps remain. No federal agency currently has authority to enact privacy and security requirements to cover the telehealth ecosystem. This article examines privacy risks and security threats to telehealth applications and summarizes the extent to which technical controls and federal law adequately address these risks. We argue for a comprehensive federal regulatory framework for telehealth, developed and enforced by a single federal entity, the Federal Trade Commission, to bolster trust and fully realize the benefits of telehealth.
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Cost-benefit analysis of telehealth in pre-hospital care.
Langabeer, James R; Champagne-Langabeer, Tiffany; Alqusairi, Diaa; Kim, Junghyun; Jackson, Adria; Persse, David; Gonzalez, Michael
2017-09-01
Objective There has been very little use of telehealth in pre-hospital emergency medical services (EMS), yet the potential exists for this technology to transform the current delivery model. In this study, we explore the costs and benefits of one large telehealth EMS initiative. Methods Using a case-control study design and both micro- and gross-costing data from the Houston Fire Department EMS electronic patient care record system, we conducted a cost-benefit analysis (CBA) comparing costs with potential savings associated with patients treated through a telehealth-enabled intervention. The intervention consisted of telehealth-based consultation between the 911 patient and an EMS physician, to evaluate and triage the necessity for patient transport to a hospital emergency department (ED). Patients with non-urgent, primary care-related conditions were then scheduled and transported by alternative means to an affiliated primary care clinic. We measured CBA as both total cost savings and cost per ED visit averted, in US Dollars ($USD). Results In total, 5570 patients were treated over the first full 12 months with a telehealth-enabled care model. We found a 6.7% absolute reduction in potentially medically unnecessary ED visits, and a 44-minute reduction in total ambulance back-in-service times. The average cost for a telehealth patient was $167, which was a statistically significantly $103 less than the control group ( p cost savings from the societal perspective, or $2468 cost savings per ED visit averted (benefit). Conclusion Patient care enabled by telehealth in a pre-hospital environment, is a more cost effective alternative compared to the traditional EMS 'treat and transport to ED' model.
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DEFF Research Database (Denmark)
Ellis, I.; Cheek, C.; Jaffray, L.
2013-01-01
Background: Telehealth services are promoted to reduce the cost of travel for people living in rural areas. The previous Australian Government, through the national Digital Economy Strategy, invested heavily in telehealth service development, at the same time introducing a carbon pricing mechanis...
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Telehealth innovations in health education and training.
Conde, José G; De, Suvranu; Hall, Richard W; Johansen, Edward; Meglan, Dwight; Peng, Grace C Y
2010-01-01
Telehealth applications are increasingly important in many areas of health education and training. In addition, they will play a vital role in biomedical research and research training by facilitating remote collaborations and providing access to expensive/remote instrumentation. In order to fulfill their true potential to leverage education, training, and research activities, innovations in telehealth applications should be fostered across a range of technology fronts, including online, on-demand computational models for simulation; simplified interfaces for software and hardware; software frameworks for simulations; portable telepresence systems; artificial intelligence applications to be applied when simulated human patients are not options; and the development of more simulator applications. This article presents the results of discussion on potential areas of future development, barries to overcome, and suggestions to translate the promise of telehealth applications into a transformed environment of training, education, and research in the health sciences.
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Attitudes to telehealth use among rural residents
DEFF Research Database (Denmark)
Sørensen, Jens Fyhn Lykke
2008-01-01
. One prerequisite for successful delivery of health care by means of telehealth is the existence of positive attitudes toward telehealth solutions among the potential end beneficiaries. Purpose: The purpose of this study was to examine the attitudes toward telehealth use among residents in a Danish...... rural area. Method: A representative sample from the island of Ærø (n=1000) was selected and attitudes toward two telehealth applications were examined by structured telephone interviews regarding: 1) video consultation between patient and specialist, and 2) transfer of work tasks from local hospital...
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A Proposed Information Architecture for Telehealth System Interoperability
Energy Technology Data Exchange (ETDEWEB)
Warren, S.; Craft, R.L.; Parks, R.C.; Gallagher, L.K.; Garcia, R.J.; Funkhouser, D.R.
1999-04-07
Telemedicine technology is rapidly evolving. Whereas early telemedicine consultations relied primarily on video conferencing, consultations today may utilize video conferencing, medical peripherals, store-and-forward capabilities, electronic patient record management software, and/or a host of other emerging technologies. These remote care systems rely increasingly on distributed, collaborative information technology during the care delivery process, in its many forms. While these leading-edge systems are bellwethers for highly advanced telemedicine, the remote care market today is still immature. Most telemedicine systems are custom-designed and do not interoperate with other commercial offerings. Users are limited to a set of functionality that a single vendor provides and must often pay high prices to obtain this functionality, since vendors in this marketplace must deliver entire systems in order to compete. Besides increasing corporate research and development costs, this inhibits the ability of the user to make intelligent purchasing decisions regarding best-of-breed technologies. We propose a secure, object-oriented information architecture for telemedicine systems that promotes plug-and-play interaction between system components through standardized interfaces, communication protocols, messaging formats, and data definitions. In this architecture, each component functions as a black box, and components plug together in a lego-like fashion to achieve the desired device or system functionality. The architecture will support various ongoing standards work in the medical device arena.
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Telehealth at the US Department of Veterans Affairs after Hurricane Sandy.
Der-Martirosian, Claudia; Griffin, Anne R; Chu, Karen; Dobalian, Aram
2018-01-01
Background Like other integrated health systems, the US Department of Veterans Affairs has widely implemented telehealth during the past decade to improve access to care for its patient population. During major crises, the US Department of Veterans Affairs has the potential to transition healthcare delivery from traditional care to telecare. This paper identifies the types of Veterans Affairs telehealth services used during Hurricane Sandy (2012), and examines the patient characteristics of those users. Methods This study conducted both quantitative and qualitative analyses. Veterans Affairs administrative and clinical data files were used to illustrate the use of telehealth services 12 months pre- and 12 months post- Hurricane Sandy. In-person interviews with 31 key informants at the Manhattan Veterans Affairs Medical Center three-months post- Hurricane Sandy were used to identify major themes related to telecare. Results During the seven-month period of hospital closure at the Manhattan Veterans Affairs Medical Center after Hurricane Sandy, in-person patient visits decreased dramatically while telehealth visits increased substantially, suggesting that telecare was used in lieu of in-person care for some vulnerable patients. The most commonly used types of Veterans Affairs telehealth services included primary care, triage, mental health, home health, and ancillary services. Using qualitative analyses, three themes emerged from the interviews regarding the use of Veterans Affairs telecare post- Hurricane Sandy: patient safety, provision of telecare, and patient outreach. Conclusion Telehealth offers the potential to improve post-disaster access to and coordination of care. More information is needed to better understand how telehealth can change the processes and outcomes during disasters. Future studies should also evaluate key elements, such as adequate resources, regulatory and technology issues, workflow integration, provider resistance, diagnostic fidelity and
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Telehealth on advanced networks.
Wilson, Laurence S; Stevenson, Duncan R; Cregan, Patrick
2010-01-01
We address advanced Internet for complex telehealth applications by reviewing four hospital-based broadband telehealth projects and identifying common threads. These projects were conducted in Australia under a 6-year research project on broadband Internet applications. Each project addressed specific clinical needs and its development was guided by the clinicians involved. Each project was trialed in the field and evaluated against the initial requirements. The four projects covered remote management of a resuscitation team in a district hospital, remote guidance and interpretation of echocardiography, virtual-reality-based instructor-student surgical training, and postoperative outpatient consultations following pediatric surgery. Each was characterized by a high level of interpersonal communication, a high level of clinical expertise, and multiple participants. Each made use of multiple high-quality video and audio links and shared real-time access to clinical data. Four common threads were observed. Each application provided a high level of usability and task focus because the design and use of broadband capability was aimed directly to meet the clinicians' needs. Each used the media quality available over broadband to convey words, gestures, body movements, and facial expressions to support communication and a sense of presence among the participants. Each required a complex information space shared among the participants, including real-time access to stored patient data and real-time interactive access to the patients themselves. Finally, each application supported the social and organizational aspects of their healthcare focus, creating and maintaining relationships between the various participants, and this was done by placing the telehealth application into a wider functioning clinical context. These findings provide evidence for a significantly enhanced role for appropriate telemedicine systems running on advanced networks, in a wider range of clinical
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Social acceptance and population confidence in telehealth in Quebec.
Poder, Thomas G; Bellemare, Christian A; Bédard, Suzanne K; Lemieux, Renald
2015-02-21
Access to healthcare in remote areas is difficult and telehealth could be a promising avenue if accepted by the population. The aim of this study is to assess social acceptance and population confidence in telehealth in the Province of Quebec. We conducted a survey using a questionnaire assessing the social acceptance of and confidence level in telehealth. Two strategies were used: 1) paper questionnaires were sent to two hospitals in Quebec; and 2) online questionnaires were randomly sent by a firm specialized in online survey to a representative sample of the population of the Province of Quebec. Respondents were all residents of the Province of Quebec and 18 years and older. Questions were scored with a four-level Likert scale. A total of 1816 questionnaires were analyzed (229 written and 1,587 online questionnaires). The socio-demographic variables in our samples, especially the online questionnaires, were fairly representative of Quebec's population. Overall, social acceptance scored at 77.71% and confidence level at 65.76%. Both scores were higher in the case of treatment (3 scenarios were proposed) vs. diagnosis (p < 0.05). No difference was found when respondents were asked to respond for themselves and for a member of their family, which demonstrates a true interest in telehealth in Quebec. In addition, we found a significant difference (p < 0.05) between written and online questionnaires regarding social acceptance (80.75% vs. 77.33%) and confidence level (74.84% vs. 64.55%). These differences may be due to social desirability or avidity bias in the written questionnaires. Our results suggest that the population in Quebec encourages the development of telehealth for real time diagnosis and long distance treatment for regions deprived of healthcare professionals.
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Telehealth and Medicare - Payment Policy, Current Use...
U.S. Department of Health & Human Services — Despite legislative changes from 2001 to 2008 that increased Medicare payment rates for telehealth and decreased regulatory burdens, the study Telehealth and...
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Telehealth: current practices and future directions
David, Yadin B.
1996-02-01
When we review the positive impact that the integration of ostensibly independent patient-care services have on the efficient management of quality care, education, and collaborative research, it is not surprising that telehealth deployment is on the rise. The forces that drive this phenomenon include: the need to manage the entire disease episode; the desire for wider geographically-distributed quality health care; the escalation of customer expectations; globalization of healthcare and its support services; an increase in patient and provider convenience; and the acceptance of the present technological community. At the Telehealth Center at the Texas Children's Hospital, current classifications of clinical applications are listed: (1) initial urgent evaluation of patients, (2) triage decisions and pretransfer arrangements, (3) medical and surgical follow-up and medication review, (4) consultation for primary care encounters, (5) real-time subspecialty care consultation and planning, (6) management of chronic diseases and conditions, (7) extended diagnostic work-ups, (8) review of diagnostic images, and (9) preventive medicine and patient education. The delivery of such services is associated with challenges and opportunities. As we move forward from limited data processing to an integrated communication system, from centralized main frame functions to personalized and location-independent workstations, and from hospitals to clinics and homecare, an increase in the minimum features provided by the equipment and the communication systems must accompany the widening variety of clinical applications. Future expansion of telehealth systems stands to revolutionize the delivery of services to the benefits of providers' networks, our economy, and patients through integration.
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Patient Centric Ontology for Telehealth Domain
DEFF Research Database (Denmark)
Jørgensen, Daniel Bjerring; Hallenborg, Kasper; Demazeau, Yves
2015-01-01
This paper presents an ontology for the telehealth domain, a domain that concerns the use of telecommunication to support and deliver health related services e.g. patient monitoring and rehabilitative training. Our vision for the future of telehealth solutions is that they adapt their behavior to...
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Chen, Ying-Hsien; Hung, Chi-Sheng; Huang, Ching-Chang; Hung, Yu-Chien
2017-01-01
Background Atrial fibrillation (AF) is a common form of arrhythmia that is associated with increased risk of stroke and mortality. Detecting AF before the first complication occurs is a recognized priority. No previous studies have examined the feasibility of undertaking AF screening using a telehealth surveillance system with an embedded cloud-computing algorithm; we address this issue in this study. Objective The objective of this study was to evaluate the feasibility of AF screening in nonmetropolitan areas using a telehealth surveillance system with an embedded cloud-computing algorithm. Methods We conducted a prospective AF screening study in a nonmetropolitan area using a single-lead electrocardiogram (ECG) recorder. All ECG measurements were reviewed on the telehealth surveillance system and interpreted by the cloud-computing algorithm and a cardiologist. The process of AF screening was evaluated with a satisfaction questionnaire. Results Between March 11, 2016 and August 31, 2016, 967 ECGs were recorded from 922 residents in nonmetropolitan areas. A total of 22 (2.4%, 22/922) residents with AF were identified by the physician’s ECG interpretation, and only 0.2% (2/967) of ECGs contained significant artifacts. The novel cloud-computing algorithm for AF detection had a sensitivity of 95.5% (95% CI 77.2%-99.9%) and specificity of 97.7% (95% CI 96.5%-98.5%). The overall satisfaction score for the process of AF screening was 92.1%. Conclusions AF screening in nonmetropolitan areas using a telehealth surveillance system with an embedded cloud-computing algorithm is feasible. PMID:28951384
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Resilient Systemics to Telehealth Support for Clinical Psychiatry and Psychology.
Fiorini, Rodolfo A; De Giacomo, Piero; L'Abate, Luciano
2015-01-01
Reliably expanding our clinical practice and lowering our overhead with telepsychiatry, telepsychology, distance counseling and online therapy, requires resilient and antifragile system and tools. When utilized appropriately these technologies may provide greater access to needed services to include more reliable treatment, consultation, supervision, and training. The wise and proper use of technology is fundamental to create and boost outstanding social results. We present, as an example, the main steps to achieve application resilience and antifragility at system level, for diagnostic and therapeutic telepractice and telehealth support, devoted to psychiatry and psychology application. This article presents a number of innovations that can take psychotherapy treatment, supervision, training, and research forward, towards increased effectiveness application.
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Gagnon, Marie-Pierre; Duplantie, Julie; Fortin, Jean-Paul; Landry, Réjean
2006-08-24
Telehealth, as other information and communication technologies (ICTs) introduced to support the delivery of health care services, is considered as a means to answer many of the imperatives currently challenging health care systems. In Canada, many telehealth projects are taking place, mostly targeting rural, remote or isolated populations. So far, various telehealth applications have been implemented and have shown promising outcomes. However, telehealth utilisation remains limited in many settings, despite increased availability of technology and telecommunication infrastructure. A qualitative field study was conducted in four remote regions of Quebec (Canada) to explore perceptions of physicians and managers regarding the impact of telehealth on clinical practice and the organisation of health care services, as well as the conditions for improving telehealth implementation. A total of 54 respondents were interviewed either individually or in small groups. Content analysis of interviews was performed and identified several effects of telehealth on remote medical practice as well as key conditions to ensure the success of telehealth implementation. According to physicians and managers, telehealth benefits include better access to specialised services in remote regions, improved continuity of care, and increased availability of information. Telehealth also improves physicians' practice by facilitating continuing medical education, contacts with peers, and access to a second opinion. At the hospital and health region levels, telehealth has the potential to support the development of regional reference centres, favour retention of local expertise, and save costs. Conditions for successful implementation of telehealth networks include the participation of clinicians in decision-making, the availability of dedicated human and material resources, and a planned diffusion strategy. Interviews with physicians and managers also highlighted the importance of considering
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Directory of Open Access Journals (Sweden)
Duplantie Julie
2006-08-01
Full Text Available Abstract Background Telehealth, as other information and communication technologies (ICTs introduced to support the delivery of health care services, is considered as a means to answer many of the imperatives currently challenging health care systems. In Canada, many telehealth projects are taking place, mostly targeting rural, remote or isolated populations. So far, various telehealth applications have been implemented and have shown promising outcomes. However, telehealth utilisation remains limited in many settings, despite increased availability of technology and telecommunication infrastructure. Methods A qualitative field study was conducted in four remote regions of Quebec (Canada to explore perceptions of physicians and managers regarding the impact of telehealth on clinical practice and the organisation of health care services, as well as the conditions for improving telehealth implementation. A total of 54 respondents were interviewed either individually or in small groups. Content analysis of interviews was performed and identified several effects of telehealth on remote medical practice as well as key conditions to ensure the success of telehealth implementation. Results According to physicians and managers, telehealth benefits include better access to specialised services in remote regions, improved continuity of care, and increased availability of information. Telehealth also improves physicians' practice by facilitating continuing medical education, contacts with peers, and access to a second opinion. At the hospital and health region levels, telehealth has the potential to support the development of regional reference centres, favour retention of local expertise, and save costs. Conditions for successful implementation of telehealth networks include the participation of clinicians in decision-making, the availability of dedicated human and material resources, and a planned diffusion strategy. Interviews with physicians and
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Transforming home health nursing with telehealth technology.
Farrar, Francisca Cisneros
2015-06-01
Telehealth technology is an evidence-based delivery model tool that can be integrated into the plan of care for mental health patients. Telehealth technology empowers access to health care, can help decrease or prevent hospital readmissions, assist home health nurses provide shared decision making, and focuses on collaborative care. Telehealth and the recovery model have transformed the role of the home health nurse. Nurses need to be proactive and respond to rapidly emerging technologies that are transforming their role in home care. Copyright © 2015 Elsevier Inc. All rights reserved.
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Competencies required for nursing telehealth activities: A Delphi-study.
van Houwelingen, Cornelis T M; Moerman, Anna H; Ettema, Roelof G A; Kort, Helianthe S M; Ten Cate, Olle
2016-04-01
Telehealth is viewed as a major strategy to address the increasing demand for care and a shrinking care professional population. However, most nurses are not trained or are insufficiently trained to use these technologies effectively. Therefore, the potential of telehealth fails to reach full utilization. A better understanding of nursing telehealth entrustable professional activities (NT-EPAs) and the required competencies can contribute to the development of nursing telehealth education. In a four-round Delphi-study, a panel of experts discussed which NT-EPAs are relevant for nurses and which competencies nurses need to possess to execute these activities effectively. The 51 experts, including nurses, nursing faculty, clients and technicians all familiar with telehealth, were asked to select items from a list of 52 competencies based on the literature and on a previous study. Additionally, the panelists could add competencies based on their experience in practice. The threshold used for consensus was set at 80%. Consensus was achieved on the importance of fourteen NT-EPAs, requiring one or more of the following core competencies; coaching skills, the ability to combine clinical experience with telehealth, communication skills, clinical knowledge, ethical awareness, and a supportive attitude. Each NT-EPA requires a specific set of competencies (at least ten). In total, 52 competencies were identified as essential in telehealth. Many competencies for telehealth, including clinical knowledge and communication skills, are not novel competencies. They are fundamental to nursing care as a whole and therefore are also indispensable for telehealth. Additionally, the fourteen NT-EPAs appeared to require additional subject specific competencies, such as the ability to put patients at ease when they feel insecure about using technology. The NT-EPAs and related competencies presented in this study can be used by nursing schools that are considering including or expanding
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Telehealth and eHealth in nurse practitioner training: current perspectives
Directory of Open Access Journals (Sweden)
Rutledge CM
2017-06-01
Full Text Available Carolyn M Rutledge,1 Karen Kott,2 Patty A Schweickert,3 Rebecca Poston,1 Christianne Fowler,1 Tina S Haney1 1College of Health Sciences, School of Nursing, 2College of Health Sciences, School of Physical Therapy, Old Dominion University, Norfolk, 3Department of Neuroradiology, University of Virginia, Charlottesville, VA, USA Abstract: Telehealth is becoming a vital process for providing access to cost-effective quality care to patients at a distance. As such, it is important for nurse practitioners, often the primary providers for rural and disadvantaged populations, to develop the knowledge, skills, and attitudes needed to utilize telehealth technologies in practice. In reviewing the literature, very little information was found on programs that addressed nurse practitioner training in telehealth. This article provides an overview of both the topics and the techniques that have been utilized for training nurse practitioners and nurse practitioner students in the delivery of care utilizing telehealth. Specifically, this article focuses on topics including 1 defining telehealth, 2 telehealth etiquette, 3 interprofessional collaboration, 4 regulations, 5 reimbursement, 6 security/Health Insurance Portability and Accountability Act (HIPAA, 7 ethical practice in telehealth, and 8 satisfaction of patients and providers. A multimodal approach based on a review of the literature is presented for providing the training: 1 didactics, 2 simulations including standardized patient encounters, 3 practice immersions, and 4 telehealth projects. Studies found that training using the multimodal approach allowed the students to develop comfort, knowledge, and skills needed to embrace the utilization of telehealth in health care. Keywords: telehealth, nurse practitioner education, telemedicine, simulation, health care
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Chen, Ying-Hsien; Hung, Chi-Sheng; Huang, Ching-Chang; Hung, Yu-Chien; Hwang, Juey-Jen; Ho, Yi-Lwun
2017-09-26
Atrial fibrillation (AF) is a common form of arrhythmia that is associated with increased risk of stroke and mortality. Detecting AF before the first complication occurs is a recognized priority. No previous studies have examined the feasibility of undertaking AF screening using a telehealth surveillance system with an embedded cloud-computing algorithm; we address this issue in this study. The objective of this study was to evaluate the feasibility of AF screening in nonmetropolitan areas using a telehealth surveillance system with an embedded cloud-computing algorithm. We conducted a prospective AF screening study in a nonmetropolitan area using a single-lead electrocardiogram (ECG) recorder. All ECG measurements were reviewed on the telehealth surveillance system and interpreted by the cloud-computing algorithm and a cardiologist. The process of AF screening was evaluated with a satisfaction questionnaire. Between March 11, 2016 and August 31, 2016, 967 ECGs were recorded from 922 residents in nonmetropolitan areas. A total of 22 (2.4%, 22/922) residents with AF were identified by the physician's ECG interpretation, and only 0.2% (2/967) of ECGs contained significant artifacts. The novel cloud-computing algorithm for AF detection had a sensitivity of 95.5% (95% CI 77.2%-99.9%) and specificity of 97.7% (95% CI 96.5%-98.5%). The overall satisfaction score for the process of AF screening was 92.1%. AF screening in nonmetropolitan areas using a telehealth surveillance system with an embedded cloud-computing algorithm is feasible. ©Ying-Hsien Chen, Chi-Sheng Hung, Ching-Chang Huang, Yu-Chien Hung, Juey-Jen Hwang, Yi-Lwun Ho. Originally published in JMIR Mhealth and Uhealth (http://mhealth.jmir.org), 26.09.2017.
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An evaluation of telehealth websites for design, literacy, information and content.
Whitten, Pamela; Holtz, Bree; Cornacchione, Jennifer; Wirth, Christina
2011-01-01
We examined 62 telehealth websites using four assessment criteria: design, literacy, information and telehealth content. The websites came from the member list of the American Telemedicine Association and the Office for the Advancement of Telehealth and partner sites, and were included if they were currently active and at least three clicks deep. Approximately 130 variables were examined for each website by two independent researchers. The websites reviewed contained most of the design variables (mean 74%, SD 6), but fewer of those relating to literacy (mean 26%, SD 6), website information (mean 35%, SD 16) and telehealth content (mean 37%, SD 18). Only 29% of websites encouraged users to ask about telehealth, and 19% contained information on overcoming telehealth barriers. Nonetheless, 84% promoted awareness of telehealth. All evaluation assessments were significantly correlated with each other except for literacy and information. The present study identified various matters that should be addressed when developing telehealth websites. Although much of this represents simple common sense in website design, our evaluation demonstrates that there is still much room for improvement.
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Morgan, Debra G; Kosteniuk, Julie; Stewart, Norma; O’Connell, Megan E; Karunanyake, Chandima; Beever, Rob
2015-01-01
Introduction Patient satisfaction is a key aspect of quality of care and can inform continuous quality improvement. Of the few studies that have reported on patient satisfaction with telehealth in programs aimed at individuals with memory problems, none has reported on the psychometric properties of the user satisfaction scales employed. Methods We evaluated the construct validity and internal consistency reliability of the Telehealth Satisfaction Scale (TeSS), a 10-item scale adapted for use in a Rural and Remote Memory Clinic (RRMC). The RRMC is a one-stop interprofessional clinic for rural and remote seniors with suspected dementia, located in a tertiary care hospital. Telehealth videoconferencing is used for pre-clinic assessment and for follow-up. Patients and caregivers completed the TeSS after each telehealth appointment. With data from 223 patients, exploratory factor analysis was conducted using the principal components analysis extraction method. Results The eigenvalue for the first factor (5.2) was greater than 1 and much larger than the second eigenvalue (.92), supporting a one-factor solution that was confirmed by the scree plot. The total variance explained by factor 1 was 52.1%. Factor loadings (range 0.54 – 0.84) were above recommended cutoffs. The TeSS items demonstrated high internal consistency reliability (Cronbach’s alpha = 0.90). Satisfaction scores on the TeSS items ranged from 3.43 to 3.72 on a 4-point Likert scale, indicating high satisfaction with telehealth. Conclusions The study findings demonstrate high user satisfaction with telehealth in a rural memory clinic, and sound psychometric properties of the TeSS in this population. PMID:25272141
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Wade, Victoria A; Taylor, Alan D; Kidd, Michael R; Carati, Colin
2016-05-16
This study was a component of the Flinders Telehealth in the Home project, which tested adding home telehealth to existing rehabilitation, palliative care and geriatric outreach services. Due to the known difficulty of transitioning telehealth projects services, a qualitative study was conducted to produce a preferred implementation approach for sustainable and large-scale operations, and a process model that offers practical advice for achieving this goal. Initially, semi-structured interviews were conducted with senior clinicians, health service managers and policy makers, and a thematic analysis of the interview transcripts was undertaken to identify the range of options for ongoing operations, plus the factors affecting sustainability. Subsequently, the interviewees and other decision makers attended a deliberative forum in which participants were asked to select a preferred model for future implementation. Finally, all data from the study was synthesised by the researchers to produce a process model. 19 interviews with senior clinicians, managers, and service development staff were conducted, finding strong support for home telehealth but a wide diversity of views on governance, models of clinical care, technical infrastructure operations, and data management. The deliberative forum worked through these options and recommended a collaborative consortium approach for large-scale implementation. The process model proposes that the key factor for large-scale implementation is leadership support, which is enabled by 1) showing solutions to the problems of service demand, budgetary pressure and the relationship between hospital and primary care, 2) demonstrating how home telehealth aligns with health service policies, and 3) achieving clinician acceptance through providing evidence of benefit and developing new models of clinical care. Two key actions to enable change were marketing telehealth to patients, clinicians and policy-makers, and building a community of
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Covering and Reimbursing Telehealth Services.
Blackman, Kate
2016-01-01
Policymakers who are striving to achieve better health care, improved health outcomes and lower costs are considering new strategies and technologies. Telehealth is a tool that uses technology to provide health services remotely, and state leaders are looking to it now more than ever as a way to address workforce gaps and reach underserved patients. Among the challenges facing state lawmakers who are working to introduce or expand telehealth is how to handle covering patients and reimbursing providers.
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Mixed methods for telehealth research.
Caffery, Liam J; Martin-Khan, Melinda; Wade, Victoria
2017-10-01
Mixed methods research is important to health services research because the integrated qualitative and quantitative investigation can give a more comprehensive understanding of complex interventions such as telehealth than can a single-method study. Further, mixed methods research is applicable to translational research and program evaluation. Study designs relevant to telehealth research are described and supported by examples. Quality assessment tools, frameworks to assist in the reporting and review of mixed methods research, and related methodologies are also discussed.
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User Authentication in Smartphones for Telehealth
Directory of Open Access Journals (Sweden)
Katherine A. Smith
2017-11-01
Full Text Available Many functions previously conducted on desktop computers are now performed on smartphones. Smartphones provide convenience, portability, and connectivity. When smartphones are used in the conduct of telehealth, sensitive data is invariably accessed, rendering the devices in need of user authentication to ensure data protection. User authentication of smartphones can help mitigate potential Health Insurance Portability and Accountability Act (HIPAA breaches and keep sensitive patient information protected, while also facilitating the convenience of smartphones within everyday life and healthcare. This paper presents and examines several types of authentication methods available to smartphone users to help ensure security of sensitive data from attackers. The applications of these authentication methods in telehealth are discussed. Keywords: Authentication, Biometrics, HIPAA, Mobile security, Telehealth
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WTP (willingness to pay) for tele-health consultation service in Hokkaido, Japan.
Ogasawara, Katsuhiko; Abe, Tamotsu
2013-01-01
We developed a tele-health consultation system that combines a sphygmomanometer with a tele-conference system. These were placed in pharmacies and the University. We selected five pharmacies to set up a consultation room; one in a local area, two in a suburban area, and the remaining two in an urban area. Nurses with more than 5 years of clinical experience were assigned as consultants. These consultants offer health consultation but do not practice medicine. Some researchers have indicated the economic viability of at-home health management systems, but nothing has been researched on the economic viability of tele-health consultation. The objective of present study was estimated Willingness to Payment (WTP) of Tele-health consultation service. The WTP was estimated by Double-Bounded Dichotomous-Choice model. We performed logistic-regression analysis to confirm factors to affect WTP. The number of the respondent was 480. Mean WTP was calculated 495 yen and the median was 367 yen. There was significant difference for factor of "annual income", "have a willingness to use this system", and "have a child/children".
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Diffusion of innovation: Telehealth for care at home.
Levy, Sharon
2015-01-01
The 'care at home' study focused on a Scottish telehealth service, which was designed to support children with palliative and complex care needs. Using the diffusion of innovation theory, this poster highlights the differences between the way telehealth is used in the public sector and in a third sector or a voluntary organization. Analysis of the data, taken from interviews with key stakeholders, illuminate barriers and solutions as noted by clinicians who see the clear benefits and potential risks of telehealth use at home. In conclusion, it is argued that a strategic steer towards a culture of innovation is needed to support effective use of telehealth in clinical practice. Senior managers in the National Health Service in the United Kingdom need to 'unleash' the goodwill of staff who are eager to exploit innovation in clinical practice.
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Exploring telehealth opportunities in domestic violence shelters.
Mattson, Susan; Shearer, Nelma; Long, Carol
2002-10-01
To determine the degree of interest in using a computer for the purpose of accessing services from a nurse practitioner (NP) at domestic violence shelters (DVSs); and to identify issues of privacy and confidentiality that might arise from participation by victims of intimate partner violence (IPV) in a Telehealth intervention. Focus groups with 19 women residing in two DVSs. Interviews were recorded, transcribed and themes were identified that answered the questions posed in the interviews. Most of the women understood the term NP and were favorably inclined to seek services from one. Over half of the women were not familiar with computer use, but were willing to learn in order to receive health care services, both for episodic needs and for maintenance of chronic conditions. After learning of the method proposed to allow them to access an NP through the internet while still protecting their privacy and confidentiality, the women felt comfortable with this approach to meeting their health care needs. Results from this study can be used to support the development and testing of Telehealth interventions for these victims of IPV.
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Telehealth and Autism: Treating Challenging Behavior at Lower Cost.
Lindgren, Scott; Wacker, David; Suess, Alyssa; Schieltz, Kelly; Pelzel, Kelly; Kopelman, Todd; Lee, John; Romani, Patrick; Waldron, Debra
2016-02-01
To determine whether challenging behavior in young children with autism and other developmental disabilities can be treated successfully at lower cost by using telehealth to train parents to implement applied behavior analysis (ABA). We compared data on the outcomes and costs for implementing evidence-based ABA procedures to reduce problem behavior by using 3 service delivery models: in-home therapy, clinic-based telehealth, and home-based telehealth. Participants were 107 young children diagnosed with autism or other neurodevelopmental disorders, and data analysis focused on the 94 children who completed treatment. All 3 service delivery models demonstrated successful reduction of problem behavior by training parents to conduct functional analysis and functional communication training. The mean percentage reduction in problem behavior was >90% in all 3 groups after treatment, and treatment acceptability based on parent ratings was high for all groups. Total costs for implementing treatment were lowest for home telehealth, but both telehealth models were significantly less costly than in-home therapy. This research demonstrated that parents can use ABA procedures to successfully treat behavior problems associated with autism spectrum disorders regardless of whether treatment is directed by behavior consultants in person or via remote video coaching. Because ABA telehealth can achieve similar outcomes at lower cost compared with in-home therapy, geographic barriers to providing access to ABA for treating problem behavior can be minimized. These findings support the potential for using telehealth to provide research-based behavioral treatment to any family that has access to the Internet. Copyright © 2016 by the American Academy of Pediatrics.
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Community Hospital Telehealth Consortium
National Research Council Canada - National Science Library
Williams, Elton
2004-01-01
The Community Hospital Telehealth Consortium is a unique, forward-thinking, community-based healthcare service project organized around 5 not-for-profit community hospitals located throughout Louisiana and Mississippi...
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Community Hospital Telehealth Consortium
National Research Council Canada - National Science Library
Williams, Elton
2003-01-01
The Community Hospital Telehealth Consortium is a unique, forward-thinking, community-based healthcare service project organized around 5 not-for-profit community hospitals located throughout Louisiana and Mississippi...
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Community Hospital Telehealth Consortium
National Research Council Canada - National Science Library
Williams, Jr, Elton L
2007-01-01
The Community Hospital Telehealth Consortium is a unique, forward-thinking, community-based healthcare service project organized around 5 not-for-profit community hospitals located throughout Louisiana and Mississippi...
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Technology support to a telehealth in the home service: Qualitative observations.
Taylor, Alan; Wade, Victoria; Morris, Greg; Pech, Joanne; Rechter, Stuart; Kidd, Michael; Carati, Colin
2016-07-01
The Flinders University Telehealth in the Home (FTH) trial was an action research initiative that introduced and evaluated the impact of telehealth services on palliative care patients living in the community, home-based rehabilitation services for the elderly, and services to the elderly in residential aged care. The aim of this study was to understand the issues encountered during the provision of technology services that supported this trial. A mixed methods approach was undertaken to analyse the roles of information and communication technology (ICT) and clinical staff in design, technology management and training. The data sources were staff observations and documents including job logs, meetings, emails and technology descriptions. Use of consumer technology for telehealth required customisation of applications and services. Clinicians played a key role in definition of applications and the embedding of workflow into applications. Usability of applications was key to their subsequent use. Management of design creep and technology services, coupled with support and training for clinicians were important to maintenance of a telehealth service. In the setting described, an iterative approach to the development of telehealth services to the home using consumer technologies was needed. The efficient management of consumer devices in multiple settings will become critical as telehealth services grow in scale. Effective collaboration between clinical and technical stakeholders and further workforce education in telehealth can be key enablers for the transition of face-to-face care to a telehealth mode of delivery. © The Author(s) 2015.
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Rossos, P G; St-Cyr, O; Purdy, B; Toenjes, C; Masino, C; Chmelnitsky, D
2015-01-01
Despite decades of international experience with the use of information and communication technologies in healthcare delivery, widespread telehealth adoption remains limited and progress slow. Escalating health system challenges related to access, cost and quality currently coincide with rapid advancement of affordable and reliable internet based communication technologies creating unprecedented opportunities and incentives for telehealth. In this paper, we will describe how Human Factors Engineering (HFE) and user-centric elements have been incorporated into the establishment of telehealth within a large academic medical center to increase acceptance and sustainability. Through examples and lessons learned we wish to increase awareness of HFE and its importance in the successful implementation, innovation and growth of telehealth programs.
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An overview of the national telehealth initiative in Malaysia.
Maon, Siti N; Edirippulige, Sisira
2010-01-01
Malaysia's national health statistics for the last half century show a remarkable improvement in the nation's health status. One important factor for this improvement is the Malaysian government's proactive intervention in the health sector. Among others, e-health has played a vital role in delivering and managing healthcare services in Malaysia. While the Government has integrated telehealth in its national digital infrastructure re-design, it has heavily invested in telehealth. The enactment of new laws to facilitate telehealth practices can also be noted as an important measure.
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Tieman, Jennifer Joy; Morgan, Deidre Diane; Swetenham, Kate; To, Timothy Hong Man; Currow, David Christopher
2014-09-04
Changing population demography and patterns of disease are increasing demands on the health system. Telehealth is seen as providing a mechanism to support community-based care, thus reducing pressure on hospital services and supporting consumer preferences for care in the home. This study examined the processes involved in developing a prototype telehealth intervention to support palliative care patients involved with a palliative care service living in the community. The challenges and considerations in developing the palliative care telehealth prototype were reviewed against the Center for eHealth Research (CeHRes) framework, a telehealth development model. The project activities to develop the prototype were specifically mapped against the model's first four phases: multidisciplinary project management, contextual inquiry, value specification, and design. This project has been developed as part of the Telehealth in the Home: Aged and Palliative Care in South Australia initiative. Significant issues were identified and subsequently addressed during concept and prototype development. The CeHRes approach highlighted the implicit diversity in views and opinions among participants and stakeholders and enabled issues to be considered, resolved, and incorporated during design through continuous engagement. The CeHRes model provided a mechanism that facilitated "better" solutions in the development of the palliative care prototype by addressing the inherent but potentially unrecognized differences in values and beliefs of participants. This collaboration enabled greater interaction and exchange among participants resulting in a more useful and clinically valuable telehealth prototype.
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Community Hospital Telehealth Consortium
National Research Council Canada - National Science Library
Williams, Elton
2003-01-01
.... The central tenet of the CHTC project is the utilization of TeleHealth technology to improve and expand the opportunity for rural and urban underserved populations to receive quality, affordable health care...
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Community Hospital Telehealth Consortium
National Research Council Canada - National Science Library
Williams, Jr, Elton L
2007-01-01
.... The central tenet of the CHTC project is the utilization of TeleHealth technology to improve and expand the opportunity for rural and urban underserved populations to receive quality, affordable health care...
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Community Hospital Telehealth Consortium
National Research Council Canada - National Science Library
Williams, Elton
2004-01-01
.... The central tenet of the CHTC project is the utilization of TeleHealth technology to improve and expand the opportunity for rural and urban underserved populations to receive quality, affordable health care...
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Heckemann, Birgit; Wolf, Axel; Ali, Lilas; Sonntag, Steffen Mark; Ekman, Inger
2016-03-02
To explore factors that influence relationship building between telehealth professionals and patients with chronic illness over a distance, from a telehealth professional's perspective. 4 focus group interviews were conducted in June 2014. Digital recordings were transcribed verbatim and qualitative content analysis was performed using an iterative process of 3 coding rounds. 20 telehealth professionals. A telehealth service centre in the south of Germany that provided care for 12,000 patients with chronic heart failure across Germany. Non-video telehealth technology creates an atmosphere that fosters sharing of personal information and a non-judgemental attitude. This facilitates the delivery of fair and equal healthcare. A combination of a protocol-driven service structure along with shared team and organisational values provide a basis for establishing long-term healthcare relationships. However, each contact between a telehealth professional and a patient has an uncertain outcome and requires skillful negotiation of the relationship. Although care provision was personalised, there was scope to include the patients as 'experts on their own illness' to a greater extent as advocated by person-centred care. Currently, provision of person-centred care is not sufficiently addressed in telehealth professional training. Telehealth offers a viable environment for the delivery of person-centred care for patients with long-standing disease. Current telehealth training programmes may be enhanced by teaching person-centred care skills. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/
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Occupational Therapy Home Safety Intervention via Telehealth
BREEDEN, LORI E.
2016-01-01
Photography can be an effective addition for education-based telehealth services delivered by an occupational therapist. In this study, photography was used as antecedent to telehealth sessions delivered by an occupational therapist focused on narrative learning about home safety. After taking photographs of past home safety challenges, six participants experienced three web-based occupational therapy sessions. Sessions were recorded and transcribed. Data were examined using content analysis. The content analysis identified the following themes: the value of photos to support learning; the value of narrative learning related to home safety education; and abstract versus concrete learners. Procedural findings are included to support future endeavors. Findings indicate that within a wellness context, home safety education for older adults can be delivered effectively via telehealth when using photography as a part of an occupational therapy intervention. PMID:27563389
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Telehealth--an effective delivery method for diabetes self-management education?
Fitzner, Karen; Moss, Gail
2013-06-01
Diabetes is a chronic disease that is often comorbid with cardiovascular disease, hypertension, kidney disease, and neuropathy. Its management is complex, requiring ongoing clinical management, lifestyle changes, and self-care. This article examines recent literature on telehealth and emerging technological tools for supporting self-management of diabetes and identifies best practices. The authors conducted a PubMed search (January 2008-2012) that was supplemented by review of meeting materials and a scan of the Internet to identify emerging technologies. Fifty-eight papers were reviewed; 12 were selected for greater analysis. This review supports earlier findings that the delivery of diabetes self-management and training (DSME/T) via telehealth is useful, appropriate, and acceptable to patients and providers. Best practices are emerging; not all technology is appropriate for all populations--interactive technology needs to be appropriate to the patient's age, abilities, and sensitivities. Telehealth is scalable and sustainable provided that it adds value, does not add to the provider's workload, and is fairly reimbursed. However, there are multiple barriers (patient, provider, health system) to remotely provided DSME/T. DSME/T delivered via telehealth offers effective, efficient, and affordable ways to reach and support underserved minorities and other people with diabetes and related comorbidities. The new generation of smartphones, apps, and other technologies increase access, and the newest interventions are designed to meet patient needs, do not increase workloads, are highly appropriate, enhance self-management, and are desired by patients.
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Competencies required for nursing telehealth activities: A Delphi-study
Dr. H.S.M. Kort; Olle ten Cate; Thijs van Houwelingen; Anna H. Moerman; Roelof G.A. Ettema
2016-01-01
Background: Telehealth is viewed as a major strategy to address the increasing demand for care and a shrinking care professional population. However, most nurses are not trained or are insufficiently trained to use these technologies effectively. Therefore, the potential of telehealth fails to reach
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Competencies required for nursing telehealth activities: a Delphi-study
van Houwelingen, C.T.M.; Moerman, A.H.; Ettema, R.G.A.; Kort, H.S.M.; ten Cate, O.
2016-01-01
Background: Telehealth is viewed as a major strategy to address the increasing demand for care and a shrinking care professional population. However, most nurses are not trained or are insufficiently trained to use these technologies effectively. Therefore, the potential of telehealth fails to reach
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Occupational Therapy Home Safety Intervention via Telehealth
Lori E. Breeden
2016-01-01
Photography can be an effective addition for education-based telehealth services delivered by an occupational therapist. In this study, photography was used as antecedent to telehealth sessions delivered by an occupational therapist focused on narrative learning about home safety. After taking photographs of past home safety challenges, six participants experienced three web-based occupational therapy sessions each. Sessions were recorded and transcribed. Data were examined using content ...
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Telehealth, Mobile Applications, and Wearable Devices are Expanding Cancer Care Beyond Walls.
Cannon, Carol
2018-05-01
To review telehealth solutions, mobile applications, and wearable devices that are currently impacting patients, caregivers, and providers who work in the oncology setting. A literature search was conducted using the terms (Telehealth, Mobile Health, mHealth, Wearable Devices) + (Oncology, Cancer Care). There are many current applications of telehealth and mobile health in the oncology setting. Nurses who care for patients with cancer should be aware of the pervasiveness and impact of telehealth and mobile health to this unique population. Copyright © 2018 Elsevier Inc. All rights reserved.
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Rural Family Physicians Are Twice as Likely to Use Telehealth as Urban Family Physicians.
Jetty, Anuradha; Moore, Miranda A; Coffman, Megan; Petterson, Stephen; Bazemore, Andrew
2018-04-01
Telehealth has the potential to reduce health inequities and improve health outcomes among rural populations through increased access to physicians, specialists, and reduced travel time for patients. Although rural telehealth services have expanded in several specialized areas, little is known about the attitudes, beliefs, and uptake of telehealth use in rural American primary care. This study characterizes the differences between rural and urban family physicians (FPs), their perceptions of telehealth use, and barriers to further adoption. Nationally representative randomly sampled survey of 5,000 FPs. Among the 31.3% of survey recipients who completed the survey, 83% practiced in urban areas and 17% in rural locations. Rural FPs were twice as likely to use telehealth as urban FPs (22% vs. 10%). Logistic regressions showed rural FPs had greater odds of reporting telehealth use to connect their patients to specialists and to care for their patients. Rural FPs were less likely to identify liability concerns as a barrier to using telehealth. Telemedicine allows rural patients to see specialists without leaving their communities and permits rural FPs to take advantage of specialist expertise, expand their scope of practice, and reduce the feeling of isolation experienced by rural physicians. Efforts to raise awareness of current payment policies for telehealth services, addressing the limitations of current reimbursement policies and state regulations, and creating new avenues for telehealth reimbursement and technological investments are critical to increasing primary care physician use of telehealth services.
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Are people with chronic diseases interested in using telehealth? A cross-sectional postal survey.
Edwards, Louisa; Thomas, Clare; Gregory, Alison; Yardley, Lucy; O'Cathain, Alicia; Montgomery, Alan A; Salisbury, Chris
2014-05-08
There is growing interest in telehealth-the use of technology to support the remote delivery of health care and promote self-management-as a potential alternative to face-to-face care for patients with chronic diseases. However, little is known about what precipitates interest in the use of telehealth among these patients. This survey forms part of a research program to develop and evaluate a telehealth intervention for patients with two exemplar chronic diseases: depression and raised cardiovascular disease (CVD) risk. The survey was designed to explore the key factors that influence interest in using telehealth in these patient groups. Thirty-four general practices were recruited from two different regions within England. Practice records were searched for patients with (1) depression (aged 18+ years) or (2) 10-year risk of CVD ≥20% and at least one modifiable risk factor (aged 40-74 years). Within each general practice, 54 patients in each chronic disease group were randomly selected to receive a postal questionnaire. Questions assessed five key constructs: sociodemographics, health needs, difficulties accessing health care, technology-related factors (availability, confidence using technology, perceived benefits and drawbacks of telehealth), and satisfaction with prior use of telehealth. Respondents also rated their interest in using different technologies for telehealth (phone, email and Internet, or social media). Relationships between the key constructs and interest in using the three mediums of telehealth were examined using multivariable regression models. Of the 3329 patients who were sent a study questionnaire, 44.40% completed it (872/1740, 50.11% CVD risk; 606/1589, 38.14% depression). Overall, there was moderate interest in using phone-based (854/1423, 60.01%) and email/Internet-based (816/1425, 57.26%) telehealth, but very little interest in social media (243/1430, 16.99%). After adjusting for health needs, access difficulties, technology
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Telehealth exercise-based cardiac rehabilitation: a systematic review and meta-analysis.
Rawstorn, Jonathan C; Gant, Nicholas; Direito, Artur; Beckmann, Christina; Maddison, Ralph
2016-08-01
Despite proven effectiveness, participation in traditional supervised exercise-based cardiac rehabilitation (exCR) remains low. Telehealth interventions that use information and communication technologies to enable remote exCR programme delivery can overcome common access barriers while preserving clinical supervision and individualised exercise prescription. This meta-analysis aimed to determine the benefits of telehealth exCR on exercise capacity and other modifiable cardiovascular risk factors compared with traditional exCR and usual care, among patients with coronary heart disease (CHD). CINAHL, The Cochrane Library, Embase, MEDLINE, PubMed and PsycINFO were searched from inception through 31 May 2015 for randomised controlled trials comparing telehealth exCR with centre-based exCR or usual care among patients with CHD. Outcomes included maximal aerobic exercise capacity, modifiable cardiovascular risk factors and exercise adherence. 11 trials (n=1189) met eligibility criteria and were included in the review. Physical activity level was higher following telehealth exCR than after usual care. Compared with centre-based exCR, telehealth exCR was more effective for enhancing physical activity level, exercise adherence, diastolic blood pressure and low-density lipoprotein cholesterol. Telehealth and centre-based exCR were comparably effective for improving maximal aerobic exercise capacity and other modifiable cardiovascular risk factors. Telehealth exCR appears to be at least as effective as centre-based exCR for improving modifiable cardiovascular risk factors and functional capacity, and could enhance exCR utilisation by providing additional options for patients who cannot attend centre-based exCR. Telehealth exCR must now capitalise on technological advances to provide more comprehensive, responsive and interactive interventions. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/
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Telehealth in the Developing World | CRDI - Centre de recherches ...
International Development Research Centre (IDRC) Digital Library (Canada)
Telehealth in the Developing World. Couverture du livre Telehealth in the Developing World. Directeur(s) : Richard Wootton, Nivritti G. Patil, Richard E. Scott, et Kendall Ho. Maison(s) d'édition : Royal Society of Medicine Press, CRDI. 24 février 2009. ISBN : 9781853157844. 324 pages. e-ISBN : 9781552503966.
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Kuziemsky, Craig E; Gogia, Shashi B; Househ, Mowafa; Petersen, Carolyn; Basu, Arindam
2018-04-22
Connected healthcare is an essential part of patient-centred care delivery. Technology such as telehealth is a critical part of connected healthcare. However, exchanging health information brings the risk of privacy issues. To better manage privacy risks we first need to understand the different patterns of patient-centred care in order to tailor solutions to address privacy risks. Drawing upon published literature, we develop a business model to enable patient-centred care via telehealth. The model identifies three patient-centred connected health patterns. We then use the patterns to analyse potential privacy risks and possible solutions from different types of telehealth delivery. Connected healthcare raises the risk of unwarranted access to health data and related invasion of privacy. However, the risk and extent of privacy issues differ according to the pattern of patient-centred care delivery and the type of particular challenge as they enable the highest degree of connectivity and thus the greatest potential for privacy breaches. Privacy issues are a major concern in telehealth systems and patients, providers, and administrators need to be aware of these privacy issues and have guidance on how to manage them. This paper integrates patient-centred connected health care, telehealth, and privacy risks to provide an understanding of how risks vary across different patterns of patient-centred connected health and different types of telehealth delivery. Georg Thieme Verlag KG Stuttgart.
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Wade, Victoria A; Hamlyn, Jeremy S
2013-10-01
The relationship between the clinical and technical aspects of a telehealth operation is frequently problematic, and technically-driven projects often fail to achieve sustainability. Qualitative data from a study of 37 Australian telehealth services were analysed to understand how the relationship between telehealth providers and information technology (IT) departments helps or hinders the development of telehealth. The most frequent difficulties reported were between telehealth services and the internal IT departments of health services, rather than with external vendors. The difficulties included barriers to installing telehealth over IT networks, a lack of priority given to telehealth services, and IT departments insisting on standardised approach. Alternatively, when IT staff were assigned to supporting clinical staff and had a close working relationship with them, they were major enablers of telehealth services. Authorising dedicated IT support and encouraging joint problem solving should provide a strong foundation for a healthy relationship which contributes to the growth and sustainability of telehealth.
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Radhakrishna, K.; Bowles, K.; Zettek-Sumner, A.
2013-01-01
Summary Background Telehealth data overload through high alert generation is a significant barrier to sustained adoption of telehealth for managing HF patients. Objective To explore the factors contributing to frequent telehealth alerts including false alerts for Medicare heart failure (HF) patients admitted to a home health agency. Materials and Methods A mixed methods design that combined quantitative correlation analysis of patient characteristic data with number of telehealth alerts and qualitative analysis of telehealth and visiting nurses’ notes on follow-up actions to patients’ telehealth alerts was employed. All the quantitative and qualitative data was collected through retrospective review of electronic records of the home heath agency. Results Subjects in the study had a mean age of 83 (SD = 7.6); 56% were female. Patient co-morbidities (ppatient characteristics along with establishing patient-centered telehealth outcome goals may allow meaningful generation of telehealth alerts. Reducing avoidable telehealth alerts could vastly improve the efficiency and sustainability of telehealth programs for HF management. PMID:24454576
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Are People With Chronic Diseases Interested in Using Telehealth? A Cross-Sectional Postal Survey
Thomas, Clare; Gregory, Alison; Yardley, Lucy; O'Cathain, Alicia; Montgomery, Alan A; Salisbury, Chris
2014-01-01
Background There is growing interest in telehealth—the use of technology to support the remote delivery of health care and promote self-management—as a potential alternative to face-to-face care for patients with chronic diseases. However, little is known about what precipitates interest in the use of telehealth among these patients. Objective This survey forms part of a research program to develop and evaluate a telehealth intervention for patients with two exemplar chronic diseases: depression and raised cardiovascular disease (CVD) risk. The survey was designed to explore the key factors that influence interest in using telehealth in these patient groups. Methods Thirty-four general practices were recruited from two different regions within England. Practice records were searched for patients with (1) depression (aged 18+ years) or (2) 10-year risk of CVD ≥20% and at least one modifiable risk factor (aged 40-74 years). Within each general practice, 54 patients in each chronic disease group were randomly selected to receive a postal questionnaire. Questions assessed five key constructs: sociodemographics, health needs, difficulties accessing health care, technology-related factors (availability, confidence using technology, perceived benefits and drawbacks of telehealth), and satisfaction with prior use of telehealth. Respondents also rated their interest in using different technologies for telehealth (phone, email and Internet, or social media). Relationships between the key constructs and interest in using the three mediums of telehealth were examined using multivariable regression models. Results Of the 3329 patients who were sent a study questionnaire, 44.40% completed it (872/1740, 50.11% CVD risk; 606/1589, 38.14% depression). Overall, there was moderate interest in using phone-based (854/1423, 60.01%) and email/Internet-based (816/1425, 57.26%) telehealth, but very little interest in social media (243/1430, 16.99%). After adjusting for health needs
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Home-Based Telehealth Hospitalization for Exacerbation of Chronic Obstructive Pulmonary Disease
DEFF Research Database (Denmark)
Jakobsen, Anna Svarre; Laursen, Lars C; Rydahl-Hansen, Susan
2015-01-01
Background: Telehealth interventions for patients with chronic obstructive pulmonary disease (COPD) have focused primarily on stable outpatients. Telehealth designed to handle the acute exacerbation that normally requires hospitalization could also be of interest. The aim of this study...... was to compare the effect of home-based telehealth hospitalization with conventional hospitalization for exacerbation in severe COPD. Materials and Methods: A two-center, noninferiority, randomized, controlled effectiveness trial was conducted between June 2010 and December 2011. Patients with severe COPD...... admitted because of exacerbation were randomized 1:1 either to home-based telehealth hospitalization or to continue standard treatment and care at the hospital. The primary outcome was treatment failure defined as re-admission due to exacerbation in COPD within 30 days after initial discharge...
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Occupational Therapy Home Safety Intervention via Telehealth
Directory of Open Access Journals (Sweden)
Lori E. Breeden
2016-07-01
Full Text Available Photography can be an effective addition for education-based telehealth services delivered by an occupational therapist. In this study, photography was used as antecedent to telehealth sessions delivered by an occupational therapist focused on narrative learning about home safety. After taking photographs of past home safety challenges, six participants experienced three web-based occupational therapy sessions each. Sessions were recorded and transcribed. Data were examined using content analysis. A content analysis identified the following themes as well as an understanding of the learning process. Analyses yielded themes of: the value of photos to support learning, the value of narrative learning related to home safety education, abstract versus concrete learners. Procedural findings are included to support future endeavors. Findings indicate that within a wellness context, home safety education for older adults can be delivered effectively via telehealth when using photography as a part of an occupational therapy intervention.
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Telehealth in the Developing World | CRDI - Centre de recherches ...
International Development Research Centre (IDRC) Digital Library (Canada)
Telehealth in the Developing World. Book cover Telehealth in the Developing World. Directeur(s) : Richard Wootton, Nivritti G. Patil, Richard E. Scott, and Kendall Ho. Maison(s) d'édition : Royal Society of Medicine Press, IDRC. 24 février 2009. ISBN : 9781853157844. 324 pages. e-ISBN : 9781552503966. Téléchargez le ...
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Cancer Survivors’ Experience With Telehealth: A Systematic Review and Thematic Synthesis
Lucas, Grace; Marcu, Afrodita; Piano, Marianne; Grosvenor, Wendy; Mold, Freda; Maguire, Roma; Ream, Emma
2017-01-01
Background Net survival rates of cancer are increasing worldwide, placing a strain on health service provision. There is a drive to transfer the care of cancer survivors—individuals living with and beyond cancer—to the community and encourage them to play an active role in their own care. Telehealth, the use of technology in remote exchange of data and communication between patients and health care professionals (HCPs), is an important contributor to this evolving model of care. Telehealth interventions are “complex,” and understanding patient experiences of them is important in evaluating their impact. However, a wider view of patient experience is lacking as qualitative studies detailing cancer survivor engagement with telehealth are yet to be synthesized. Objective To systematically identify, appraise, and synthesize qualitative research evidence on the experiences of adult cancer survivors participating in telehealth interventions, to characterize the patient experience of telehealth interventions for this group. Methods Medline (PubMed), PsychINFO, Cumulative Index for Nursing and Allied Health Professionals (CINAHL), Embase, and Cochrane Central Register of Controlled Trials were searched on August 14, 2015, and March 8, 2016, for English-language papers published between 2006 and 2016. Inclusion criteria were as follows: adult cancer survivors aged 18 years and over, cancer diagnosis, experience of participating in a telehealth intervention (defined as remote communication or remote monitoring with an HCP delivered by telephone, Internet, or hand-held or mobile technology), and reporting qualitative data including verbatim quotes. An adapted Critical Appraisal Skill Programme (CASP) checklist for qualitative research was used to assess paper quality. The results section of each included article was coded line by line, and all papers underwent inductive analysis, involving comparison, reexamination, and grouping of codes to develop descriptive themes
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Schwamm, Lee H
2014-02-01
"Telehealth" refers to the use of electronic services to support a broad range of remote services, such as patient care, education, and monitoring. Telehealth must be integrated into traditional ambulatory and hospital-based practices if it is to achieve its full potential, including addressing the six domains of care quality defined by the Institute of Medicine: safe, effective, patient-centered, timely, efficient, and equitable. Telehealth is a disruptive technology that appears to threaten traditional health care delivery but has the potential to reform and transform the industry by reducing costs and increasing quality and patient satisfaction. This article outlines seven strategies critical to successful telehealth implementation: understanding patients' and providers' expectations, untethering telehealth from traditional revenue expectations, deconstructing the traditional health care encounter, being open to discovery, being mindful of the importance of space, redesigning care to improve value in health care, and being bold and visionary.
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World Federation of Occupational Therapists' Position Statement on Telehealth
Directory of Open Access Journals (Sweden)
World Federation of Occupational Therapists
2014-09-01
Full Text Available The purpose of this document is to state the World Federation of Occupational Therapists’ (WFOT position on the use of telehealth for the delivery of occupational therapy services. Telehealth is the use of information and communication technologies (ICT to deliver health-related services when the provider and client are in different physical locations. Additional terms used to describe this service delivery model include: tele-occupational therapy, telerehabilitation, teletherapy, telecare, telemedicine, and telepractice, among other terms. Telehealth may be used by occupational therapy practitioners for evaluation, intervention, monitoring, supervision, and consultation (between remote therapist, client, and/or local health-care provider as permitted by jurisdictional, institutional, and professional regulations and policies governing the practice of occupational therapy.Occupational therapy services via telehealth should be appropriate to the individuals, groups and cultures served,and contextualized to the occupations and interests of clients. Important considerations related to licensure/registration, collaboration with local occupational therapists, client selection, consent to treat, professional liability insurance, confidentiality, personal and cultural attributes, provider competence/standards of care, reimbursement/payer guidelines, and authentic occupational therapy practice are discussed.
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Nursing Telehealth Applications Initiative
2011-01-01
promotion, diagnosis, consultation, education, and/or therapy " (5). Telehealth encompasses videoconferencing, transmission of still images, e-health, remote...one 16 ounce chocolate milkshake at McDonalds has 580 calories and 102 grams of carbohydrate, one Minute Maid apple juice box has 90 calories and
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User Authentication in Smartphones for Telehealth.
Smith, Katherine A; Zhou, Leming; Watzlaf, Valerie J M
2017-01-01
Many functions previously conducted on desktop computers are now performed on smartphones. Smartphones provide convenience, portability, and connectivity. When smartphones are used in the conduct of telehealth, sensitive data is invariably accessed, rendering the devices in need of user authentication to ensure data protection. User authentication of smartphones can help mitigate potential Health Insurance Portability and Accountability Act (HIPAA) breaches and keep sensitive patient information protected, while also facilitating the convenience of smartphones within everyday life and healthcare. This paper presents and examines several types of authentication methods available to smartphone users to help ensure security of sensitive data from attackers. The applications of these authentication methods in telehealth are discussed.
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Langabeer, James R; Gonzalez, Michael; Alqusairi, Diaa; Champagne-Langabeer, Tiffany; Jackson, Adria; Mikhail, Jennifer; Persse, David
2016-11-01
Emergency medical services (EMS) agencies transport a significant majority of patients with low acuity and non-emergent conditions to local emergency departments (ED), affecting the entire emergency care system's capacity and performance. Opportunities exist for alternative models that integrate technology, telehealth, and more appropriately aligned patient navigation. While a limited number of programs have evolved recently, no empirical evidence exists for their efficacy. This research describes the development and comparative effectiveness of one large urban program. The Houston Fire Department initiated the Emergency Telehealth and Navigation (ETHAN) program in 2014. ETHAN combines telehealth, social services, and alternative transportation to navigate primary care-related patients away from the ED where possible. Using a case-control study design, we describe the program and compare differences in effectiveness measures relative to the control group. During the first 12 months, 5,570 patients participated in the telehealth-enabled program, which were compared against the same size control group. We found a 56% absolute reduction in ambulance transports to the ED with the intervention compared to the control group (18% vs. 74%, P models are effective at reducing unnecessary ED ambulance transports and increasing EMS unit productivity. This provides support for broader EMS mobile integrated health programs in other regions.
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Cady, Rhonda G.; Finkelstein, Stanley M.
2015-01-01
Nurse-delivered telephone triage is a common component of outpatient clinic settings. Adding new communication technology to clinic triage has the potential to not only transform the triage process, but also alter triage workflow. Evaluating the impact of new technology on an existing workflow is paramount to maximizing efficiency of the delivery system. This study investigated triage nurse workflow before and after the implementation of video telehealth using a sequential mixed methods protocol that combined ethnography and time-motion study to provide a robust analysis of the implementation environment. Outpatient clinic triage using video telehealth required significantly more time than telephone triage, indicating a reduction in nurse efficiency. Despite the increased time needed to conduct video telehealth, nurses consistently rated it useful in providing triage. Interpretive analysis of the qualitative and quantitative data suggests the increased depth and breadth of data available during video triage alters the assessment triage nurses provide physicians. This in turn could impact the time physicians spend formulating a diagnosis and treatment plan. While the immediate impact of video telehealth is a reduction in triage nurse efficiency, what is unknown is the impact of video telehealth on physician and overall clinic efficiency. Future studies should address this area. PMID:24080753
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Success factors for telehealth--a case study.
Moehr, J R; Schaafsma, J; Anglin, C; Pantazi, S V; Grimm, N A; Anglin, S
2006-01-01
To present the lessons learned from an evaluation of a comprehensive telehealth project regarding success factors and evaluation methodology for such projects. A recent experience with the evaluation of new telehealth services in BC, Canada, is summarized. Two domains of clinical applications, as well as educational and administrative uses, and the project environment were evaluated. In order to contribute to the success of the project, the evaluation included formative and summative approaches employing qualitative and quantitative methods with data collection from telehealth events, participants and existing databases. The evaluation had to be carried out under severe budgetary and time constraints. We therefore deliberately chose a broad ranging exploratory approach within a framework provided, and generated questions to be answered on the basis of initial observations and participant driven interviews with progressively more focused and detailed data gathering, including perusal of a variety of existing data sources. A unique feature was an economic evaluation using static simulation models. The evaluation yielded rich and detailed data, which were able to explain a number of unanticipated findings. One clinical application domain was cancelled after 6 months, the other continues. The factors contributing to success include: Focus on chronic conditions which require visual information for proper management. Involvement of established teams in regular scheduled visits or in sessions scheduled well in advance. Problems arose with: Ad hoc applications, in particular under emergency conditions. Applications that disregard established referral patterns. Applications that support only part of a unit's services. The latter leads to the service mismatch dilemma (SMMD) with the end result that even those e-health services provided are not used. The problems encountered were compounded by issues arising from the manner in which the telehealth services had been introduced
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Ritchie, Catherine L W; Miller, Linda L; Antle, David M
2017-01-01
Telehealth approaches to delivering ergonomics assessment hold great potential to improve service delivery in rural and remote settings. This case study describes a telehealth-based ergonomics service delivery process, and compares in-person and telehealth-based ergonomics approaches at an Alberta-based non-profit advocacy group. This project demonstrates that telehealth approaches to ergonomics do not lead to significantly different scoring outcomes for assessment of ergonomics issues, when compared to in-person assessments. This project also outlines the importance of live real-time video conferencing to improving communication, attaining key assessment information, and demonstrating ergonomic adjustments. However, some key considerations of bandwidth and hardware capabilities need to be taken into account. Key communication strategies are outlined to improve rapport, maintain employee confidentiality, and reduce client anxiety around telehealth ergonomics assessments. This project provides further support for telehealth approaches to office ergonomics, and outlines some key implementation strategies and barriers that should be considered.
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Task-technology fit of video telehealth for nurses in an outpatient clinic setting.
Cady, Rhonda G; Finkelstein, Stanley M
2014-07-01
Incorporating telehealth into outpatient care delivery supports management of consumer health between clinic visits. Task-technology fit is a framework for understanding how technology helps and/or hinders a person during work processes. Evaluating the task-technology fit of video telehealth for personnel working in a pediatric outpatient clinic and providing care between clinic visits ensures the information provided matches the information needed to support work processes. The workflow of advanced practice registered nurse (APRN) care coordination provided via telephone and video telehealth was described and measured using a mixed-methods workflow analysis protocol that incorporated cognitive ethnography and time-motion study. Qualitative and quantitative results were merged and analyzed within the task-technology fit framework to determine the workflow fit of video telehealth for APRN care coordination. Incorporating video telehealth into APRN care coordination workflow provided visual information unavailable during telephone interactions. Despite additional tasks and interactions needed to obtain the visual information, APRN workflow efficiency, as measured by time, was not significantly changed. Analyzed within the task-technology fit framework, the increased visual information afforded by video telehealth supported the assessment and diagnostic information needs of the APRN. Telehealth must provide the right information to the right clinician at the right time. Evaluating task-technology fit using a mixed-methods protocol ensured rigorous analysis of fit within work processes and identified workflows that benefit most from the technology.
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Directory of Open Access Journals (Sweden)
Duplantie Julie
2007-01-01
Full Text Available Abstract Background The availability of medical human resource supply is a growing concern for rural and remote communities in many countries. In the last decade, various telehealth experiences in Canada have highlighted the potential impact of this technology on professional practice. The purpose of this study was to explore physicians' and managers' perceptions regarding the potential of telehealth to support recruitment and retention of physicians in remote and rural regions. Methods A case study in Eastern Quebec was performed to explore this complex phenomenon. The analytical framework was based on two literature reviews and a Delphi study. Data were collected from semi-structured interviews with 41 physicians and 22 managers. Transcripts were produced and interview content was coded independently by two judges and validated by an expert panel. Results Interviews have highlighted the potential impact of telehealth on several factors influencing the recruitment and retention of physicians in rural and remote regions. The potential effects of telehealth on physicians' choice of practice location could be seen at the professional, organizational, educational and individual levels. For instance, telehealth could improve work satisfaction by allowing a regional on-call duty system and a better follow-up of patients. However, there are also certain limits related to telehealth, such as the fear that it would eventually replace all continuing medical education activities and onsite specialists in remoteregions. Conclusion Telehealth is likely to have an impact on several factors related to medical workforce supply in remote and rural regions. However, the expected benefits will materialize if and only if this technology is properly integrated into organizations as a support to professional practice.
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Fraser, Sarah; Mackean, Tamara; Grant, Julian; Hunter, Kate; Towers, Kurt; Ivers, Rebecca
2017-01-01
Telehealth may be a cost effective modality in healthcare delivery, but how well used or how appropriate it is for the care of Indigenous peoples is unclear. This review examines the evidence for telehealth in facilitating chronic conditions management with Indigenous peoples. Databases were systematically searched for qualitative or quantitative primary research studies that investigated telehealth use for chronic conditions management with Indigenous peoples worldwide. Evidence of effectiveness was by consumer health outcomes, evidence of acceptability was through consumer and user perception, and health service feasibility was evident by service impact. Data were assessed for quality and data extracted using pre-defined tools. Articles (n=32) examined effectiveness (n=11), critiqued telehealth from the perspectives of the client (n=10) and healthcare professionals (n=8), and examined feasibility (n=12). Studies reported Indigenous people tend to be satisfied with telehealth, but are sceptical about its cultural safety. Evidence for the effectiveness of telehealth from a western biomedical perspective was found. Telehealth is promising; however, a lack of robust studies in this review make tangible conclusions difficult. A better overall understanding of telehealth use with Indigenous peoples, including delivery of culturally competent health care, true consultation and cultural competency of the professionals involved, would be helpful. Telehealth may have the potential to improve health care for Indigenous people, however the modality needs to be culturally competent and the care received must be culturally safe.
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The use of telehealth in early autism training for parents: a scoping review
Directory of Open Access Journals (Sweden)
Boisvert M
2014-03-01
Full Text Available Michelle Boisvert,1 Nerissa Hall2 1WorldTide, Inc., Williamsburg, MA, USA; 2Communicare, LLC, Ludlow, MA, USA Abstract: Telehealth involves the application of technology to deliver services over a geographical distance. Studies in which telehealth procedures were used in the training or coaching of parents with young children (aged 6 years and under who were diagnosed with autism were reviewed. Scoping searches identified two studies that met the inclusion criteria. These studies were evaluated in terms of the: 1 characteristics of the participants; 2 technology utilized; 3 services delivered via telehealth; 4 research methodology; and 5 results and conclusions of the study. Telehealth was used by speech–language pathologists and university researchers to provide training to parents on specific intervention approaches to facilitate targeted communication initiations and responses by gestures, picture pointing, or verbalizations, as well as the delivery and evaluation of the Early Start Denver Model. While the available literature is limited on this topic, this review suggests that the use of telehealth is a viable means to provide training to parents with young children diagnosed with autism. Keywords: autism spectrum disorder, telehealth, training, education, caregivers, parents
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Use of telehealth to treat and manage chronic viral hepatitis in regional Queensland.
Keogh, Kandice; Clark, Paul; Valery, Patricia C; McPhail, Steven M; Bradshaw, Candise; Day, Melany; Smith, Anthony C
2016-12-01
For regional and rural Queenslanders, chronic viral hepatitis treatment is a major unmet health need, with restricted access to specialists outside of tertiary, largely metropolitan hospitals. To increase treatment of chronic viral hepatitis in regional Queensland, a team-based telehealth model was expanded. This expansion embedded an initial nursing consultation prior to specialist telehealth consultation. We conducted a retrospective audit of the introduction and expansion of hepatology telehealth services. Activity from July 2014-June 2015 (pre-expansion) was compared with July 2015- June 2016 (post-expansion). Interviews were conducted with key staff to determine factors contributing to success of the service and identify ongoing challenges to the service model. A greater than four-fold increase in clinical consultation was observed (131 telehealth consultations pre-expansion vs 572 post-expansion; p Queensland. It may serve as a model to further expand telehealth management of chronic disease for regional Queenslanders. © The Author(s) 2016.
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Smith, Anthony C; Caffery, Liam J; Saunders, Ruth; Bradford, Natalie K; Gray, Leonard C
2014-10-01
We implemented a community telehealth project in the three towns in the Darling Downs area of Queensland over a 2-year period starting in July 2012. The purpose of the project was to generate telehealth activity in hospitals, general practice and selected residential aged care facilities. Telehealth education and training was provided to clinicians in the three towns and a community awareness campaign was delivered using advertisements in newspapers, messages in social media and presentations at community events. A total of 55 stakeholders were engaged with during 61 site visits to health care facilities during the first two years of the project. During the study period, telehealth activity in Queensland increased in the hospital sector by 39% and in the non-hospital sector by 99%. In the Darling Downs region, telehealth activity in the hospital sector increased by 104%, compared to 28% in the rest of Queensland. However, in the non-hospital sector, the increase in telehealth activity in the Darling Downs region was similar to the rest of Queensland. Telehealth services established and/or facilitated by the project included specialist geriatric ward rounds in Dalby, Chinchilla and Miles for patients in the local hospitals and nursing homes; and ad-hoc teleconsultations for children and adults living in these communities, with specialists at Toowoomba and hospitals in Brisbane. An increase in telehealth implies better access to a range of clinical services, which may result in improved clinical outcomes for patients. © The Author(s) 2014 Reprints and permissions:]br]sagepub.co.uk/journalsPermissions.nav.
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42 CFR 410.78 - Telehealth services.
2010-10-01
...-based renal dialysis center (including satellites). (vii) A skilled nursing facility (as defined in... as telehealth services. (f) Process for adding or deleting services. Changes to the list of Medicare...
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Video-conferencing Telehealth Linkage attempts to Schools to Facilitate Mental Health Consultation.
McLennan, John D
2018-04-01
Telehealth to schools may be a strategic approach to expand child mental health service delivery, however, there are only a few published examples. This report describes video-conferencing telehealth linkage attempts to schools to facilitate mental health consultation. A series of synchronous video-conferencing linkage strategies were attempted to connect a mental health consultation service to multiple schools in a Canadian setting. Consultation to support the implementation of the Daily Report Card, for students with attentional and behavioural problems, was the core content of this pilot linkage attempt. Synchronous video conference consultations were successfully delivered to six elementary schools across three school districts. Two of three linkage strategies were functional. One used existing health centre-based telehealth units to connect to school-based dedicated tablets with a video collaboration app and reliance on existing school Wi-Fi. A second used existing laptops in both the health and school system linked through a communication platform. A third connection, using 3G/4G hotspots to obviate the need to access school Wi-Fi, was deemed too expensive in this setting. The potential to use existing computer hardware to connect mental health providers and schools could facilitate scale-up. However, it is unknown whether mental health systems and school sectors will invest in such linkages and reorganize core mental health services to be delivered in this way.
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Marcolino, Milena S; Carvalho, Bárbara C; Lucena, Aline M; França, Ana Luiza N; Pessoa, Cristiane G; Neves, Daniel S; Alkmim, Maria Beatriz M
2015-01-01
The Telehealth Network of Minas Gerais (TNMG) is a public telehealth service in Brazil that has performed electrocardiogram (ECG) analysis since 2005. From February to March 2014, 28% of ECGs were classified as "emergency" by the primary care tele-health sites. This quasi-experimental study aimed to investigate the reasons behind the high number of emergency ECGs being sent in, the implementation of corrective actions, and an assessment of the impact of these actions. In the 1st phase, primary care units that sent >70% of ECGs as emergency from February to March 2014 were selected. The 2nd phase consisted of the intervention. In the 3rd phase, the proportion of ECGs sent as an emergency during the 1st and 2nd months post intervention were assessed. Of the 63 cities selected during the 1st phase, 50% of the practitioners did not know the proper definition of emergency. After the intervention, 67% of the cities had a significant reduction in the proportion of ECGs sent as an emergency during the 1st month, and 17% had a significant reduction during the 2nd month.
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Garne Holm, Kristina; Brødsgaard, Anne; Zachariassen, Gitte; Smith, Anthony C; Clemensen, Jane
2017-01-01
Neonatal homecare delivered during home visits by neonatal nurses is a common method for supporting families of preterm infants following discharge. Telehealth has been introduced for the provision of neonatal homecare, resulting in positive feedback from parents of preterm infants. While the benefits are beginning to be realised, widespread uptake of telehealth has been limited due to a range of logistical challenges. Understanding user requirements is important when planning and developing a clinical telehealth service. We therefore used participatory design to develop a clinical telehealth service for neonatal homecare. The study adopted a participatory design approach to engage users in the development and design of a new telehealth service. Participatory design embraces qualitative research methods. Creative and technical workshops were conducted as part of the study. Tests of the telehealth service were conducted in the neonatal unit. Participants in this study were former and current parents of preterm infants eligible for neonatal homecare, and clinical staff (medical and nursing) from the neonatal unit. Preterm infants accompanied their parents. Based on the results obtained during the workshops and subsequent testing, we developed an application (app), which was integrated into the medical record at the neonatal unit. The app was used to initiate videoconferences and chat messages between the family at home and the neonatal unit, and to share information regarding infant growth and well-being. Results obtained from the workshops and testing demonstrated the importance of involving users when developing new telehealth applications. The workshops helped identify the challenges associated with delivery of the service, and helped instruct the design of a new telehealth service for neonatal homecare based on the needs of parents and clinical staff.
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JACOBS, KAREN; CASON, JANA; MCCULLOUGH, ANN
2015-01-01
The World Federation of Occupational Therapists (WFOT) consists of 84 member organizations representing over 420,000 occupational therapists internationally (WFOT, 2014). In 2014, WFOT published the WFOT Telehealth Position Statement on the use of telehealth in occupational therapy. The process for the formulation of the official document involved reviewing WFOT member organizations’ telehealth position statements and data collected from a survey sent to member organizations’ delegates in April 2014. Qualitative data from 39 countries yielded factors to consider in five key areas: licensure/registration requirements, the cost of technology, privacy and security, reimbursement/payment models, and other issues (e.g., need for collaboration/transfer of knowledge, client selection, provider competencies, standard of care). The WFOT Telehealth Position Statement addressed each of these areas. The collaborative effort resulting in the development of the WFOT Telehealth Position Statement serves as a model for other international organizations. PMID:27563380
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The organising vision for telehealth and telecare: discourse analysis.
Greenhalgh, Trisha; Procter, Rob; Wherton, Joe; Sugarhood, Paul; Shaw, Sara
2012-01-01
To (1) map how different stakeholders understand telehealth and telecare technologies and (2) explore the implications for development and implementation of telehealth and telecare services. Discourse analysis. 68 publications representing diverse perspectives (academic, policy, service, commercial and lay) on telehealth and telecare plus field notes from 10 knowledge-sharing events. Following a familiarisation phase (browsing and informal interviews), we studied a systematic sample of texts in detail. Through repeated close reading, we identified assumptions, metaphors, storylines, scenarios, practices and rhetorical positions. We added successive findings to an emerging picture of the whole. Telehealth and telecare technologies featured prominently in texts on chronic illness and ageing. There was no coherent organising vision. Rather, four conflicting discourses were evident and engaged only minimally with one another's arguments. Modernist discourse presented a futuristic utopian vision in which assistive technologies, implemented at scale, would enable society to meet its moral obligations to older people by creating a safe 'smart' home environment where help was always at hand, while generating efficiency savings. Humanist discourse emphasised the uniqueness and moral worth of the individual and tailoring to personal and family context; it considered that technologies were only sometimes fit for purpose and could create as well as solve problems. Political economy discourse envisaged a techno-economic complex of powerful vested interests driving commodification of healthcare and diversion of public funds into private business. Change management discourse recognised the complicatedness of large-scale technology programmes and emphasised good project management and organisational processes. Introduction of telehealth and telecare is hampered because different stakeholders hold different assumptions, values and world views, 'talk past' each other and compete for
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Silva, Andressa Sharllene Carneiro da; Rizzante, Fabio Antonio Piola; Picolini, Mirela Machado; Campos, Karis de; Corrêa, Camila de Castro; Franco, Elen Caroline; Pardo-Fanton, Cássia de Souza; Blasca, Wanderléia Quinhoneiro; Berretin-Felix, Giédre
2011-01-01
Tele-health is more than an innovative alternative; it is an excellent tool that enables access to health and education in health, making it possible to minimize distances, optimize time and reduce costs. Based on these advantages, some Brazilian Universities have used these actions in strategies of education, research and extension, aiming at the application of Tele-health in Brazil. In that way, the Bauru School of Dentistry - University of São Paulo (FOB-USP) has applied the use of information and communication technologies in health by means of a "Tele-Health League" (TL), in order to diagnose, prevent and treat diseases, in addition to educate the population and health services. The present study aims to introduce the characteristics of the Tele-Health League of FOB-USP, as well as the development of its projects. The Tele-Health League consisted as a Diffusion Course approved by the Provost of Culture and Academic Extension of the University of São Paulo. It is composed as a large group enclosing professoriate coordinator, academician principal, contributing professors and league members, those, diversified between undergraduates students, graduated, health employees, technology and information areas. The participant members are evaluated by the presence frequency (minimum of 85%), and by the performance of tests and paperwork about the theoretical content provided. In four years of activities, the TLFOB-USP obtained a high satisfaction index (90%), an increased number of vacancies due to the interest to become a member, more commitment of the professors of the University and the accomplishment of association with other Brazilian leagues. It is emphasized that the approval percentage of the course results in approval from approximately half of its members. Also, it is important to identify and repair the causes related to the quitting of some members. The results showed that the TLFOB-USP members, adjoining to the professor's participants, develop projects
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Directory of Open Access Journals (Sweden)
Andressa Sharllene Carneiro da Silva
2011-12-01
Full Text Available Tele-health is more than an innovative alternative; it is an excellent tool that enables access to health and education in health, making it possible to minimize distances, optimize time and reduce costs. Based on these advantages, some Brazilian Universities have used these actions in strategies of education, research and extension, aiming at the application of Tele-health in Brazil. In that way, the Bauru School of Dentistry - University of São Paulo (FOB-USP has applied the use of information and communication technologies in health by means of a "Tele-Health League" (TL, in order to diagnose, prevent and treat diseases, in addition to educate the population and health services. Objective: The present study aims to introduce the characteristics of the Tele-Health League of FOB-USP, as well as the development of its projects. Material and Methods: The Tele-Health League consisted as a Diffusion Course approved by the Provost of Culture and Academic Extension of the University of São Paulo. It is composed as a large group enclosing professoriate coordinator, academician principal, contributing professors and league members, those, diversified between undergraduates students, graduated, health employees, technology and information areas. The participant members are evaluated by the presence frequency (minimum of 85%, and by the performance of tests and paperwork about the theoretical content provided. Results: In four years of activities, the TLFOB-USP obtained a high satisfaction index (90%, an increased number of vacancies due to the interest to become a member, more commitment of the professors of the University and the accomplishment of association with other Brazilian leagues. It is emphasized that the approval percentage of the course results in approval from approximately half of its members. Also, it is important to identify and repair the causes related to the quitting of some members. Conclusions: The results showed that the TLFOB
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[Nursing contributions to the development of the Brazilian Telehealth Lactation Support Program].
Prado, Cláudia; Silva, Isília Aparecida; Soares, Alda Valéria Neves; Aragaki, Ilva Marico Mizumoto; Shimoda, Gilcéria Tochika; Zaniboni, Vanessa Forte; Padula, Camila Brolezzi; Muller, Fabiana Swain; Salve, Jeanine Maria; Daré, Sergio Junior; Wen, Chao Lung; Peres, Heloísa Helena Ciqueto; Leite, Maria Madalena Januário
2013-08-01
The National Telehealth Program was founded by the Ministry of Health, in partnership with the Ministry of Education (Ministério da Educação - MEC) and the Ministry of Science and Technology (Ministério da Ciência e Tecnologia - MCT), to support the development of family healthcare teams throughout the country. The São Paulo Telehealth Center has developed the Telehealth Lactation Support program, which provides primary healthcare professionals with information on diverse aspects of breastfeeding. This paper reports the development of the Lactation Support program and the nursing contributions. Project methodology included the formation of a multidisciplinary group of pediatricians, nurses, speech and language therapists, nutritionists, and dentists. Multimedia teaching resources were prepared for inclusion in the Cybertutor platform. Telehealth Lactation Support is an innovative and promising addition to continuing education for healthcare professionals and provides a framework for the development of other programs.
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Turner, Jane; Larsen, Mark; Tarassenko, Lionel; Neil, Andrew; Farmer, Andrew
2009-01-01
Initiating and adjusting insulin treatment for people with type 2 diabetes (T2D) requires frequent clinician contacts both face-to-face and by telephone. We explored the use of a telehealth system to offer additional support to these patients. Twenty-three patients with uncontrolled T2D were recruited from nine general practices to assess the feasibility and acceptability of telehealth monitoring and support for insulin initiation and adjustment. The intervention included a standard algorithm for self-titration of insulin dose, a Bluetooth enabled glucose meter linked to a mobile phone, an integrated diary to record insulin dose, feedback of charted blood glucose data and telehealth nurse review with telephone follow-up. Additional contact with patients was initiated when no readings were transmitted for >3 days or when persistent hyper- or hypoglycaemia was identified. Reponses of patients and clinicians to the system were assessed informally. The mean (SD) patient age was 58 years (12) with 78% male. The mean (SD) diabetes duration was 6.4 years (4.5), HbA1c at baseline was 9.5% (2.2), and the decrease in HbA1c at three months was 0.52% (0.91) with an insulin dose increase of 9 units (26). A mean (SD) of 160 (93) blood glucose readings was transmitted per patient in these three months. Practice nurses and general practitioners (GPs) viewed the technology as having the potential to improve patient care. Most patients were able to use the equipment with training and welcomed review of their blood glucose readings by a telehealth nurse. Although the concept of telehealth monitoring is unfamiliar to most patients and practice nurses, the technology improved the support available for T2D patients commencing insulin treatment.
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Conceptualizing Telehealth in Nursing Practice: Advancing a Conceptual Model to Fill a Virtual Gap.
Nagel, Daniel A; Penner, Jamie L
2016-03-01
Increasingly nurses use various telehealth technologies to deliver health care services; however, there has been a lag in research and generation of empirical knowledge to support nursing practice in this expanding field. One challenge to generating knowledge is a gap in development of a comprehensive conceptual model or theoretical framework to illustrate relationships of concepts and phenomena inherent to adoption of a broad range of telehealth technologies to holistic nursing practice. A review of the literature revealed eight published conceptual models, theoretical frameworks, or similar entities applicable to nursing practice. Many of these models focus exclusively on use of telephones and four were generated from qualitative studies, but none comprehensively reflect complexities of bridging nursing process and elements of nursing practice into use of telehealth. The purpose of this article is to present a review of existing conceptual models and frameworks, discuss predominant themes and features of these models, and present a comprehensive conceptual model for telehealth nursing practice synthesized from this literature for consideration and further development. This conceptual model illustrates characteristics of, and relationships between, dimensions of telehealth practice to guide research and knowledge development in provision of holistic person-centered care delivery to individuals by nurses through telehealth technologies. © The Author(s) 2015.
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Overview of States' Use of Telehealth for the Delivery of Early Intervention (IDEA Part C Services
Directory of Open Access Journals (Sweden)
Jana Cason
2012-12-01
Full Text Available Background: Early intervention (EI services are designed to promote the development of skills and enhance the quality of life of infants and toddlers who have been identified as having a disability or developmental delay, enhance capacity of families to care for their child with special needs, reduce future educational costs, and promote independent living (NECTAC 2011. EI services are regulated by Part C of the Individuals with Disabilities Education Improvement Act (IDEA; however, personnel shortages, particularly in rural areas, limit access for children who qualify. Telehealth is an emerging delivery model demonstrating potential to deliver EI services effectively and efficiently, thereby improving access and ameliorating the impact of provider shortages in underserved areas. The use of a telehealth delivery model facilitates inter-disciplinary collaboration, coordinated care, and consultation with specialists not available within a local community. Method: A survey sent by the National Early Childhood Technical Assistance Center (NECTAC to IDEA Part C coordinators assessed their utilization of telehealth within states’ IDEA Part C programs. Reimbursement for provider type and services and barriers to implement a telehealth service delivery model were identified. Results: Representatives from 26 states and one jurisdiction responded to the NECTAC telehealth survey. Of these, 30% (n=9 indicated that they are either currently using telehealth as an adjunct service delivery model (n=6 or plan to incorporate telehealth within the next 1-2 years (n=3. Identified telehealth providers included developmental specialists, teachers of the Deaf/Hard of Hearing (DHH, speech-language pathologists, occupational therapists, physical therapists, behavior specialists, audiologists, and interpreters. Reimbursement was variable and included use of IDEA Part C funding, Medicaid, and private insurance. Expressed barriers and concerns for
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Telehealth Applications to Enhance CKD Knowledge and Awareness Among Patients and Providers.
Tuot, Delphine S; Boulware, L Ebony
2017-01-01
CKD affects 13% of the US adult population, causes excess mortality, and is associated with significant sociodemographic disparities. Optimal CKD management slows progression of disease and reduces cardiovascular-related outcomes. Resources for patients and primary care providers, major stakeholders in preventive CKD care, are critically needed to enhance understanding of the disease and to optimize CKD health, particularly because of the asymptomatic nature of kidney disease. Telehealth is defined as the use of electronic communication and telecommunications technology to support long-distance clinical health care, patient and professional health-related education, and public health and health administration. It provides new opportunities to enhance awareness and understanding among these important stakeholders. This review will examine the role of telehealth within existing educational theories, identify telehealth applications that can enhance CKD knowledge and behavior change among patients and primary care providers, and examine the advantages and disadvantages of telehealth vs usual modalities for education. Copyright © 2016 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.
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Ag Ahmed, Mohamed Ali; Gagnon, Marie-Pierre; Hamelin-Brabant, Louise; Mbemba, Gisele Irène Claudine; Alami, Hassane
2017-01-01
Access to health care is still limited for many women in sub-Saharan Africa (SSA), while it remains an important determinant of maternal mortality and morbidity. Information and communication technologies (ICTs), such as mhealth and telehealth, can help to facilitate this access by acting on the various obstacles encountered by women, be they socio-cultural, economic, geographical or organizational. However, various factors contribute to the success of mhealth and telehealth implementation and use, and must be considered for these technologies to go beyond the pilot project stage. The objective of this systematic literature review is to synthesize the empirical knowledge on the success factors of the implementation and use of telehealth and mhealth to facilitate access to maternal care in SSA. The methodology used is based on that of the Cochrane Collaboration, including a documentary search using standardized language in six databases, selection of studies corresponding to the inclusion criteria, data extraction, evaluation of study quality, and synthesis of the results. A total of 93 articles were identified, which allowed the inclusion of seven studies, six of which were on mhealth. Based on the framework proposed by Broens et al ., we synthesized success factors into five categories: (I) technology, such as technical support to maintain, troubleshoot and train users, good network coverage, existence of a source of energy and user friendliness; (II) user acceptance, which is facilitated by factors such as unrestricted use of the device, perceived usefulness to the worker, adequate literacy, or previous experience of use ; (III) short- and long-term funding; (IV) organizational factors, such as the existence of a well-organized health system and effective coordination of interventions; and (V) political or legislative aspects, in this case strong government support to deploy technology on a large scale. Telehealth and mhealth are promising solutions to reduce
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Sutherland, Rebecca; Trembath, David; Hodge, Antoinette; Drevensek, Suzi; Lee, Sabrena; Silove, Natalie; Roberts, Jacqueline
2017-01-01
Introduction Telehealth can be an effective way to provide speech pathology intervention to children with speech and language impairments. However, the provision of reliable and feasible standardised language assessments via telehealth to establish children's needs for intervention and to monitor progress has not yet been well established. Further, there is limited information about children's reactions to telehealth. This study aimed to examine the reliability and feasibility of conducting standardised language assessment with school-aged children with known or suspected language impairment via a telehealth application using consumer grade computer equipment within a public school setting. Method Twenty-three children (aged 8-12 years) participated. Each child was assessed using a standardised language assessment comprising six subtests. Two subtests were administered by a speech pathologist face-to-face (local clinician) and four subtests were administered via telehealth. All subtests were completed within a single visit to the clinic service, with a break between the face to face and telehealth sessions. The face-to-face clinician completed behaviour observation checklists in the telehealth and face to face conditions and provided feedback on the audio and video quality of the application from the child's point of view. Parent feedback about their child's experience was elicited via survey. Results There was strong inter-rater reliability in the telehealth and face-to-face conditions (correlation coefficients ranged from r = 0.96-1.0 across the subtests) and good agreement on all measures. Similar levels of attention, distractibility and anxiety were observed in the two conditions. Clinicians rated only one session of 23 as having poor audio quality and no sessions were rated as having poor visual quality. Parent and child reactions to the use of telehealth were largely positive and supportive of using telehealth to assess rural children. Discussion The
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Education and training to support the use of clinical telehealth: A review of the literature.
Edirippulige, S; Armfield, N R
2017-02-01
Introduction Despite a growing literature base, substantial investment, and policy changes within governments, the integration of telehealth into routine clinical care has been limited. The availability of appropriate systematic education and training for practitioners has been highlighted as necessary for strong adoption. However, the availability and nature of telehealth-related education and training for practitioners is not understood. By reviewing the literature, we aimed to describe the delivery of education and training in telehealth, with particular focus on content, modes of delivery, types of institutions, and target clinician groups. Methods We performed searches using PubMed, Scopus, Embase, Web of Science, PsycINFO, the Cochrane Library, and ERIC. We included studies that were focused on the delivery of telehealth-related academic or vocational education and training. We extracted information pertaining to country, programs and their participants, and tabulated the results. Results Altogether 388 articles were identified, of which nine studies were selected for final review. Programs from five countries were represented and articles were spread across telemedicine and clinically oriented journals. Education and training in telehealth has been provided as both university level and vocational courses using conventional classroom based delivery methods and e-learning. Reported curriculum items included terminology, clinical applications, the evidence-base, and technological aspects. Conclusions Published evidence in peer-reviewed literature on telehealth education and training is limited. According to this review, a number of topics relating to telehealth have been covered by existing education programs both within tertiary and professional development levels.
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Nurses' and community support workers' experience of telehealth: a longitudinal case study.
Sharma, Urvashi; Clarke, Malcolm
2014-04-10
Introduction of telehealth into the healthcare setting has been recognised as a service that might be experienced as disruptive. This paper explores how this disruption is experienced. In a longitudinal qualitative study, we conducted focus group discussions prior to and semi structured interviews post introduction of a telehealth service in Nottingham, U.K. with the community matrons, congestive heart failure nurses, chronic obstructive pulmonary disease nurses and community support workers that would be involved in order to elicit their preconceptions and reactions to the implementation. Users experienced disruption due to the implementation of telehealth as threatening. Three main factors add to the experience of threat and affect the decision to use the technology: change in clinical routines and increased workload; change in interactions with patients and fundamentals of face-to-face nursing work; and change in skills required with marginalisation of clinical expertise. Since the introduction of telehealth can be experienced as threatening, managers and service providers should aim at minimising the disruption caused by taking the above factors on board. This can be achieved by employing simple yet effective measures such as: providing timely, appropriate and context specific training; provision of adequate technical support; and procedures that allow a balance between the use of telehealth and personal visit by nurses delivering care to their patients.
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2013-12-16
... Coordination Home Telehealth (CCHT) Patient Satisfaction Survey) Activities Under OMB Review AGENCY: Veterans... patient perspective on satisfaction with the CCHT program and messaging devices. DATES: Comments must be...: Care Coordination Home Telehealth (CCHT) Patient Satisfaction Survey, VA Form 10-0481. Type of Review...
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Interpersonal Communication in Behavioral Telehealth: What Can We Learn from Other Fields?
Collie, Katharine R.
In this paper, research about mediated communication is used to shed light on questions that have arisen in relation to behavioral telehealth about the relative merits of different modes of distance communication for the transaction of behavioral telehealth services. The paper is in two parts. The first part contains a presentation of questions…
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Directory of Open Access Journals (Sweden)
Beth Cole
2016-12-01
Full Text Available The use of telehealth has been discussed nationally as an option to address provider shortages for children, birth through two, enrolled in Part C of the Individuals with Disabilities Education Act (IDEA Early Intervention (EI programs. Telehealth is an evidence-based service delivery model which can be used to remove barriers in providing EI services to children and their families. In 2016, Colorado’s Part C Early Intervention (EI program began allowing the use of telehealth as an option for providers to conduct sessions with children and their caregivers. This article outlines the process taken to develop the necessary requirements and supports for telehealth to be incorporated into EI current practice.
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Newman, Lareen; Bidargaddi, Niranjan; Schrader, Geoffrey
2016-10-01
Despite evidence of benefits of telehealth networks in increasing access to, or providing, previously unavailable mental health services, care providers still prefer traditional approaches. For psychiatric assessment, digital technology can offer improvements over analog systems for the technical and, subsequently, the social quality of provider-client interaction. This is in turn expected to support greater provider uptake and enhanced patient benefits. Within the framework of Innovation Diffusion Theory, to study service providers' experiences of an existing regional telehealth network for mental health care practice twelve months after digitisation in order to identify the benefits of digital telehealth over an analog system for mental health care purposes in rural Australia. Qualitative interviews and focus groups were conducted with over 40 service providers from June to September 2013 in South Australia, ranging from the metropolitan central operations to health providers located up to 600km away in rural and remote areas of the same state. Participants included rural mental health teams, directors of nursing at rural hospitals, metropolitan-based psychiatrists and registrars, the metropolitan-based mental health team dedicated to rural provider support, rural GPs, administrative staff, and the executive group of the state rural health department. Fieldwork was conducted 12 months after the analog system was digitised. The interview and focus group data were analysed using thematic analysis, focusing on three key areas of innovation diffusion theory: relative advantage, technical complexity and technical compatibility. Five themes with 11 sub-themes were identified: (1) "Existing Uses", with three sub-themes: current mental health use, use by GPs, and use for staff support; (2) "Relative Advantage", with four sub-themes: improved technical quality, improved clinical practice, time and cost benefits for providers, and improved patient care; (3) "Technical
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Wade, Rachael; Cartwright, Colleen; Shaw, Kelly
2015-06-01
This paper aims to report carers' perceptions of the impact of home telehealth on the provision of care and the sustainability of home telehealth use. This paper is reporting on a sample of 15 carers who were involved in the telehealth arm of a larger controlled trial. Carers primarily believed that telehealth helped to provide better care. None of the carers had organised, or planned to organise, ongoing telehealth monitoring beyond the study. The main reason given for non-sustained usage was the belief that the person they cared for no longer required, or would benefit from, the monitoring. As the person being cared for was a frail older person with multiple chronic diseases and a history of recent hospitalisation, the non-sustained usage of home telehealth by carers raises questions about what is needed to ensure sustainability of use; this requires further investigation. © 2014 AJA Inc.
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A Review of Telehealth Service Implementation Frameworks
Directory of Open Access Journals (Sweden)
Liezl Van Dyk
2014-01-01
Full Text Available Despite the potential of telehealth services to increase the quality and accessibility of healthcare, the success rate of such services has been disappointing. The purpose of this paper is to find and compare existing frameworks for the implementation of telehealth services that can contribute to the success rate of future endeavors. After a thorough discussion of these frameworks, this paper outlines the development methodologies in terms of theoretical background, methodology and validation. Finally, the common themes and formats are identified for consideration in future implementation. It was confirmed that a holistic implementation approach is needed, which includes technology, organizational structures, change management, economic feasibility, societal impacts, perceptions, user-friendliness, evaluation and evidence, legislation, policy and governance. Furthermore, there is some scope for scientifically rigorous framework development and validation approaches.
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Increasing Access to an ASD Imitation Intervention via a Telehealth Parent Training Program
Wainer, Allison L.; Ingersoll, Brooke R.
2015-01-01
Systematic research focused on developing and improving strategies for the dissemination and implementation of effective ASD services is essential. An innovative and promising area of research is the use of telehealth programs to train parents of children with ASD in intervention techniques. A hybrid telehealth program, combining self-directed…
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Telehealth Stroke Dysphagia Evaluation Is Safe and Effective.
Morrell, Kate; Hyers, Megan; Stuchiner, Tamela; Lucas, Lindsay; Schwartz, Karissa; Mako, Jenniffer; Spinelli, Kateri J; Yanase, Lisa
2017-01-01
Rapid evaluation of dysphagia poststroke significantly lowers rates of aspiration pneumonia. Logistical barriers often significantly delay in-person dysphagia evaluation by speech language pathologists (SLPs) in remote and rural hospitals. Clinical swallow evaluations delivered via telehealth have been validated in a number of clinical contexts, yet no one has specifically validated a teleswallow evaluation for in-hospital post-stroke dysphagia assessment. A team of 6 SLPs experienced in stroke care and a telestroke neurologist designed, implemented, and tested a teleswallow evaluation for acute stroke patients, in which 100 patients across 2 affiliated, urban certified stroke centers were sequentially evaluated by a bedside and telehealth SLP. Inter-rater reliability was analyzed using percent agreement, Cohen's kappa, Kendall's tau-b, and Wilcoxon matched-pairs signed rank tests. Logistic regression models accounting for age and gender were used to test the impact of stroke severity and stroke location on agreement. We found excellent agreement for both liquid (91% agreement; kappa = 0.808; Kendall's tau-b = 0.813, p Dysphagia evaluation by a remote SLP via telehealth is safe and effective following stroke. We plan to implement teleswallow across our multistate telestroke network as standard practice for poststroke dysphagia evaluation. © 2017 S. Karger AG, Basel.
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DEFF Research Database (Denmark)
Raunsbæk Knudsen, Line; Thurah, Annette De; Lomborg, Kirsten
2017-01-01
the patients' different needs, wishes and abilities to take part in tele-health follow-up. Our findings reveal a need for more insight into how tele-health follow-up could be integrated in routine clinical practice, paying special attention to how reluctant patients may be supported.......: Adopting a strategy of interpretive description, we conducted individual, semi-structured interviews with 15 RA patients participating in a tele-health follow-up. Participants were selected purposively and consecutive from both genders and with various ages, disease durations and disease severity....... The analysis was inductive with a constant comparative approach. First, we identified the main themes conveying the participants' experiences. Then, we constructed patient typologies to explain different perspectives on the tele-health follow-up. RESULTS: Five themes covered the participants' experiences: 'A...
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An Exploration of Intent to Use Telehealth at Home for Patients with Chronic Diseases
Directory of Open Access Journals (Sweden)
Shu-Lin Uei
2017-12-01
Full Text Available Telecare is defined as care practiced at a distance. It is an effective strategy for improving the self-health care management of home-patients with chronic diseases. The purpose of this study was to explore the intent to use of telehealth patients. The correlation between the self-care behaviors, the intent to use of telehealth, and the effects on physiological indicators of patients with chronic disease at home were studied. A cross-sectional study design employing purposive sampling was selected. The structured questionnaire ‘Telecare Usage Intention Scale and Self-Care Behavior Scale’ were used, ‘HbA1c, glucose levels and monthly blood pressure measurements’ were analyzed in this thirteen month study. The self-care behaviors of the participants were positively correlated with their intent to use telehealth (p < 0.01. The results also indicated that HbA1c, glucose levels and frequency BP measurement of the participants improved significantly after using telecare (p < 0.005. The results indicated a strong intent to use telehealth and positive perception of telecare services by in-home patients with a chronic disease. Telehealth improves the self-care behavior of in-home chronic disease patients and enhances medical professionals’ ability to deliver quality and effective healthcare.
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Telehealth application on the rehabilitation of children and adolescents
Directory of Open Access Journals (Sweden)
Maria Tereza N. dos Santos
2014-03-01
Full Text Available Objective: To systematically review the literature on the telehealth initiatives in telerehabilitation practices in children and adolescents from zero to 18 years old. Data sources: Randomized and controlled clinical trials published in the past ten years (January 2002 to February 2012 in Medline/PubMed, Medline/BVS, PEDro and Cochrane Library databases. The descriptors "telemedicine", "rehabilitation" and "telehealth" were used in three different languages (English, Portuguese and Spanish. Data synthesis: From the 20 studies found in the literature, nine were included in this review. Most of the studies showed that telerehabilitation is able to produce better results in the treatment when compared to the traditional methods, providing less frequency of symptoms, better disease control, better quality of life and greater adherence to treatment. Conclusions: Telerehabilitation is a viable and effective strategy in the treatment of common diseases in children and adolescents. However, there are few studies on the subject in this age group. Although telehealth is already consolidated worldwide, there are no studies in Brazil that used the telerehabilitation in children and adolescents, which reinforces the need for more research and investments.
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Lichstein, Kenneth L.; Scogin, Forrest; Thomas, S. Justin; DiNapoli, Elizabeth A.; Dillon, Haley R.; McFadden, Anna
2015-01-01
Objective Telehealth has proven effective with a wide range of disorders, but there is a paucity of data on the use of telehealth using cognitive-behavior therapy (CBT) with late-life insomnia and depression. This pilot study was designed to examine the feasibility and effectiveness of using telehealth to treat older adults with comorbid insomnia and depression living in rural Alabama. Method Five patients received 10 sessions of CBT for insomnia and depression. Patients were engaged in treatment via Skype from their primary care physician’s office. Assessments were conducted at baseline, posttreatment, and 2-month follow-up. Results Patients exhibited clinically significant improvement in both insomnia (sleep diaries and Insomnia Severity Index) and depression (Hamilton Rating Scale for Depression) at posttreatment, and these gains were well maintained at 2-month follow-up. Conclusions These preliminary data suggest that telehealth may be an effective means of providing treatment to older adults, including underserved populations. PMID:24014056
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Cottrell, Elizabeth; McMillan, Kate; Chambers, Ruth
2012-01-01
To determine the patient experience of using a simple telehealth strategy to manage hypertension in adults. As part of a pragmatic service evaluation, the acceptability of, satisfaction with and ease of use of a simple telehealth strategy was determined via text, cross-sectional questionnaire survey administered by telephone, case studies, discussion groups and informal feedback from practices. This simple telehealth approach required patients to take home blood pressure (BP) readings and text them to a secure server ('Florence') for immediate automatic analysis and individual healthcare professional review. 124 intervention patients who used the Florence system. 10 volunteer general practitioner's (GP) practices in Stoke on Trent, UK, with poor health and high levels of material deprivation took part. Patient satisfaction was high. In particular, patients found the system easy to use, were very satisfied about the feedback from their GP regarding their BP readings, found the advice sent via Florence useful and preferred to send BP readings using Florence rather than having to go to the practice monthly to get BP checked. Overall satisfaction with the system was 4.81/5.00 at week 13 of the programme. Other advantages of being enrolled with Florence were improved education about hypertension, a greater feeling of support and companionship and flexibility which allowed self-care to occur at a time that suited the patient rather than their practice. This simple telehealth strategy for managing hypertension in the community was met with high levels of patient satisfaction and feelings of control and support. This management approach should thus be considered for widespread implementation for clinical management of hypertension and other long-term conditions involving monitoring of patients' bodily measurements and symptoms as a large number of meaningful readings can be obtained from many patients in a prompt, efficient, interactive and acceptable way.
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Telehealth ICT Infrastructures in the Nordic Countries
DEFF Research Database (Denmark)
Jørgensen, Daniel Bjerring; Hallenborg, Kasper
2015-01-01
This paper presents an overview and recommendations of ICT infrastructures and reference architectures for telehealth in the Nordic countries (Denmark, Finland, Iceland, Norway, and Sweden). This study shows that so far only Denmark has designed a complete reference architecture, and by the end...
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Telehealth for Expanding the Reach of Early Autism Training to Parents
Directory of Open Access Journals (Sweden)
Laurie A. Vismara
2012-01-01
Full Text Available Although there is consensus that parents should be involved in interventions designed for young children with autism spectrum disorder (ASD, parent participation alone does not ensure consistent, generalized gains in children’s development. Barriers such as costly intervention, time-intensive sessions, and family life may prevent parents from using the intervention at home. Telehealth integrates communication technologies to provide health-related services at a distance. A 12 one-hour per week parent intervention program was tested using telehealth delivery with nine families with ASD. The goal was to examine its feasibility and acceptance for promoting child learning throughout families’ daily play and caretaking interactions at home. Parents became skilled at using teachable moments to promote children’s spontaneous language and imitation skills and were pleased with the support and ease of telehealth learning. Preliminary results suggest the potential of technology for helping parents understand and use early intervention practices more often in their daily interactions with children.
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Radhakrishnan, Kavita; Jacelon, Cynthia S; Bigelow, Carol; Roche, Joan P; Marquard, Jenna L; Bowles, Kathryn H
2013-01-01
Comorbidities adversely impact heart failure (HF) outcomes. Telehealth can assist healthcare providers, especially nurses, in guiding their patients to follow the HF regimen. However, factors, including comorbidity patterns, that act in combination with telehealth to reduce home care nursing utilization are still unclear. The purpose of this article was to examine the association of the comorbidity characteristics of HF patients with nursing utilization along with withdrawal from telehealth service during an episode of tele-home care. A descriptive, correlational study design using retrospective chart review was used. The sample comprised Medicare patients admitted to a New England home care agency who had HF as a diagnosis and had used telehealth from 2008 to 2010. The electronic documentation at the home care agency served as the data source, which included Outcome and Assessment Information Set data of patients with HF. Logistic and multiple regression analyses were used to analyze data. The sample consisted of 403 participants, of whom 70% were older than 75 years, 55% were female, and 94% were white. Comorbidities averaged 5.19 (SD, 1.92), ranging from 1 to 11, and nearly 40% of the participants had 5 or more comorbidities. The mean (SD) nursing contacts in the sample was 9.9 (4.7), ranging from 1 to 26, and 52 (12.7%) patients withdrew from telehealth service. For patients with HF on telehealth, comorbidity characteristics of anemia, anxiety, musculoskeletal, and depression were significantly associated with nursing utilization patterns, and renal failure, cancer, and depression comorbidities were significantly associated with withdrawal from telehealth service. Knowledge of the association of comorbidity characteristics with the home care service utilization patterns of patients with HF on telehealth can assist the home health nurse to develop a tailored care plan that attains optimal patient outcomes. Knowledge of such associations would also focus home
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Telehealth for Hepatitis C Care in the DAA Era; Ensuring Everyone Can Access a Cure
Schulz, Thomas Ray; Kanhutu, Kudzai; Sasadeusz, Joe; Watkinson, Sally; Biggs, Beverley Ann
2017-01-01
Abstract Background The Victorian Infectious Diseases Service currently provides telehealth care for rural and regional patients with hepatitis C. From March 2016 direct acting antiviral therapy (DAA) for Hepatitis C has been subsidised for all Australian adults with Hepatitis C. The wide geographic distribution of Australia’s population means patients have to travel considerable distances to access specialist care. The increasing availability of web-based videoconferencing platforms have provided unprecedented capacity to manage patients remotely. The primary aim of this study is to determine whether telehealth delivered hepatitis C management achieves virological outcomes comparable to that achieved in randomised clinical trials. Methods The study is part of a quality audit of the hepatitis and outreach service. Measured outcomes were; (i) proportion of patients achieving a sustained virological response (SVR); (ii) failure to attend rate (FTA); (iii) frequency of technical difficulties; (iv) patient travel kilometres saved through not attending clinic in person; (v) Reduced carbon production due to reduced travel; and (vi) Consultation duration time. Results In 1 year from March 1, 2016, 58 patients have been commenced on Hepatitis C treatment and managed either partially or completely via telehealth. Of those who have so far completed therapy (29 patients) an SVR rate of 97% has been achieved. Expected SVR genotype 1 (>95%); genotype 3 (>85%). The average travel avoided for each telehealth consultation was 616km and each patient had a median of two telehealth consultations. Technical difficulties occurred in less than 10% of consultations with FTA of 17%. Consult duration averaged 15 minutes or less. Conclusion Our completed patient cohort results demonstrate comparable virological outcomes for telehealth managed patients as compared with onsite management, even when adjusted for age, gender and hepatic fibrosis status. This suggests efforts to
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Directory of Open Access Journals (Sweden)
Sue Grogan-Johnson
2011-05-01
Full Text Available This article describes a school-based telehealth service delivery model and reports outcomes made by school-age students with speech sound disorders in a rural Ohio school district. Speech therapy using computer-based speech sound intervention materials was provided either by live interactive videoconferencing (telehealth, or conventional side-by-side intervention. Progress was measured using pre- and post-intervention scores on the Goldman Fristoe Test of Articulation-2 (Goldman & Fristoe, 2002. Students in both service delivery models made significant improvements in speech sound production, with students in the telehealth condition demonstrating greater mastery of their Individual Education Plan (IEP goals. Live interactive videoconferencing thus appears to be a viable method for delivering intervention for speech sound disorders to children in a rural, public school setting. Keywords: Telehealth, telerehabilitation, videoconferencing, speech sound disorder, speech therapy, speech-language pathology; E-Helper
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Energy Technology Data Exchange (ETDEWEB)
Li, Yaquin [University of Tennessee, Knoxville (UTK); Karnowski, Thomas Paul [ORNL; Tobin Jr, Kenneth William [ORNL; Giancardo, Luca [ORNL; Garg, Seema [University of North Carolina; Fox, Karen [Delta Health Alliance; Chaum, Edward [University of Tennessee, Knoxville (UTK)
2011-01-01
In this article, we present the design and implementation of a regional ocular telehealth network for remote assessment and management of diabetic retinopathy (DR), including the design requirements, network topology, protocol design, system work flow, graphics user interfaces, and performance evaluation. The Telemedical Retinal Image Analysis and Diagnosis Network is a computer-aided, image analysis telehealth paradigm for the diagnosis of DR and other retinal diseases using fundus images acquired from primary care end users delivering care to underserved patient populations in the mid-South and southeastern United States.
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Towards Resilient Telehealth Support for Clinical Psychiatry and Psychology: A Strategic Review.
Fiorini, Rodolfo A; De Giacomo, Piero; L'Abate, Luciano
2015-01-01
Human beings have increasingly shown a willingness to adopt Internet, mHealth and telehealth applications as a part of managing their health. Recent technological advances in the use of the Internet and video technologies has greatly impacted the provision of psychotherapy and other clinical services as well as how the training of psychotherapists may be conducted. When utilized appropriately these technologies may provide greater access to needed services to include treatment, consultation, supervision, and training. The major issue in such a development is whether online interventions will be structured or unstructured. The proper use of technology is fundamental to create and boost outstanding results. We present a strategic review and, as an example, the main steps to develop and achieve application resilience and antifragility at system level, for diagnostic and therapeutic telepractice and telehealth support. This article presents a number of innovations that can take psychotherapy treatment, supervision, training, and research forward, towards increased effectiveness application.
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The Use of Telehealth to Teach Reproductive Health to Female Rural High School Students.
Yoost, Jennie Lee; Starcher, Rachael Whitley; King-Mallory, Rebecca Ann; Hussain, Nafeeza; Hensley, Christina Ann; Gress, Todd William
2017-04-01
To evaluate the use of telehealth to teach reproductive health to rural areas with high rates of teen pregnancy. Prospective cohort study. Two high schools in rural West Virginia. High school female students who attended telehealth sessions. Teleconferencing equipment connected rural high schools to a distal academic institution. Telehealth sessions included reproductive health and life skills topics. Demographic information, session pre- and post-tests, and 6- month assessment was obtained. Reproductive health knowledge, behavior, and self-efficacy were assessed at intervention and at 6 months, along with Likert scale evaluation of telehealth as an educational tool. Fifty-five students participated in the program with an average age of 16.14 (SD 1.24) years. Only 20% (10/50) of subjects' mothers and 12% (6/50) of subjects' fathers had achieved education beyond high school, and 20% (10/50) of subject's mothers had experienced teen pregnancies (age 18 or younger). Sexual activity was reported among 52% (26/50) of subjects, 4/50 (8%) reported desire to become pregnant within the next year, and 4/50 (8%) reported already pregnant. Thirty-seven students completed the 6-month follow-up survey. Reported condom use increased from 20% (10/50) at baseline to 40% (15/37) at 6 months (P = .04) and hormonal contraception use increased from 22% (11/50) to 38% (14/37) (P = .12). Report of human papillomavirus vaccination increased from 38% (10/26) to 70% (26/37) (P = .001) among all subjects. At 6 months, 91.8% (34/37) reported the use of telehealth was "very effective" as a means to teach the material. Telehealth is an effective tool to teach reproductive health to rural areas. Copyright © 2016 North American Society for Pediatric and Adolescent Gynecology. Published by Elsevier Inc. All rights reserved.
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Brunton, Lisa; Bower, Peter; Sanders, Caroline
2015-01-01
As the global burden of chronic disease rises, policy makers are showing a strong interest in adopting telehealth technologies for use in long term condition management, including COPD. However, there remain barriers to its implementation and sustained use. To date, there has been limited qualitative investigation into how users (both patients/carers and staff) perceive and experience the technology. We aimed to systematically review and synthesise the findings from qualitative studies that investigated user perspectives and experiences of telehealth in COPD management, in order to identify factors which may impact on uptake. Systematic review and meta-synthesis of published qualitative studies of user (patients, their carers and clinicians) experience of telehealth technologies for the management of Chronic Obstructive Pulmonary Disease. ASSIA, CINAHL, Embase, Medline, PsychInfo and Web of Knowledge databases were searched up to October 2014. Reference lists of included studies and reference lists of key papers were also searched. Quality appraisal was guided by an adapted version of the CASP qualitative appraisal tool. 705 references (after duplicates removed) were identified and 10 papers, relating to 7 studies were included in the review. Most authors of included studies had identified both positive and negative experiences of telehealth use in the management of COPD. Through a line of argument synthesis we were able to derive new insights from the data to identify three overarching themes that have the ability to either impede or promote positive user experience of telehealth in COPD: the influence on moral dilemmas of help seeking-(enables dependency or self-care); transforming interactions (increases risk or reassurance) and reconfiguration of 'work' practices (causes burden or empowerment). Findings from this meta-synthesis have implications for the future design and implementation of telehealth services. Future research needs to include potential users at
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Directory of Open Access Journals (Sweden)
Lisa Brunton
Full Text Available As the global burden of chronic disease rises, policy makers are showing a strong interest in adopting telehealth technologies for use in long term condition management, including COPD. However, there remain barriers to its implementation and sustained use. To date, there has been limited qualitative investigation into how users (both patients/carers and staff perceive and experience the technology. We aimed to systematically review and synthesise the findings from qualitative studies that investigated user perspectives and experiences of telehealth in COPD management, in order to identify factors which may impact on uptake.Systematic review and meta-synthesis of published qualitative studies of user (patients, their carers and clinicians experience of telehealth technologies for the management of Chronic Obstructive Pulmonary Disease. ASSIA, CINAHL, Embase, Medline, PsychInfo and Web of Knowledge databases were searched up to October 2014. Reference lists of included studies and reference lists of key papers were also searched. Quality appraisal was guided by an adapted version of the CASP qualitative appraisal tool.705 references (after duplicates removed were identified and 10 papers, relating to 7 studies were included in the review. Most authors of included studies had identified both positive and negative experiences of telehealth use in the management of COPD. Through a line of argument synthesis we were able to derive new insights from the data to identify three overarching themes that have the ability to either impede or promote positive user experience of telehealth in COPD: the influence on moral dilemmas of help seeking-(enables dependency or self-care; transforming interactions (increases risk or reassurance and reconfiguration of 'work' practices (causes burden or empowerment.Findings from this meta-synthesis have implications for the future design and implementation of telehealth services. Future research needs to include
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Perspectives of Nurses Toward Telehealth Efficacy and Quality of Health Care: Pilot Study.
Bashir, Ayisha; Bastola, Dhundy R
2018-05-25
Telehealth nursing, or the delivery, management, and coordination of nursing care services provided via telecommunications technology, is one of the methods of delivering health care to patients in the United States. It is important to assess the service quality of the involved health professionals as well as the telehealth nursing process. The focus of this study is the innovative model of telehealth care delivery by nurses for managing patients with chronic disease while they are living in their own residence. The primary objective of this pilot study was to examine whether telehealth technology impacts the perceived level of internal service quality delivered by nurses within a telehealth organization. To address this research goal, the notion of telehealth nursing service quality (TNSQ) is empirically tested and validated with a survey instrument. Data were collected from nurses belonging to a home care agency based on interview questions inquiring about facilitators and inhibitors to TNSQ. A survey to measure TNSQ based on the SERVQUAL instrument was completed by adjusting descriptions of the original instrument to suit the context. Follow-up interviews were conducted to validate questions on the revised instrument. The findings of this survey research were positive, based on mean differences between expectations and perceptions of TNSQ. This indicates satisfaction with TNSQ and shows that the quality of the service is higher than what the respondents expect. The Wilcoxon signed-rank test using the P value for the test, which is .35, did not show a statistically significant change between the median differences of perception and expectation. The total number of respondents was 13. Results indicate that overall perceived service quality is a positive value (0.05332). This means the perceptions of the level of service are slightly higher than what they expect, indicating there is satisfaction with TNSQ. The responses to the interview questions and data gathered
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Hanlon, Peter; Daines, Luke; Campbell, Christine; McKinstry, Brian; Weller, David; Pinnock, Hilary
2017-05-17
Self-management support is one mechanism by which telehealth interventions have been proposed to facilitate management of long-term conditions. The objectives of this metareview were to (1) assess the impact of telehealth interventions to support self-management on disease control and health care utilization, and (2) identify components of telehealth support and their impact on disease control and the process of self-management. Our goal was to synthesise evidence for telehealth-supported self-management of diabetes (types 1 and 2), heart failure, asthma, chronic obstructive pulmonary disease (COPD) and cancer to identify components of effective self-management support. We performed a metareview (a systematic review of systematic reviews) of randomized controlled trials (RCTs) of telehealth interventions to support self-management in 6 exemplar long-term conditions. We searched 7 databases for reviews published from January 2000 to May 2016 and screened identified studies against eligibility criteria. We weighted reviews by quality (revised A Measurement Tool to Assess Systematic Reviews), size, and relevance. We then combined our results in a narrative synthesis and using harvest plots. We included 53 systematic reviews, comprising 232 unique RCTs. Reviews concerned diabetes (type 1: n=6; type 2, n=11; mixed, n=19), heart failure (n=9), asthma (n=8), COPD (n=8), and cancer (n=3). Findings varied between and within disease areas. The highest-weighted reviews showed that blood glucose telemonitoring with feedback and some educational and lifestyle interventions improved glycemic control in type 2, but not type 1, diabetes, and that telemonitoring and telephone interventions reduced mortality and hospital admissions in heart failure, but these findings were not consistent in all reviews. Results for the other conditions were mixed, although no reviews showed evidence of harm. Analysis of the mediating role of self-management, and of components of successful
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Beard, Matthew; Orlando, Joseph F; Kumar, Saravana
2017-09-01
Introduction There is consistent evidence to indicate people living in rural and remote regions have limited access to healthcare and poorer health outcomes. One way to address this inequity is through innovative models of care such as telehealth. The aim of this pilot trial was to determine the feasibility, appropriateness and access to a telehealth clinic. In this pilot trial, the telehealth clinic outcomes are compared with the outreach clinic. Both models of care are commonly utilised means of providing healthcare to meet the needs of people living in rural and remote regions. Methods A prospective audit was conducted on a Spinal Assessment Clinic Telehealth pilot trial for patients with spinal disorders requiring non-urgent surgical consultation. Data were recorded from all consultations managed using videoconferencing technology between the Royal Adelaide Hospital and Port Augusta Community Health Service, South Australia between September 2013 and January 2014. Outcomes included analysis of process, service activity, clinical actions, safety and costs. Data were compared to a previous spinal assessment outreach clinic in the same area between August and December 2012. Results There were 25 consultations with 22 patients over the five-month telehealth pilot trial. Spinal disorders were predominantly of the lumbar region (88%); the majority of initial consultations (64%) were discharged to the general practitioner. There were three requests for further imaging, five for minor interventions and three for other specialist/surgical consultation. Patient follow-up post telehealth pilot trial revealed no adverse outcomes. The total cost of AUD$11,187 demonstrated a 23% reduction in favour of the spinal assessment telehealth pilot trial, with the greatest savings in travel costs. Discussion The telehealth model of care demonstrated the efficient management of patients with spinal disorders in rural regions requiring non-urgent surgical consultation at low costs with
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Fairweather, Glenn C; Lincoln, Michelle A; Ramsden, Robyn
2017-01-01
Difficulties in accessing allied health services, especially in rural and remote areas, appear to be driving the use of telehealth services to children in schools. The objectives of this study were to investigate the experiences and views of school executive staff and therapy assistants regarding the feasibility and acceptability of a speech-language pathology telehealth program for children attending schools in rural and remote New South Wales, Australia. The program, called Come N See, provided therapy interventions remotely via low-bandwidth videoconferencing, with email follow-up. Over a 12-week period, children were offered therapy blocks of six fortnightly sessions, each lasting a maximum of 30 minutes. School executives (n=5) and therapy assistants (n=6) described factors that promoted or threatened the program's feasibility and acceptability, during semistructured interviews. Thematic content analysis with constant comparison was applied to the transcribed interviews to identify relationships in the data. Emergent themes related to (a) unmet speech pathology needs, (b) building relationships, (c) telehealth's advantages, (d) telehealth's disadvantages, (e) anxiety replaced by joy and confidence in growing skills, and (f) supports. School executive staff and therapy assistants verified that the delivery of the school-based telehealth service was feasible and acceptable. However, the participants saw significant opportunities to enhance this acceptability through building into the program stronger working relationships and supports for stakeholders. These findings are important for the future development of allied health telehealth programs that are sustainable as well as effective and fit the needs of all crucial stakeholders. The results have significant implications for speech pathology clinical practice relating to technology, program planning and teamwork within telehealth programs.
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Directory of Open Access Journals (Sweden)
Gisèle Irène Claudine Mbemba
2016-05-01
Full Text Available Objectives: The telehealth project EQUI-ResHuS (in French, Les TIC pour un accès Équitable aux Ressources Humaines en Santé aimed to contribute to more equitable access to care and support practice in remote regions in Mali. This study explored the evolution of perceptions concerning telehealth among healthcare professionals in the four district health centres that participated in the EQUI-ResHus project and identified variables influencing their perceptions of telehealth impact on recruitment and retention of health professionals. Methods: One year after a first survey (T1, a second data collection (T2 was carried out among healthcare professionals using a 91-item questionnaire. Questions assessing telehealth use and perceptions and perceived impact on recruitment and retention of healthcare professionals were rated on a 5-point Likert scale. A total of 10 independent variables were considered for the analyses. A Wilcoxon signed-rank test was performed to detect differences between T1 and T2, and a bivariate linear regression model for repeated measures was carried out to assess the impact of independent variables on dependent variables. Results: There were no noticeable changes in perceptions related to telehealth influence on recruitment and retention. Only access to information and communication technology significantly differed between T1 and T2 according the Wilcoxon rank test (p = 0.001. Perceived influence of telehealth on recruitment and retention was mostly explained by attitude towards telehealth, perceived effect on recruitment and retention and barriers to recruitment and retention. Conclusion: Based on our results, telehealth was perceived as having a positive influence but mostly indirect influence on healthcare professional recruitment and retention. Also, there were no major changes after 1 year of telehealth use.
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Directory of Open Access Journals (Sweden)
Valerie J.M. Watzlaf
2017-11-01
Full Text Available The objective of this systematic review was to systematically review papers in the United States that examine current practices in privacy and security when telehealth technologies are used by healthcare providers. A literature search was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols (PRISMA-P. PubMed, CINAHL and INSPEC from 2003 – 2016 were searched and returned 25,404 papers (after duplications were removed. Inclusion and exclusion criteria were strictly followed to examine title, abstract, and full text for 21 published papers which reported on privacy and security practices used by healthcare providers using telehealth. Data on confidentiality, integrity, privacy, informed consent, access control, availability, retention, encryption, and authentication were all searched and retrieved from the papers examined. Papers were selected by two independent reviewers, first per inclusion/exclusion criteria and, where there was disagreement, a third reviewer was consulted. The percentage of agreement and Cohen’s kappa was 99.04% and 0.7331 respectively. The papers reviewed ranged from 2004 to 2016 and included several types of telehealth specialties. Sixty-seven percent were policy type studies, and 14 percent were survey/interview studies. There were no randomized controlled trials. Based upon the results, we conclude that it is necessary to have more studies with specific information about the use of privacy and security practices when using telehealth technologies as well as studies that examine patient and provider preferences on how data is kept private and secure during and after telehealth sessions. Keywords: Computer security, Health personnel, Privacy, Systematic review, Telehealth
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Leveraging Telehealth to Bring Volunteer Physicians Into Underserved Communities.
Uscher-Pines, Lori; Rudin, Robert; Mehrotra, Ateev
2017-06-01
Many disadvantaged communities lack sufficient numbers of local primary care and specialty physicians. Yet tens of thousands of physicians, in particular those who are retired or semiretired, desire meaningful volunteer opportunities. Multiple programs have begun to use telehealth to bridge the gap between volunteer physicians and underserved patients. In this brief, we describe programs that are using this model and discuss the promise and pitfalls. Physician volunteers in these programs report that the work can be fulfilling and exciting, a cutting-edge yet convenient way to remain engaged and contribute. Given the projected shortfall of physicians in the United States, recruiting retired and semiretired physicians to provide care through telehealth increases the total supply of active physicians and the capacity of the existing workforce. However, programs typically use volunteers in a limited capacity because of uncertainty about the level and duration of commitment. Acknowledging this reality, most programs only use volunteer physicians for curbside consults rather than fully integrating them into longitudinal patient care. The part-time availability of volunteers may also be difficult to incorporate into the workflow of busy safety net clinics. As more physicians volunteer in a growing number of telehealth programs, the dual benefits of enriching the professional lives of volunteers and improving care for underserved communities will make further development of these programs worthwhile.
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du Toit, Marie; Malau-Aduli, Bunmi; Vangaveti, Venkat; Sabesan, Sabe; Ray, Robin A
2017-01-01
Background Telehealth has been used extensively in emergency departments to improve healthcare provision. However, its impact on the management of non-critical emergency presentations within rural and remote emergency department settings has not been adequately explored. The objective of this systematic review is to identify how telehealth has been used to assist in the management of non-critical presentations in rural and remote emergency departments and the outcomes. Methods Articles were identified through database searches of CINAHL, Cochrane, MEDLINE (OVID), Informit and SCOPUS, as well as the screening of relevant article reference and citation lists. To determine how telehealth can assist in the management of non-critical emergencies, information was extracted relating to telehealth programme model, the scope of service and participating health professionals. The outcomes of telehealth programmes were determined by analysing the uptake and usage of telehealth, the impact on altering a diagnosis or management plan as well as patient disposition including patient transfer, discharge, local hospital admission and rates of discharge against medical advice. Results Of the 2532 identified records, 15 were found to match the eligibility criteria and were included in the review. Uptake and usage increased for telehealth programmes predominantly utilised by nursing staff with limited local medical support. Teleconsultation conservatively altered patient diagnosis or management in 18-66% of consultations. Although teleconsultation was associated with increased patient transfer rates, unnecessary transfers were reduced. Simultaneously, an increase in local hospital admission was noted and fewer patients were discharged home. Discharge against medical advice rates were low at 0.9-1.1%. Conclusion The most widely implemented hub-and-spoke telehealth model could be incorporated into existing referral frameworks. Telehealth programmes may assist in reducing unnecessary
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A Modeled Analysis of Telehealth Methods for Treating Pressure Ulcers after Spinal Cord Injury
Directory of Open Access Journals (Sweden)
Mark W. Smith
2012-01-01
Full Text Available Home telehealth can improve clinical outcomes for conditions that are common among patients with spinal cord injury (SCI. However, little is known about the costs and potential savings associated with its use. We developed clinical scenarios that describe common situations in treatment or prevention of pressure ulcers. We calculated the cost implications of using telehealth for each scenario and under a range of reasonable assumptions. Data were gathered primarily from US Department of Veterans Affairs (VA administrative records. For each scenario and treatment method, we multiplied probabilities, frequencies, and costs to determine the expected cost over the entire treatment period. We generated low-, medium-, and high-cost estimates based on reasonable ranges of costs and probabilities. Telehealth care was less expensive than standard care when low-cost technology was used but often more expensive when high-cost, interactive devices were installed in the patient’s home. Increased utilization of telehealth technology (particularly among rural veterans with SCI could reduce the incidence of stage III and stage IV ulcers, thereby improving veterans' health and quality of care without increasing costs. Future prospective studies of our present scenarios using patients with various healthcare challenges are recommended.
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Telehealth Business: Boom Times, but Profits May Wait.
Calandra, Robert
2017-04-01
What we have here is irrational telehealth exuberance. Investors are plowing millions into startups. And even though millennials could be eager adopters, these are still early days for the industry. It may take years-and some regulatory changes-for profits to materialize.
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Carlisle, Karen; Warren, Robin
2013-10-01
The present study formed part of a randomised controlled trial of telehealth for in-home monitoring to support people with poorly controlled type 2 diabetes. We explored the experiences of patients and healthcare practitioners, and their perceptions of the telehealth model of care used in the trial. In addition to their usual diabetes care, participants receive diabetes care from a diabetes educator nurse via an in-home broadband communication device. On average, each patient participated in 14 videoconferences with a diabetes care coordinator during the 12-month trial period. Qualitative data was collected from two general practices and included semi-structured interviews and document review of patient clinical notes. A total of 12 people were interviewed: 8 health practitioners and 4 patients. Patients and health practitioners expressed a high level of satisfaction with the model of care provided. Patients also reported positive health and social outcomes as a result of being involved in the trial and indicated that in the main they had achieved their goals and were happy with their progress over the 12-month period. Analysis of interviews revealed three broad elements associated with the implementation of telehealth: interpersonal factors, operational problems and the wider health system context within which the general practices and trial team were operating. The findings suggest that adopting telehealth in the management of type 2 diabetes can lead to improved diabetes control, but more support is required to ensure sustainability and widespread implementation.
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DEFF Research Database (Denmark)
Garne Holm, Kristina; Brødsgaard, Anne; Zachariassen, Gitte
2017-01-01
. While the benefits are beginning to be realised, widespread uptake of telehealth has been limited due to a range of logistical challenges. Understanding user requirements is important when planning and developing a clinical telehealth service. We therefore used participatory design to develop a clinical...... on the results obtained during the workshops and subsequent testing, we developed an application (app), which was integrated into the medical record at the neonatal unit. The app was used to initiate videoconferences and chat messages between the family at home and the neonatal unit, and to share information...... regarding infant growth and well-being. CONCLUSION: Results obtained from the workshops and testing demonstrated the importance of involving users when developing new telehealth applications. The workshops helped identify the challenges associated with delivery of the service, and helped instruct the design...
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Shaikh, Ulfat; Nettiksimmons, Jasmine; Romano, Patrick
2011-01-01
Objective: To determine health care provider needs related to pediatric obesity management in rural California and to explore strategies to improve care through telehealth. Methods: Cross-sectional survey of health care providers who treated children and adolescents at 41 rural clinics with existing telehealth connectivity. Results: Most of the…
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eConsent management and enforcement in personal telehealth
Asim, M.; Koster, R.P.; Petkovic, M.; Rosner, M.; Reimer, H.; Pohlmann, N.; Schneider, W.
2013-01-01
Advances in information and communication technologies are expected to bring large benefits in the healthcare domain. Personal telehealth is one such example that has the potential to address some of the important challenges currently faced by healthcare such as improvement in the quality of
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Brooks, Elizabeth; Manson, Spero M; Bair, Byron; Dailey, Nancy; Shore, Jay H
2012-01-01
Mental health issues are a serious concern for many American Indian Veterans, especially for post-traumatic stress disorder and related psychiatric conditions. Yet, acquiring mental health treatment can be a challenge in Native communities where specialized services are largely unavailable. Consequently, telehealth is increasingly being suggested as a way to expand healthcare access on or near reservation lands. In this study, we wanted to understand the factors affecting the diffusion of telehealth clinics that provided mental health care to rural, American Indian Veterans. We surveyed 39 key personnel and stakeholders who were involved in the decision-making process, technological infrastructure, and implementation of three clinics. Using Roger Everett's Diffusion Theory as a framework, we gathered information about specific tasks, factors hindering progress, and personal reactions to telehealth both before and after implementation. Many participants expressed initial concerns about using telehealth; however, most became positive over time. Factors that influenced participants' viewpoint largely included patient and staff feedback and witnessing the fulfillment of a community health need. The use of outside information to support the implementation of the clinics and personal champions also showed considerable influence in the clinics' success. The findings presented here address critical gaps in our understanding of telehealth diffusion and inform research strategies regarding the cultural issues and outcomes related to telemental health services. Information contained in this report serves as a long overdue guide for developing telemental health programs and policies among American Indians, specifically, and rural populations in general.
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Directory of Open Access Journals (Sweden)
Renee Speyer
2017-12-01
Full Text Available Objective: To describe telehealth interventions delivered by allied health professionals and nurses in rural and remote areas, and to compare the effects of telehealth interventions with standard face-to-face interventions. Data sources: CINAHL, Embase, PsycINFO and PubMed databases were searched. The content of relevant journals and published articles were also searched. Study selection: Studies examining the effectiveness of allied health and nursing telehealth interventions for rural and remote populations were included in descriptive analyses. Studies comparing telehealth intervention with standard face-to-face interventions grouped by type of intervention approach were used to examine between-groups effect sizes. Data extraction: Methodological quality of studies was rated using the QualSyst critical appraisal tool and the National Health and Medical Research Council (NHMRC Evidence Hierarchy levels. Data synthesis: After quality ratings, 43 studies were included. A majority of studies had strong methodological quality. The disciplines of psychology and nursing were represented most frequently, as were studies using a cognitive intervention approach. Meta-analysis results slightly favoured telehealth interventions compared with face-to-face interventions, but did not show significant differences. Interventions using a combined physical and cognitive approach appeared to be more effective. Conclusion: Telehealth services may be as effective as face-to-face interventions, which is encouraging given the potential benefits of telehealth in rural and remote areas with regards to healthcare access and time and cost savings.
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Ethical practice in Telehealth and Telemedicine.
Chaet, Danielle; Clearfield, Ron; Sabin, James E; Skimming, Kathryn
2017-10-01
This article summarizes the report of the American Medical Association's (AMA) Council on Ethical and Judicial Affairs (CEJA) on ethical practice in telehealth and telemedicine. Through its reports and recommendations, CEJA is responsible for maintaining and updating the AMA Code of Medical Ethics (Code). CEJA reports are developed through an iterative process of deliberation with input from multiple stakeholders; report recommendations, once adopted by the AMA House of Delegates, become ethics policy of the AMA and are issued as Opinions in the Code. To provide enduring guidance for the medical profession as a whole, CEJA strives to articulate expectations for conduct that are as independent of specific technologies or models of practice as possible. The present report, developed at the request of the House of Delegates, provides broad guidance for ethical conduct relating to key issues in telehealth/telemedicine. The report and recommendations were debated at meetings of the House in June and November 2015; recommendations were adopted in June 2016 and published as Opinion E-1.2.12, Ethical Practice in Telemedicine, in November 2016. A summary of the key points of the recommendations can be found in Appendix A (online), and the full text of the opinion can be found in Appendix B (online).
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Bohingamu Mudiyanselage, Shalika; Stevens, Jo; Watts, Jennifer J; Toscano, Julian; Kotowicz, Mark A; Steinfort, Christopher L; Bell, Jennifer; Byrnes, Janette; Bruce, Stephanie; Carter, Sarah; Hunter, Claire; Barrand, Chris; Hayles, Robyn
2018-01-01
Introduction The aim of this study was to assess the impact of home-based telehealth monitoring on health outcomes, quality of life and costs over 12 months for patients with diabetes and/or chronic obstructive pulmonary disease (COPD) who were identified as being at high risk of readmission to hospital. Methods This pilot study was a randomised controlled trial combined with an economic analysis to examine the outcomes of standard care versus home-based telehealth for people with diabetes and/or COPD who were at risk of hospital readmission within one year. The primary outcomes were (i) hospital admission and length of stay (LOS); and (ii) health-related quality of life (HRQOL); and the secondary outcomes were (i) health-related clinical outcomes; (ii) anxiety and depression scores; and (iii) health literacy. The costs of the intervention and hospitalisations were included. Results A total of 86 and 85 participants were randomised to the intervention and control groups respectively. The difference between groups in hospital LOS was -3.89 (95% confidence interval (CI): -9.40, 1.62) days, and for HRQOL, 0.09 (95% CI: 0.05, 0.14) in favour of the telehealth monitoring group. There was a saving of AUD$6553 (95% CI: -12145, -961) in the cost of hospitalisation over 12 months, which offset the increased cost of tele-monitoring. The intervention group showed an improvement in anxiety, depression and health literacy at 12 months, and in the diabetes group, a reduction in microalbuminuria. Discussion The telehealth monitoring intervention improved patient's health outcomes and quality of life at no additional cost.
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The Church as a Bridge to Deliver Health Resources Via Telehealth
2017-10-25
Obesity; Diet, Food, and Nutrition; Church; Healthcare Disparities; Minority Health; Mobile Health; Telehealth; Community-based Participatory Research; Primary Health Care; Weight Loss Programs; Health Behavior
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Directory of Open Access Journals (Sweden)
Alexa Riggs
2018-05-01
Full Text Available Transcranial direct current stimulation (tDCS delivered in multiple sessions can reduce symptom burden, but access of chronically ill patients to tDCS studies is constrained by the burden of office-based tDCS administration. Expanded access to this therapy can be accomplished through the development of interventions that allow at-home tDCS applications.Objective: We describe the development and initial feasibility assessment of a novel intervention for the chronically ill that combines at-home tDCS with telehealth support.Methods: In the developmental phase, the tDCS procedure was adjusted for easy application by patients or their informal caregivers at home, and a tDCS protocol with specific elements for enhanced safety and remote adherence monitoring was created. Lay language instructional materials were written and revised based on expert feedback. The materials were loaded onto a tablet allowing for secure video-conferencing. The telehealth tablet was paired with an at-home tDCS device that allowed for remote dose control via electronic codes dispensed to patients prior to each session. tDCS was delivered in two phases: once daily on 10 consecutive days, followed by an as needed regimen for 20 days. Initial feasibility of this tDCS-telehealth system was evaluated in four patients with advanced chronic illness and multiple symptoms. Change in symptom burden and patient satisfaction were assessed with the Condensed Memorial Symptom Assessment Scale (CMSAS and a tDCS user survey.Results: The telehealth-tDCS protocol includes one home visit and has seven patient-tailored elements and six elements enhancing safety monitoring. Replicable electrode placement at home without 10–20 EEG measurement is achieved via a headband that holds electrodes in a pre-determined position. There were no difficulties with patients’ training, protocol adherence, or tolerability. A total of 60 tDCS sessions were applied. No session required discontinuation, and
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Riggs, Alexa; Patel, Vaishali; Paneri, Bhaskar; Portenoy, Russell K; Bikson, Marom; Knotkova, Helena
2018-01-01
Transcranial direct current stimulation (tDCS) delivered in multiple sessions can reduce symptom burden, but access of chronically ill patients to tDCS studies is constrained by the burden of office-based tDCS administration. Expanded access to this therapy can be accomplished through the development of interventions that allow at-home tDCS applications. Objective: We describe the development and initial feasibility assessment of a novel intervention for the chronically ill that combines at-home tDCS with telehealth support. Methods: In the developmental phase, the tDCS procedure was adjusted for easy application by patients or their informal caregivers at home, and a tDCS protocol with specific elements for enhanced safety and remote adherence monitoring was created. Lay language instructional materials were written and revised based on expert feedback. The materials were loaded onto a tablet allowing for secure video-conferencing. The telehealth tablet was paired with an at-home tDCS device that allowed for remote dose control via electronic codes dispensed to patients prior to each session. tDCS was delivered in two phases: once daily on 10 consecutive days, followed by an as needed regimen for 20 days. Initial feasibility of this tDCS-telehealth system was evaluated in four patients with advanced chronic illness and multiple symptoms. Change in symptom burden and patient satisfaction were assessed with the Condensed Memorial Symptom Assessment Scale (CMSAS) and a tDCS user survey. Results: The telehealth-tDCS protocol includes one home visit and has seven patient-tailored elements and six elements enhancing safety monitoring. Replicable electrode placement at home without 10-20 EEG measurement is achieved via a headband that holds electrodes in a pre-determined position. There were no difficulties with patients' training, protocol adherence, or tolerability. A total of 60 tDCS sessions were applied. No session required discontinuation, and there were no adverse
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A security framework for nationwide health information exchange based on telehealth strategy.
Zaidan, B B; Haiqi, Ahmed; Zaidan, A A; Abdulnabi, Mohamed; Kiah, M L Mat; Muzamel, Hussaen
2015-05-01
This study focuses on the situation of health information exchange (HIE) in the context of a nationwide network. It aims to create a security framework that can be implemented to ensure the safe transmission of health information across the boundaries of care providers in Malaysia and other countries. First, a critique of the major elements of nationwide health information networks is presented from the perspective of security, along with such topics as the importance of HIE, issues, and main approaches. Second, a systematic evaluation is conducted on the security solutions that can be utilized in the proposed nationwide network. Finally, a secure framework for health information transmission is proposed within a central cloud-based model, which is compatible with the Malaysian telehealth strategy. The outcome of this analysis indicates that a complete security framework for a global structure of HIE is yet to be defined and implemented. Our proposed framework represents such an endeavor and suggests specific techniques to achieve this goal.
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Diniz, Paula Rejane Beserra; Ribeiro Sales, Fernando José; de Araújo Novaes, Magdala
2016-08-01
Information technologies have been applied in primary care domains to improve the delivery of health services. This article reports the telehealth network experience in Pernambuco, Brazil. Five different data sets were used, one by each service and the structural aspects of the network, collected from 2008 until August 2015. The data include solicited themes for educational activities, users' evaluation of services, numbers of sites, municipalities participating, participants in tele-education activities, teleconsultations, telediagnosis, and remote screenings. The analysis was done in absolute and percentage values using Microsoft Excel (version 2007). The indicators show high utilization of tele-education resources, followed by the teleconsultation service. The synchronous modality was the most used and the general clinical question was the most frequent type of question. Nurses are the professional category that most used the teleconsultation services (36%). Telediagnosis of electrocardiography has growth utilization, overcoming teleconsulting more recently. The satisfaction rate was 89%, and 68.5% of professionals changed their planning to patients' referrals to specialists. Telehealth has been considered effective since it avoids inappropriate referrals of the patient and provides continuous actualization to health professionals. Our results provide evidence of the feasibility and importance of using telehealth as a tool to ensure the universality, equality, and completeness in the health system.
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Weinstein, Ronald S; Krupinski, Elizabeth A; Doarn, Charles R
2018-05-01
Telemedicine and telehealth are the practices of medicine at a distance. Performing the equivalent of a complete clinical examination by telemedicine would be unusual. However, components of a more traditional clinical examination are part of the telemedicine workup for specific conditions. Telemedicine clinical examinations are facilitated, and enhanced, through the integration of a class of medical devices referred to as telemedicine peripherals (eg, electronic stethoscopes, tele-ophthalmoscopes, video-otoscopes, and so forth). Direct-to-consumer telehealth is a rapidly expanding segment of the health care service industry. Copyright © 2018 Elsevier Inc. All rights reserved.
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The burden of seasonal respiratory infections on a national telehealth service in England.
Morbey, R A; Harcourt, S; Pebody, R; Zambon, M; Hutchison, J; Rutter, J; Thomas, H; Smith, G E; Elliot, A J
2017-07-01
Seasonal respiratory illnesses present a major burden on primary care services. We assessed the burden of respiratory illness on a national telehealth system in England and investigated the potential for providing early warning of respiratory infection. We compared weekly laboratory reports for respiratory pathogens with telehealth calls (NHS 111) between week 40 in 2013 and week 29 in 2015. Multiple linear regression was used to identify which pathogens had a significant association with respiratory calls. Children aged respiratory pathogens explained over 83% of the variation in cold/flu, cough and difficulty breathing calls. Based on the first two seasons available, the greatest burden was associated with respiratory syncytial virus (RSV) and influenza, with associations found in all age bands. The most sensitive signal for influenza was calls for 'cold/flu', whilst for RSV it was calls for cough. The best-fitting models showed calls increasing a week before laboratory specimen dates. Daily surveillance of these calls can provide early warning of seasonal rises in influenza and RSV, contributing to the national respiratory surveillance programme.
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Ho, Yi-Lwun; Yu, Jiun-Yu; Lin, Yen-Hung; Chen, Ying-Hsien; Huang, Ching-Chang; Hsu, Tse-Pin; Chuang, Pao-Yu; Hung, Chi-Sheng; Chen, Ming-Fong
2014-06-10
Telehealth programs are a growing field in the care of patients. The evolution of information technology has resulted in telehealth becoming a fourth-generation synchronous program. However, long-term outcomes and cost-effectiveness analysis of fourth-generation telehealth programs have not been reported in patients with chronic cardiovascular diseases. We conducted this study to assess the clinical outcomes and cost-effectiveness of a fourth-generation synchronous telehealth program for patients with chronic cardiovascular diseases. We retrospectively analyzed 575 patients who had joined a telehealth program and compared them with 1178 patients matched for sex, age, and Charlson comorbidity index. The program included: (1) instant transmission of biometric data, (2) daily telephone interview, and (3) continuous decision-making support. Data on hospitalization, emergency department (ED) visits, and medical costs were collected from the hospital's database and were adjusted to the follow-up months. The mean age was 64.5 years (SD 16.0). The mean number of monthly ED visits (mean 0.06 SD 0.13 vs mean 0.09 SD 0.23, P<.001), hospitalizations (mean 0.05 SD 0.12 vs mean 0.11 SD 0.21, P<.001), length of hospitalization (mean 0.77 days SD 2.78 vs mean 1.4 SD 3.6, P<.001), and intensive care unit admissions (mean 0.01 SD 0.07 vs mean 0.036 SD 0.14, P<.001) were lower in the telehealth group. The monthly mean costs of ED visits (mean US$20.90 SD 66.60 vs mean US$37.30 SD 126.20, P<.001), hospitalizations (mean US$386.30 SD 1424.30 vs mean US$878.20 SD 2697.20, P<.001), and all medical costs (mean US$587.60 SD 1497.80 vs mean US$1163.60 SD 3036.60, P<.001) were lower in the telehealth group. The intervention costs per patient were US$224.80 per month. Multivariate analyses revealed that age, telehealth care, and Charlson index were the independent factors for ED visits, hospitalizations, and length of hospitalization. A bootstrap method revealed the dominant cost
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Segar, Julia; Rogers, Anne; Salisbury, Chris; Thomas, Clare
2013-11-01
Shifting the balance of care towards home and community is viewed as requiring interventions which enhance or complement primary care. Technology-based interventions are seen as key to the future in this work. Telehealthcare implicates a new agenda for inter-professional working across boundaries of healthcare. One such interface is between telehealthcare professionals and professionals located in primary care. This study reports the findings from a qualitative study forming part of a broader project examining the potential of developing and implementing telehealth interventions to support patients with long-term conditions. Semi-structured interviews were undertaken with telehealth nurse care managers, practice nurses and general practitioners in their respective work settings (39 interviews with 62 participants). Observation was undertaken at a telehealth call centre. The research took place between April 2010 and March 2011. Thematic analysis of qualitative data was undertaken. Telehealth nurse care managers' interviews suggested narrative constructions of new roles and identities to fit telehealth work, combining a holistic ideal and retro-appeal with 'traditional' values of nursing, which distinguished and distanced them from counterparts in general practices. Practice nurses and general practitioners were ambivalent and often sceptical about the contribution of telehealth to long-term condition work. Practice nurses' accounts suggested a sense of protectiveness about maintaining boundaries around established remits of managing long-term conditions; general practitioners, having devolved much of the care of long-term conditions to nurses, were keen to retain their positions as gatekeepers to resources. Perceptions of shifts of professional roles, new ways of working and how they are valued form a relevant contextual element to the introduction of telehealth interventions. A pre-emptive view and response to how professionals understand and approach increasingly
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Directory of Open Access Journals (Sweden)
James Robert Langabeer
2016-11-01
Full Text Available Introduction Emergency medical services (EMS agencies transport a significant majority of patients with low acuity and non-emergent conditions to local emergency departments (ED, affecting the entire emergency care system’s capacity and performance. Opportunities exist for alternative models that integrate technology, telehealth, and more appropriately aligned patient navigation. While a limited number of programs have evolved recently, no empirical evidence exists for their efficacy. This research describes the development and comparative effectiveness of one large urban program. Methods The Houston Fire Department initiated the Emergency Telehealth and Navigation (ETHAN program in 2014. ETHAN combines telehealth, social services, and alternative transportation to navigate primary care-related patients away from the ED where possible. Using a case-control study design, we describe the program and compare differences in effectiveness measures relative to the control group. Results During the first 12 months, 5,570 patients participated in the telehealth-enabled program, which were compared against the same size control group. We found a 56% absolute reduction in ambulance transports to the ED with the intervention compared to the control group (18% vs. 74%, P<.001. EMS productivity (median time from EMS notification to unit back in service was 44 minutes faster for the ETHAN group (39 vs. 83 minutes, median. There were no statistically significant differences in mortality or patient satisfaction. Conclusion We found that mobile technology-driven delivery models are effective at reducing unnecessary ED ambulance transports and increasing EMS unit productivity. This provides support for broader EMS mobile integrated health programs in other regions.
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Clay-Williams, Robyn; Baysari, Melissa; Taylor, Natalie; Zalitis, Dianne; Georgiou, Andrew; Robinson, Maureen; Braithwaite, Jeffrey; Westbrook, Johanna
2017-01-01
Background Telephone consultation and triage services are increasingly being used to deliver health advice. Availability of high speed internet services in remote areas allows healthcare providers to move from telephone to video telehealth services. Current approaches for assessing video services have limitations. This study aimed to identify the challenges for service providers associated with transitioning from audio to video technology. Methods Using a mixed-method, qualitative approach, w...
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DEFF Research Database (Denmark)
Brooks, Tony
2005-01-01
The goal of the project was to produce a unique, cost effective, and user-friendly computer based telehealth system product which had longevity and the ability to be integrated modularly into a future internet-based health care communication provision. This was conceptualised as an aid to home-ba...
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Exploring challenges to telehealth communication by specialists in poison information.
Rothwell, Erin; Ellington, Lee; Planalp, Sally; Crouch, Barbara
2012-01-01
The use of the telephone for providing health care is growing. A significant amount of social meaning is derived from visual information, and the absence of visual stimuli provides unique barriers to communication and increases the risks for misunderstandings and distractions. Understanding challenges to telephone communication can provide insight into training opportunities for overcoming these difficulties and improving patient care. The purpose of this research was to explore through focus groups the challenges of phone communication perceived by specialists in poison information. General types of challenges to effective phone communication included developing new communication skills to compensate for lack of visual information, difficulty assessing caller understanding, difficulty managing caller misunderstandings, maintaining distinctive assessments for routine calls, and managing the multifaceted aspects of job stress. The desire for training to enhance telehealth and cultural competency skills was also mentioned, and these findings might provide guidance for the development of training opportunities for telehealth professionals.
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Threatt, Tiffaney B; Ward, Eileen D
Primary study objectives were to (1) describe mean change in A1c from baseline of a free clinic population enrolled in telehealth diabetes self-management education and support (DSME/S) services and (2) to compare change in A1C and other clinical outcomes measures with free clinic patients enrolled in a traditional face-to-face DSME/S program. An exploratory study design and comparative evaluation of telehealth DSME/S services in a free clinic population was used. Baseline clinical measures were collected upon referral. Diabetes educators met with patients individually over 2-3 months. Clinical outcomes measures were collected within 6 months of program completion. Data from the telehealth group was assessed individually and compared to a free clinic traditional DSME/S program population. Twelve patients completed a telehealth free clinic DSME/S pilot program with a mean ± SD change in A1C from baseline of -1.03 ± 1.53% (P = 0.050). Mean ± SD change in A1C from baseline in the free clinic population participating in traditional face-to-face DSME/S services was -1.42 ± 1.80% (P = 0.001). No significant differences in secondary outcomes measures, including body mass index and blood pressure, were revealed among the study populations. Expanding access to care in populations faced with challenges of socioeconomics, limited education, and lower health literacy is a step toward reducing health disparities and positively affecting care. Mean A1C can be improved with telehealth DSME/S services in an underserved, free clinic population. Copyright © 2017 American Pharmacists Association®. Published by Elsevier Inc. All rights reserved.
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The Role of School Nursing in Telehealth. Position Statement
Haynie, Kathey M.; Mauter, Elaine; Lindahl, Brenda; Simons-Major, Keisha; Meadows, Lynne; Maughan, Erin D.
2017-01-01
It is the position of the National Association of School Nurses (NASN) that utilization of telehealth technology may be a valuable tool to assist registered professional school nurses (herein referred to as a school nurse) to provide school health services. The health of many students is impacted by lack of access to primary care and specialty…
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Edirippulige, Sisira; Reyno, John; Armfield, Nigel R; Bambling, Matthew; Lloyd, Owen; McNevin, Elizabeth
2016-10-01
The purpose of this study was to understand the methods of current delivery of health care services to cerebral palsy (CP) patients in Queensland, Australia. The study also examines the current use of telehealth by clinicians and their perceptions about telehealth use. Patient records during July 2013-July 2014 were accessed from the Queensland Paediatric Rehabilitation Service (QPRS) to collect information relating to the service delivery for CP patients. Analysis was carried out to examine the patient locations and travel distances using ArcMap geoprocessing software. In addition, 13 face-to-face semi structured interviews were conducted with clinicians from the QPRS and the Cerebral Palsy Health Service (CPHS) to understand the perceptions of clinicians relating to the current level of health care delivery. We also examined the clinicians' current use of telehealth and their opinions about this method. Records of 329 paediatric CP patients were accessed and reviewed. The majority of patients (96%, n = 307) who attended the clinics at the Royal Children's Hospital (RCH), Brisbane, were from remote, rural or regional areas of Queensland. Only 4% of patients (n = 13) were from major cities. During 12 months, patients had attended nine outreach programmes that were conducted by the QPRS and CPHS. The study found that non-local patients were required to travel an average distance of 836 km to access QPRS and CPHS services in Brisbane. The average distance for receiving a consultation at an outreach clinic was 173 km. Clinicians perceived that access to health care services to CP patients in Queensland is inadequate. Nearly all clinicians interviewed had some experience in using telehealth. They had high satisfaction levels with the method. Traditional methods of delivering services to CP patients do not meet their needs. Clinicians have found telehealth is a feasible and satisfactory delivery method. However, the use of telehealth is still limited. © The
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Nursing care by telehealth: what is the influence of distance on communication?
Barbosa, Ingrid de Almeida; Silva, Maria Júlia Paes da
2017-01-01
Evaluate the perception of nurses regarding interpersonal communication while providing care via telehealth. Qualitative research realized with seven nurses working in telehealth in Brazil, the sample was determined by data saturation. A questionnaire with open questions was applied and then content analysis of the dialogues was conducted, focusing on thematic analysis. Four categories emerged from the dialogues: Understanding the importance of communication; the interpersonal relationship interfering with communication; Communicating via technology; and Learning the communication process. The perception of nurses working in telehealth in Brazil is that technology has facilitated their professional practice; however, in relation to the communication process, they believe it is harder to communicate by telehealth, mainly due to difficulty in perceiving nonverbal signals. To overcome these difficulties, they agreed that interpersonal communication is a skill that must be acquired during their professional training. Avaliar a percepção do enfermeiro referente à Comunicação interpessoal no cuidado por telessaúde. Pesquisa qualitativa, realizada com sete enfermeiros que atuam em telessaúde no Brasil, com amostra determinada pela saturação de dados. Aplicou-se um questionário com perguntas abertas e foi realizada análise de conteúdo dos discursos, com enfoque na análise temática. Dos discursos emergiram quatro categorias: Entendendo a importância da comunicação; O relacionamento interpessoal interferindo na comunicação; Comunicando-se por meio da tecnologia; e Aprendendo o processo de comunicação. A percepção dos enfermeiros que atuam em telessaúde no Brasil é de que a tecnologia tem facilitado sua prática profissional; porém, em relação ao processo de comunicação, creem que seja mais difícil se comunicar pela telessaúde, principalmente devido à dificuldade de percepção de sinais não verbais. Para superar essas dificuldades, concordam
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Environmental aspects of health care in the Grampian NHS region and the place of telehealth
Wootton, Richard; Tait, Alex; Croft, Amanda
2010-01-01
Detailed information about the composition of the carbon footprint of the NHS in the Grampian health region, and in Scotland generally, is not available at present. Based on the limited information available, our best guess is that travel emissions in Grampian are substantial, perhaps 49,000 tonnes CO2 per year. This is equivalent to 233 million km of car travel per year. A well-established telemedicine network in the Grampian region, which saves over 2000 patient journeys a year from community hospitals, avoids about 260,000 km travel per year, or about 59 tonnes CO2 per year. Therefore using telehealth as it has been used historically (primarily to facilitate hospital-to-hospital interactions) seems unlikely to have a major environmental impact – although of course there may be other good reasons for persevering with conventional telehealth. On the other hand, telehealth might be useful in reducing staff travel and to a lesser extent, visitor travel. It looks particularly promising for reducing outpatient travel, where substantial carbon savings might be made by reconfiguring the way that certain services are provided. PMID:20511579
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Hendy, Jane; Chrysanthaki, Theopisti; Barlow, James; Knapp, Martin; Rogers, Anne; Sanders, Caroline; Bower, Peter; Bowen, Robert; Fitzpatrick, Ray; Bardsley, Martin; Newman, Stanton
2012-11-15
To investigate organisational factors influencing the implementation challenges of redesigning services for people with long term conditions in three locations in England, using remote care (telehealth and telecare). Case-studies of three sites forming the UK Department of Health's Whole Systems Demonstrator (WSD) Programme. Qualitative research techniques were used to obtain data from various sources, including semi-structured interviews, observation of meetings over the course programme and prior to its launch, and document review. Participants were managers and practitioners involved in the implementation of remote care services. The implementation of remote care was nested within a large pragmatic cluster randomised controlled trial (RCT), which formed a core element of the WSD programme. To produce robust benefits evidence, many aspect of the trial design could not be easily adapted to local circumstances. While remote care was successfully rolled-out, wider implementation lessons and levels of organisational learning across the sites were hindered by the requirements of the RCT. The implementation of a complex innovation such as remote care requires it to organically evolve, be responsive and adaptable to the local health and social care system, driven by support from front-line staff and management. This need for evolution was not always aligned with the imperative to gather robust benefits evidence. This tension needs to be resolved if government ambitions for the evidence-based scaling-up of remote care are to be realised.
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McKissick, Holly D; Cady, Rhonda G; Looman, Wendy S; Finkelstein, Stanley M
The purpose of this analysis was to evaluate the effects of an advanced practice nurse-delivered telehealth intervention on health care use by children with medical complexity (CMC). Because CMC account for a large share of health care use costs, finding effective ways to care for them is an important challenge requiring exploration. This was a secondary analysis of data from a randomized clinical trial with a control group and two intervention groups. The focus of the analysis was planned and unplanned clinical and therapy visits by CMC over a 30-month data collection period. Nonparametric tests were used to compare visit counts among and within the three groups. The number of unplanned visits decreased over time across all groups, with the greatest decrease in the video telehealth intervention group. Planned visits were higher in the video telehealth group across all time periods. Advanced practice registered nurse-delivered telehealth care coordination may support a shift from unplanned to planned health care service use among CMC. Copyright © 2016 National Association of Pediatric Nurse Practitioners. Published by Elsevier Inc. All rights reserved.
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Doarn, Charles R; Zacharias, Stephanie; Keck, Casey Stewart; Tabangin, Meredith; DeAlarcon, Alessandro; Kelchner, Lisa
2018-06-05
This article describes the design and implementation of a web-based portal developed to provide supported home practice between weekly voice therapy sessions delivered through telehealth to children with voice disorders. This in-between care consisted of supported home practice that was remotely monitored by speech-language pathologists (SLPs). A web-based voice therapy portal (VTP) was developed as a platform so participants could complete voice therapy home practice by an interdisciplinary team of SLPs (specialized in pediatric voice therapy), telehealth specialists, biomedical informaticians, and interface designers. The VTP was subsequently field tested in a group of children with voice disorders, participating in a larger telehealth study. Building the VTP for supported home practice for pediatric voice therapy was challenging, but successful. Key interactive features of the final site included 11 vocal hygiene questions, traditional voice therapy exercises grouped into levels, audio/visual voice therapy demonstrations, a store-and-retrieval system for voice samples, message/chat function, written guidelines for weekly therapy exercises, and questionnaires for parents to complete after each therapy session. Ten participants (9-14 years of age) diagnosed with a voice disorder were enrolled for eight weekly telehealth voice therapy sessions with follow-up in-between care provided using the VTP. The development and implementation of the VTP as a novel platform for the delivery of voice therapy home practice sessions were effective. We found that a versatile individual, who can work with all project staff (speak the language of both SLPs and information technologists), is essential to the development process. Once the website was established, participants and SLPs effectively utilized the web-based VTP. They found it feasible and useful for needed in-between care and reinforcement of therapeutic exercises.
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Brazionis, Laima; Jenkins, Alicia; Keech, Anthony; Ryan, Chris; Bursell, Sven-Erik
2017-01-05
Despite substantial investment in detection, early intervention and evidence-based treatments, current management strategies for diabetes-associated retinopathy and cardiovascular disease are largely based on real-time and face-to-face approaches. There are limited data re telehealth facilitation in type 2 diabetes management. Therefore, we aim to investigate efficacy of telehealth facilitation of diabetes and cardiovascular disease care in high-risk vulnerable Aboriginal and Torres Strait Islanders in remote/very remote Australia. Using a pre-post intervention design, 600 Indigenous Australians with type 2 diabetes will be recruited from three primary-care health-services in the Northern Territory. Diabetes status will be based on clinical records. There will be four technological interventions: 1. Baseline retinal imaging [as a real-time patient education/engagement tool and telehealth screening strategy]. 2. A lifestyle survey tool administered at ≈ 6-months. 3. At ≈ 6- and 18-months, an electronic cardiovascular disease and diabetes decision-support tool based on current guidelines in the Standard Treatment Manual of the Central Australian Rural Practitioner's Association to generate clinical recommendations. 4. Mobile tablet technology developed to enhance participant engagement in self-management. Data will include: Pre-intervention clinical and encounter-history data, baseline retinopathy status, decision-support and survey data/opportunistic mobile tablet encounter data. The primary outcome is increased participant adherence to clinical appointments, a marker of engagement and self-management. A cost-benefit analysis will be performed. Remoteness is a major barrier to provision and uptake of best-practice chronic disease management. Telehealth, beyond videoconferencing of consultations, could facilitate evidence-based management of diabetes and cardiovascular disease in Indigenous Australians and serve as a model for other conditions. Australia
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Sonia Jane Milburn; Adrian Flowerday
2012-01-01
Introduction With local and national evidence highlighting and confirming numerous benefits gained from implementing telehealth, why is it so hard to roll out the technology at scale? Solent NHS Trust has worked alongside Docobo Limited, since 2005, to successfully introduce telehealth to its patients and clinical staff. Our Chronic Obstructive Pulmonary Disease, Chronic Heart Failure and Community Matron teams have utilised Telehealth tools into their normal practice and have delivered signi...
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Steps to Offering Low Vision Rehabilitation Services through Clinical Video Telehealth
Ihirig, Carolyn
2016-01-01
Telehealth clinical applications, which allow medical professionals to use telecommunications technologies to provide services to individuals remotely, continue to expand in areas such as low vision rehabilitation, where evaluations are provided to patients who live in rural areas. As with face-to-face low vision rehabilitation, the goal of…
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Role of telehealth in renal replacement therapy education.
Malkina, Anna; Tuot, Delphine S
2018-03-01
The prevalence of end-stage renal disease is rising in the United States, which bears high financial and public health burden. The most common modality of renal replacement therapy (RRT) in the United States is in-center hemodialysis. Many patients report lack of comprehensive and timely education about their treatment options, which may preclude them from participating in home-based dialysis therapies and kidney transplantation evaluation. While RRT education has traditionally been provided in-person, the rise of telehealth has afforded new opportunities to improve upon the status quo. For example, technology-augmented RRT education has recently been implemented into telehealth nephrology clinics, informational websites and mobile applications maintained by professional organizations, patient-driven forums on social media, and multimodality programs. The benefits of technology in RRT education are increased access for geographically isolated and/or medically frail patients, versatility of content delivery, information repetition to enhance knowledge retention, and interpersonal connection for educational content and emotional support. Challenges center around privacy and accuracy of information sharing, in addition to differential access to technology due to age and socioeconomic status. A review of available scholarly and social media resources suggests that technology-aided delivery of education about treatment options for end-stage renal disease provides an important alternative and/or supplemental resource for patients and families. © 2018 Wiley Periodicals, Inc.
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Directory of Open Access Journals (Sweden)
Mountain Gail A
2011-01-01
Full Text Available Abstract Background Chronic Obstructive Pulmonary Disease (COPD is a prevalent debilitating long term condition. It is the second most common cause of emergency admission to hospital in the UK and remains one of the most costly conditions to treat through acute care. Tele-health monitoring offers potential to reduce the rates of re-hospitalisation and emergency department visits and improve quality of life for people with COPD. However, the current evidence base to support technology adoption and implementation is limited and the resource implications for implementing tele-health in practice can be very high. This trial will employ tele-health monitoring in a preventative capacity for patients diagnosed with early stage COPD following discharge from hospital to determine whether it reduces their need for additional health service support or hospital admission and improves their quality of life. Methods/Design We describe a pilot study for a two arm, one site randomized controlled trial (RCT to determine the effect of tele-health monitoring on self-management, quality of life and patient satisfaction. Sixty patients who have been discharged from one acute trust with a primary diagnosis of COPD and who have agreed to receive community clinical support following discharge from acute care will be randomly assigned to one of two groups: (a Tele-health supported Community COPD Service; or (b Usual Care. The tele-health supported service involves the patient receiving two home visits with a specialist COPD clinician (nurse or physiotherapist then participating in daily tele-monitoring over an eight week period. Usual care consists of six home visits to the patient by specialist COPD clinicians again over eight successive weeks. Health status and quality of life data for all participants will be measured at baseline, on discharge from the service and at six months post discharge from the service. Discussion The tele-health service under study is a
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Health care on demand: four telehealth priorities for 2016.
Grube, Mark E; Kaufman, Kenneth; Clarin, Dan; O'Riordan, Jason
2016-01-01
Consumers who are accustomed to on-demand, virtual services are looking for more convenient ways to access health care. Giving patients the opportunity to connect with physicians remotely can promote higher patient satisfaction and engagement. Telehealth options may have a high start-up cost, but that cost is likely well-justified by the potential to enhance quality, outcomes, and customer attraction and satisfaction/retention over the long-term.
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2012-01-01
Background To investigate organisational factors influencing the implementation challenges of redesigning services for people with long term conditions in three locations in England, using remote care (telehealth and telecare). Methods Case-studies of three sites forming the UK Department of Health’s Whole Systems Demonstrator (WSD) Programme. Qualitative research techniques were used to obtain data from various sources, including semi-structured interviews, observation of meetings over the course programme and prior to its launch, and document review. Participants were managers and practitioners involved in the implementation of remote care services. Results The implementation of remote care was nested within a large pragmatic cluster randomised controlled trial (RCT), which formed a core element of the WSD programme. To produce robust benefits evidence, many aspect of the trial design could not be easily adapted to local circumstances. While remote care was successfully rolled-out, wider implementation lessons and levels of organisational learning across the sites were hindered by the requirements of the RCT. Conclusions The implementation of a complex innovation such as remote care requires it to organically evolve, be responsive and adaptable to the local health and social care system, driven by support from front-line staff and management. This need for evolution was not always aligned with the imperative to gather robust benefits evidence. This tension needs to be resolved if government ambitions for the evidence-based scaling-up of remote care are to be realised. PMID:23153014
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Being Spontaneous: The Future of Telehealth Implementation?
Mars, Maurice; Scott, Richard E
2017-09-01
The smartphone simplifies interprofessional communication, and smartphone applications can facilitate telemedicine activity. Much has been written about the steps that need to be followed to implement and establish a successful telemedicine service that is integrated into everyday clinical practice. A traditional and systematic approach has evolved incorporating activities such as strategy development, needs assessment, business cases and plans, readiness assessment, implementation plans, change management interventions, and ongoing monitoring and evaluation. This "best practice" has been promoted in the telehealth literature for many years. In contrast, several recent initiatives have arisen without any such formal undertakings. This article describes the strengths and weaknesses of two "spontaneous" telemedicine services in dermatology and burn management that have evolved in South Africa. Two spontaneous services were identified and reviewed. In one unsolicited service, doctors at rural referring hospitals have been taking photographs of skin lesions and sending them with a brief text message history to dermatologists using the instant messaging smartphone app, WhatsApp. In the other, burns service, admissions to the burns unit or the clinic were triaged by telephonic description of the case and completion of a preadmission questionnaire. More recently, management and referral decisions are made only after completion of the questionnaire and subsequent submission of photographs of the burn sent by WhatsApp, with the decision transmitted by text message. Although efficient and effective, potential legal and ethical shortcomings have been identified. These "spontaneous" telehealth services challenge traditional best practice, yet appear to lead to truly integrated practice and, therefore, are successful and warrant further study.
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Theodore, Brian R; Whittington, Jan; Towle, Cara; Tauben, David J; Endicott-Popovsky, Barbara; Cahana, Alex; Doorenbos, Ardith Z
2015-06-01
With ever increasing mandates to reduce costs and increase the quality of pain management, health care institutions are faced with the challenge of adopting innovative technologies and shifting workflows to provide value-based care. Transaction cost economic analysis can provide comparative evaluation of the consequences of these changes in the delivery of care. The aim of this study was to establish proof-of-concept using transaction cost analysis to examine chronic pain management in-clinic and through telehealth. Participating health care providers were asked to identify and describe two comparable completed transactions for patients with chronic pain: one consultation between patient and specialist in-clinic and the other a telehealth presentation of a patient's case by the primary care provider to a team of pain medicine specialists. Each provider completed two on-site interviews. Focus was on the time, value of time, and labor costs per transaction. Number of steps, time, and costs for providers and patients were identified. Forty-six discrete steps were taken for the in-clinic transaction, and 27 steps were taken for the telehealth transaction. Although similar in costs per patient ($332.89 in-clinic vs. $376.48 telehealth), the costs accrued over 153 business days in-clinic and 4 business days for telehealth. Time elapsed between referral and completion of initial consultation was 72 days in-clinic, 4 days for telehealth. U.S. health care is moving toward the use of more technologies and practices, and the information provided by transaction cost analyses of care delivery for pain management will be important to determine actual cost savings and benefits. Wiley Periodicals, Inc.
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Joshi, Ashish; de Araujo Novaes, Magdala; Machiavelli, Josiane; Iyengar, Sriram; Vogler, Robert; Johnson, Craig; Zhang, Jiajie; Hsu, Chiehwen E
2012-01-01
Public health data is typically organized by geospatial units. Routine geographic monitoring of health data enables an understanding of the spatial patterns of events in terms of causes and controls. GeoVisualization (GeoVis) allows users to see information hidden both visually and explicitly on a map. Despite the applicability of GeoVis in public health, it is still underused for visualizing public health data. The objective of this study is to examine the perception of telehealth users' to utilize GeoVis as a proof of concept to facilitate visual exploration of telehealth data in Brazil using principles of human centered approach and cognitive fit theory. A mixed methods approach combining qualitative and quantitative assessments was utilized in this cross sectional study conducted at the Telehealth Center of the Federal University of Pernambuco (NUTE-UFPE), Recife, Brazil. A convenient sample of 20 participants currently involved in NUTES was drawn during a period of Sep-Oct 2011. Data was gathered using previously tested questionnaire surveys and in-person interviews. Socio-demographic Information such as age, gender, prior education, familiarity with the use of computer and GeoVis was gathered. Other information gathered included participants' prior spatial analysis skills, level of motivation and use of GeoVis in telehealth. Audio recording was done for all interviews conducted in both English and Portuguese, and transcription of the audio content to English was done by a certified translator. Univariate analysis was performed and means and standard deviations were reported for the continuous variables and frequency distributions for the categorical variables. For the open-ended questions, we utilized a grounded theory to identify themes and their relationship as they emerge from the data. Analysis of the quantitative data was performed using SAS V9.1 and qualitative data was performed using NVivo9. The average age of participants was 28 years (SD=7), a
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Joshi, Ashish; de Araujo Novaes, Magdala; Machiavelli, Josiane; Iyengar, Sriram; Vogler, Robert; Johnson, Craig; Zhang, Jiajie; Hsu, Chiehwen E
2012-01-01
Public health data is typically organized by geospatial unit. GeoVisualization (GeoVis) allows users to see information visually on a map. Examine telehealth users' perceptions towards existing public health GeoVis applications and obtains users' feedback about features important for the design and development of Human Centered GeoVis application "the SanaViz". We employed a cross sectional study design using mixed methods approach for this pilot study. Twenty users involved with the NUTES telehealth center at Federal University of Pernambuco (UFPE), Recife, Brazil were enrolled. Open and closed ended questionnaires were used to gather data. We performed audio recording for the interviews. Information gathered included socio-demographics, prior spatial skills and perception towards use of GeoVis to evaluate telehealth services. Card sorting and sketching methods were employed. Univariate analysis was performed for the continuous and categorical variables. Qualitative analysis was performed for open ended questions. Existing Public Health GeoVis applications were difficult to use. Results found interaction features zooming, linking and brushing and representation features Google maps, tables and bar chart as most preferred GeoVis features. Early involvement of users is essential to identify features necessary to be part of the human centered GeoVis application "the SanaViz".
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Directory of Open Access Journals (Sweden)
Sharon Levy
2014-05-01
Full Text Available Background Many young people with chronic ill health use technology for selfcare activities, but little is known about the use of telehealth amongst those with spina bifida. The limited availability of specialist continence nurses in primary care settings, for this client group in the UK, exacerbates their reliance on parents or carers.Objectives1. Exploring the way in which home-based and technology-enabled clinical interventions affect young people’s engagement in continence self-care.2. Articulating the way in which telehealth impacts on nursing practice and the conduct of remote clinical encounters.Methods A virtual nurse-led clinic was established to support a small cohort of service users and their parents from home. Data from participants were collected and analysed alongside a narrative record of a reflective diary, used by the continence specialist nurse.Results Participants reported increased level of self-confidence, which was attributed to interacting remotely with the specialist nurse. The virtual clinic assisted users to attain some self-care goals as well as assert their role as partners in care planning. The specialist nurse gained new valuable skills in mastering telehealth technology and managing remote clinical provision.Conclusions Using Skype™ to support young people with complex needs is an effective intervention to support continence care at home. Dedicated technical support during the initial set-up phase and on-going clinical mentorship are needed to ensure that telehealth is successfully embedded within health care practice.
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Dutch nurses' willingness to use home telehealth : implications for practice and education
van Houwelingen, C.T.M.; Barakat, A.; Best, R.; Boot, W.R.; Charness, N.; Kort, H.S.M.
Home telehealth (HT) refers to the use of videoconferencing to provide care to patients remotely and can help older adults age in place. However, these technologies are unlikely to impact care unless health care providers are motivated to use them. Education may play a key role in increasing
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Psychosocial health coaching for chronically ill in a telehealth context: a pilot study
Directory of Open Access Journals (Sweden)
Lenneke Van Genugten
2015-10-01
The results show that the structured, partly automated approach can be used in a telehealth context by means of health coaches. MAY appeared to be a suitable tool for providing input for psychosocial care. HCs attitudes towards the structured approach were positive, which is crucial to the success of the implementation of MAY. Based on these results, we recommend to continue this approach as it may strengthen the wellbeing of patients (to be evaluated in future work. However, improvements are necessary. The tool should get a better fit in the current working procedures, and support the translation from recommendations to action. Further automation may facilitate this. In conclusion, this study shows that it is possible for HCs to implement structured psychosocial care in a telehealth program but that combining digitalized and human efforts in one structure is a challenge. The appreciation of the health coaches is an important first step in this process.
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A randomized controlled trial of a telehealth parenting intervention: A mixed-disability trial.
Hinton, Sharon; Sheffield, Jeanie; Sanders, Matthew R; Sofronoff, Kate
2017-06-01
The quality of parenting a child receives has a major impact on development, wellbeing and future life opportunities. This study examined the efficacy of Triple P Online - Disability (TPOL-D) a telehealth intervention for parents of children with a disability. Ninety-eight parents and carers of children aged 2-12 years diagnosed with a range of developmental, intellectual and physical disabilities were randomly assigned to either the intervention (51) or treatment-as-usual (47) control group. At post-intervention parents receiving the TPOL-D intervention demonstrated significant improvements in parenting practices and parenting self-efficacy, however a significant change in parent-reported child behavioral and emotional problems was not detected. At 3-month follow up intervention gains were maintained and/or enhanced. A significant decrease in parent-reported child behavioral and emotional problems was also detected at this time. The results indicate that TPOL-D is a promising telehealth intervention for a mixed-disability group. Copyright © 2017 Elsevier Ltd. All rights reserved.
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Educational actions in human communication health: telehealth contributions in primary care
Directory of Open Access Journals (Sweden)
Gabriela Guedes de Sá Leitão
Full Text Available ABSTRACT Objective: to characterize educational actions related to human communication health produced at the Tele-Health Center for health professionals in primary care. Methods: a cross-sectional study was conducted at the Tele-Health Center at the Federal University of Pernambuco Clinical Hospital. Educational actions produced by tele-consultants between 2008 and 2014 linked to the health of human communication were considered. Data collection was conducted in two phases. In the first phase, the data were explored and educational actions were selected based on the title and the relationship with human communication. In the second phase, each action was observed and evaluated for content. The data were analyzed using descriptive statistics. Results: a few educational actions related to human communication health were concentrated in 2014. Throughout the period analyzed, the actions were restricted to the field of language and concentrated on the education issue as well as the strategic area of child and adolescent health. The most frequent occupational category among the tele-consultants was nursing. Conclusion: a small number of educational actions addressing the health of human communication was produced and the participation of speech therapists remains incipient.
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Comparing Web, Group and Telehealth Formats of a Military Parenting Program
2016-06-01
materials are available upon request: • Online questionnaire for baseline data collection (9 pages) • Online parent survey for time point 1 (69 pages...web-based parenting intervention for military families with school-aged children, we expect to strengthen parenting practices in families and...AWARD NUMBER: W81XWH-14-1-0143 TITLE: Comparing Web, Group and Telehealth Formats of a Military Parenting Program PRINCIPAL INVESTIGATOR
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Wood, Jamie; Mulrennan, Siobhain; Hill, Kylie; Cecins, Nola; Morey, Sue; Jenkins, Sue
2017-08-01
Introduction A significant proportion (15%, n = 28) of the adults with cystic fibrosis (CF) in Western Australia (WA) live in rural and remote areas and have difficulty accessing specialist care at the state adult CF centre, located in Perth. We aimed to increase access by offering telehealth clinics, and evaluate the impact on health outcomes. Methods Telehealth clinics were offered via videoconference over a 12-month period, with uptake and satisfaction measured at the end of the intervention. Participants could still attend in person clinics at the CF centre if requested. Other outcomes comprised healthcare utilisation (HCU), spirometry, weight and health-related quality of life. Results In 21 participants, total clinic visits increased from 46 (median (range) per participant 2 (0-6)) in the 12-month period preceding the study to 100 (5 (2-8), p vitality domain of the Cystic Fibrosis Questionnaire - Revised ( p < 0.05). Discussion Telehealth had good uptake and increased clinic attendance in adults with CF living in rural and remote WA, and had high satisfaction amongst participants. The increase in HCU, resulting from increased detection and treatment of exacerbations, may improve long-term outcomes in this population.
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Directory of Open Access Journals (Sweden)
Safdari Reza
2016-10-01
Full Text Available Residents of the rural and remote area always having limitations on accessing properly required service providers. In such condition, the establishment of rural health centers equipped with telehealth, and also the use of GIS for optimal site selection to the centers, would play an important role in facilitating the achievement of quality health services in desired time factor. This study intended to find the optimal sites for building the Rural Health Centers Equipped with remote health facilities in, Khorramabad City, using GIS. During the pilot study, we identified few effective locating criteria and sub-criteria for rural health centers equipped with telehealth, the priorities was also determined in that descriptive study. Further, we prepared a special layer for each criterion on the site selection, and by integrating such layers based on specified rules and patterns, about the spatial analysis , (like distance and density analysis were done. For such methods, we used Arc Map, Arc Catalog and Arc toolbox environments of Arc GIS (version 9.3. Finally, a map was prepared that indicated the possibility of appropriateness for establishing the centers in the study area. Considering a large number of areas, the research team selected the areas which were the appropriate location for build rural health centers which could be equipped with Telehealth.
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Marzuki, Nuraidah; Ismail, Saimy; Al-Sadat, Nabilla; Ehsan, Fauziah Z; Chan, Chee-Khoon; Ng, Chiu-Wan
2015-11-01
Despite the high costs involved and the lack of definitive evidence of sustained effectiveness, many low- and middle-income countries had begun to strengthen their health information system using information and communication technology in the past few decades. Following this international trend, the Malaysian Ministry of Health had been incorporating Telehealth (National Telehealth initiatives) into national health policies since the 1990s. Employing qualitative approaches, including key informant interviews and document review, this study examines the agenda-setting processes of the Telehealth policy using Kingdon's framework. The findings suggested that Telehealth policies emerged through actions of policy entrepreneurs within the Ministry of Health, who took advantage of several simultaneously occurring opportunities--official recognition of problems within the existing health information system, availability of information and communication technology to strengthen health information system and political interests surrounding the national Multimedia Super Corridor initiative being developed at the time. The last was achieved by the inclusion of Telehealth as a component of the Multimedia Super Corridor. © 2015 APJPH.
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2012-08-21
... Collection: Emergency Submission for OMB Review (Telehealth in the Parkinson's Disease Research, Education... needed to improve the care and clinical outcomes of patients with Parkinson's disease. DATES: Comments... Parkinson's Disease Research, Education and Clinical Center (PADRECC): The Key to the Patient-Centered...
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Sun, Virginia; Ercolano, Elizabeth; McCorkle, Ruth; Grant, Marcia; Wendel, Christopher S; Tallman, Nancy J; Passero, Frank; Raza, Sabreen; Cidav, Zuleyha; Holcomb, Michael; Weinstein, Ronald S; Hornbrook, Mark C; Krouse, Robert S
2018-01-01
An ostomy adversely affects health-related quality of life (HRQOL) in a diverse population of cancer survivors and their caregivers. Hit-or-miss ostomy care, nurse counseling, and community referral have been the primary modes of self-management education and support in the peri-operative setting. Few evidence-based, systematic ostomy self-management programs are available to ensure optimal post-operative care. This paper describes the study design of a telehealth-based Ostomy Self-management Training (OSMT) program for cancer survivors and their caregivers. The study is a three-year, randomized trial that tests the effectiveness of the OSMT program on survivor activation, self-efficacy, and HRQOL. The intervention integrates goal setting and problem-solving approaches to enhance survivor activation and self-efficacy to carry out ostomy care. The curriculum is delivered via four group sessions administered by trained ostomy certified nurses (WOCNs) and peer ostomates. An additional session is offered to caregivers to address their needs in relation to ostomy care. Telehealth approaches through videoconferencing are used to enhance program delivery to participants in three different geographic areas across two time zones. Participants join sessions via real-time videoconferencing from their homes. The OSMT program has high potential to make a positive impact on the unique physical, psychological, social, and spiritual needs of cancer survivors living with a permanent ostomy. The study design, process, and telehealth approach contributes to the success of future dissemination efforts of the intervention into diverse clinical and community settings. Copyright © 2017 Elsevier Inc. All rights reserved.
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CE: Telehealth: a case study in disruptive innovation.
Grady, Janet
2014-04-01
Technologic advances in health care have often outpaced our ability to integrate the technology efficiently, establish best practices for its use, and develop policies to regulate and evaluate its effectiveness. However, these may be insufficient reasons to put the brakes on innovation-particularly those "disruptive innovations" that challenge the status quo and have the potential to produce better outcomes in a number of important areas. This article discusses the concept of disruptive innovation and highlights data supporting its necessity within health care in general and nursing in particular. Focusing on telehealth as a case study in disruptive innovation, the author provides examples of its application and reviews literature that examines its effectiveness in both nursing practice and education.
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The Role of Telehealth to Assist In-Home tDCS: Opportunities, Promising Results and Acceptability
Directory of Open Access Journals (Sweden)
Brenton Hordacre
2018-06-01
Full Text Available Transcranial direct current stimulation (tDCS has shown great promise as a neuromodulatory intervention capable of improving behavioral outcomes in a range of neurological and psychiatric populations. Evidence indicates that the neuromodulatory effect of stimulation may be cumulative, with greater improvements in behavior observed following multiple treatment sessions. However, the requirement to attend clinical or research departments for multiple treatment sessions may present a barrier for many people, particularly those with greater disability or living remotely. The portability of tDCS suggests that in-home stimulation may become an avenue for further investigation. However, safe and effective use of tDCS by a participant within their home requires a form of monitoring. This review discusses how telehealth may provide real-time visual monitoring to ensure correct tDCS set-up and adherence to stimulation protocols, manage technical issues and monitor adverse events. The combination of telehealth to supplement in-home tDCS use has potential to transform the way tDCS is delivered.
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Myers, Kathleen; Vander Stoep, Ann; Zhou, Chuan; McCarty, Carolyn A; Katon, Wayne
2015-04-01
To test the effectiveness of a telehealth service delivery model for the treatment of children with attention-deficit/hyperactivity disorder (ADHD) that provided pharmacological treatment and caregiver behavior training. The Children's ADHD Telemental Health Treatment Study (CATTS) was a randomized controlled trial with 223 children referred by 88 primary care providers (PCPs) in 7 communities. Children randomized to the experimental telehealth service model received 6 sessions over 22 weeks of combined pharmacotherapy, delivered by child psychiatrists through videoconferencing, and caregiver behavior training, provided in person by community therapists who were supervised remotely. Children randomized to the control service delivery model received treatment with their PCPs augmented with a telepsychiatry consultation. Outcomes were diagnostic criteria for ADHD and oppositional defiant disorder (ODD) and role performance on the Vanderbilt ADHD Rating Scale (VADRS) completed by caregivers (VADRS-Caregivers) and teachers (VADRS-Teachers) and impairment on the Columbia Impairment Scale-Parent Version (CIS-P). Measures were completed at 5 assessments over 25 weeks. Children in both service models improved. Children assigned to the telehealth service model improved significantly more than children in the augmented primary care arm for VADRS-Caregiver criteria for inattention (χ(2)[4] = 19.47, p ADHD (χ(2)[4] = 14.90, p = .005), ODD (χ(2)[4] = 10.05, p = .04), and VADRS-Caregiver role performance (χ(2) [4] = 12.40, p = .01) and CIS-P impairment (χ(2)[4] = 20.52, p ADHD (χ(2)[4] = 9.72, p = .045). The CATTS trial demonstrated the effectiveness of a telehealth service model to treat ADHD in communities with limited access to specialty mental health services. Clinical trial registration information-Children's Attention Deficit Disorder With Hyperactivity (ADHD) Telemental Health Treatment Study; http://clinicaltrials.gov; NCT00830700. Copyright © 2015 American
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Greenhalgh, Trisha; Procter, Rob; Wherton, Joe; Sugarhood, Paul; Hinder, Sue; Rouncefield, Mark
2015-04-23
We sought to define quality in telehealth and telecare with the aim of improving the proportion of patients who receive appropriate, acceptable and workable technologies and services to support them living with illness or disability. This was a three-phase study: (1) interviews with seven technology suppliers and 14 service providers, (2) ethnographic case studies of 40 people, 60 to 98 years old, with multi-morbidity and assisted living needs and (3) 10 co-design workshops. In phase 1, we explored barriers to uptake of telehealth and telecare. In phase 2, we used ethnographic methods to build a detailed picture of participants' lives, illness experiences and technology use. In phase 3, we brought users and their carers together with suppliers and providers to derive quality principles for assistive technology products and services. Interviews identified practical, material and organisational barriers to smooth introduction and continued support of assistive technologies. The experience of multi-morbidity was characterised by multiple, mutually reinforcing and inexorably worsening impairments, producing diverse and unique care challenges. Participants and their carers managed these pragmatically, obtaining technologies and adapting the home. Installed technologies were rarely fit for purpose. Support services for technologies made high (and sometimes oppressive) demands on users. Six principles emerged from the workshops. Quality telehealth or telecare is 1) ANCHORED in a shared understanding of what matters to the user; 2) REALISTIC about the natural history of illness; 3) CO-CREATIVE, evolving and adapting solutions with users; 4) HUMAN, supported through interpersonal relationships and social networks; 5) INTEGRATED, through attention to mutual awareness and knowledge sharing; 6) EVALUATED to drive system learning. Technological advances are important, but must be underpinned by industry and service providers following a user-centred approach to design and
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Langabeer, James R.; Gonzalez, Michael; Alqusairi, Diaa; Champagne-Langabeer, Tiffany; Jackson, Adria; Mikhail, Jennifer; Persse, David
2016-01-01
Introduction Emergency medical services (EMS) agencies transport a significant majority of patients with low acuity and non-emergent conditions to local emergency departments (ED), affecting the entire emergency care system’s capacity and performance. Opportunities exist for alternative models that integrate technology, telehealth, and more appropriately aligned patient navigation. While a limited number of programs have evolved recently, no empirical evidence exists for their efficacy. T...
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Telehealth technology: consequences for structure through use.
Cornford, T; Klecun-Dabrowska, E
2001-01-01
In recent years the focus of ICTs in healthcare has changed from the â back office' to the front end of patient care. These changes have been brought about by a number of factors including the potential of technologies, pressures for modernisation and administrative reforms, including blurring of the boundaries between different organisations (within and beyond the health sector), and which break down traditional barriers between administration of health services and the practice of medicine In this paper we explore in particular how technology is implicated in such changes, focussing on the consequences of the use of the new telehealth technologies, as seen in a set of linked case studies from an inner city borough in London. The paper addresses the way these technologies, through routine use, become (or not) resources and rules that embody new structures for health care.
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John, Sheila; Premila, M; Javed, Mohd; Vikas, G; Wagholikar, Amol
2015-01-01
To inform about a very unique and first of its kind telehealth pilot study in India that has provided virtual telehealth consultation to eye care patients in low resource at remote villages. Provision of Access to eye care services in remote population is always challenging due to pragmatic reasons. Advances in Telehealth technologies have provided an opportunity to improve access to remote population. However, current Telehealth technologies are limited to face-to-face video consultation only. We inform about a pilot study that illustrates real-time imaging access to ophthalmologists. Our innovative software led technology solution allowed screening of patients with varying ocular conditions. Eye camps were conducted in 2 districts in South India over a 12-month period in 2014. Total of 196 eye camps were conducted. Total of 19,634 patients attended the eye camps. Innovative software was used to conduct consultation with the ophthalmologist located in the city hospital. The software enabled virtual visit and allowed instant sharing of fundus camera images for assessment and diagnosis. About 71% of the patients were found to have Refractive Error problems, 15% of them were found to have cataract, 7% of the patients were diagnosed to have Retina problems and 7% of the patients were found to have other ocular diseases. The patients requiring cataract surgery were immediately transferred to city hospital for treatment. Software led assessment of fundus camera images assisted in identifying retinal eye diseases. Our real-time virtual visit software assisted in specialist care provision and illustrated a novel tele health solution for low resource population.
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Tabbara, Malek; Hodel, Thomas; Müller, Urs; Briner, Gabi; Zimmermann, Heinz; Exadaktylos, Aristomenis K
2012-01-01
Development of new personal mobile and wireless devices for healthcare has become essential due to our aging population characterized by constant rise in chronic diseases that consequently require a complex treatment and close monitoring. Personal telehealth devices allow patients to adequately receive their appropriate treatment, followup with their doctors, and report any emergency without the need of the presence of any caregivers with them thus increasing their quality of life in a cost-effective fashion. This paper includes a brief overview of personal telehealth systems, a survey of 100 consecutive ED patients aged >65 years, and introduces "Limmex" a new GSM based technology packaged in a wristwatch. Limmex can by a push of a button initiate multiple emergency call and establish mobile communication between the patient and a preselected person, institution, or a search and rescue service. To the best of our knowledge, Limmex is the first of its kind worldwide.
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Hepburn, Susan L.; Blakeley-Smith, Audrey; Wolff, Brian; Reaven, Judy A.
2016-01-01
Youth with autism spectrum disorders frequently experience significant symptoms of anxiety. Empirically supported psychosocial interventions exist, yet access is limited, especially for families in rural areas. Telehealth (i.e. videoconferencing) has potential to reduce barriers to access to care; however, little is known about the feasibility or…
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Directory of Open Access Journals (Sweden)
Malek Tabbara
2012-01-01
Full Text Available Development of new personal mobile and wireless devices for healthcare has become essential due to our aging population characterized by constant rise in chronic diseases that consequently require a complex treatment and close monitoring. Personal telehealth devices allow patients to adequately receive their appropriate treatment, followup with their doctors, and report any emergency without the need of the presence of any caregivers with them thus increasing their quality of life in a cost-effective fashion. This paper includes a brief overview of personal telehealth systems, a survey of 100 consecutive ED patients aged >65 years, and introduces “Limmex” a new GSM based technology packaged in a wristwatch. Limmex can by a push of a button initiate multiple emergency call and establish mobile communication between the patient and a preselected person, institution, or a search and rescue service. To the best of our knowledge, Limmex is the first of its kind worldwide.
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O'Cathain, Alicia; Drabble, Sarah J; Foster, Alexis; Horspool, Kimberley; Edwards, Louisa; Thomas, Clare; Salisbury, Chris
2016-06-30
Evidence of benefit for telehealth for chronic conditions is mixed. Two linked randomized controlled trials tested the Healthlines Service for 2 chronic conditions: depression and high risk of cardiovascular disease (CVD). This new telehealth service consisted of regular telephone calls from nonclinical, trained health advisers who followed standardized scripts generated by interactive software. Advisors facilitated self-management by supporting participants to use Web-based resources and helped to optimize medication, improve treatment adherence, and encourage healthier lifestyles. Participants were recruited from primary care. The trials identified moderate (for depression) or partial (for CVD risk) effectiveness of the Healthlines Service. An embedded qualitative study was undertaken to help explain the results of the 2 trials by exploring mechanisms of action, context, and implementation of the intervention. Qualitative interview study of 21 staff providing usual health care or involved in the intervention and 24 patients receiving the intervention. Interviewees described improved outcomes in some patients, which they attributed to the intervention, describing how components of the model on which the intervention was based helped to achieve benefits. Implementation of the intervention occurred largely as planned. However, contextual issues in patients' lives and some problems with implementation may have reduced the size of effect of the intervention. For depression, patients' lives and preferences affected engagement with the intervention: these largely working-age patients had busy and complex lives, which affected their ability to engage, and some patients preferred a therapist-based approach to the cognitive behavioral therapy on offer. For CVD risk, patients' motivations adversely affected the intervention whereby some patients joined the trial for general health improvement or from altruism, rather than motivation to make lifestyle changes to address
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Suess, Alyssa N.; Romani, Patrick W.; Wacker, David P.; Dyson, Shannon M.; Kuhle, Jennifer L.; Lee, John F.; Lindgren, Scott D.; Kopelman, Todd G.; Pelzel, Kelly E.; Waldron, Debra B.
2014-01-01
We conducted a retrospective, descriptive evaluation of the fidelity with which parents of three children with autism spectrum disorders conducted functional communication training (FCT) in their homes. All training was provided to the parents via telehealth by a behavior consultant in a tertiary-level hospital setting. FCT trials coached by the…
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A telehealth approach to conducting clinical swallowing evaluations in children with cerebral palsy.
Kantarcigil, Cagla; Sheppard, Justine Joan; Gordon, Andrew M; Friel, Kathleen M; Malandraki, Georgia A
2016-08-01
Accurate and timely evaluation of dysphagia in children with cerebral palsy (CP) is critical. For children with limited access to quality healthcare, telehealth is an option; however, its reliability needs to be investigated. To test the reliability of an asynchronous telehealth model for evaluating dysphagia in children with CP using a standardized clinical assessment. Nineteen children (age range 6.9-17.5) were assessed at three mealtimes via the Dysphagia Disorder Survey (DDS) by three clinicians (face-to-face evaluations). Mealtimes were video-recorded to allow asynchronous evaluations by a remote clinician who also completed approximately 1/3 of face-to-face evaluations. Agreement was tested on DDS variables and dysphagia severity. Results revealed substantial to excellent agreement between face-to-face and remote assessments by the same rater (78-100%, KW=0.64-1) on all, but two variables (oral transport and oral pharyngeal swallow) and by different raters (69-89%, KW=0.6-0.86) on all but one variable (orienting). For dysphagia severity, intrarater agreement was excellent (100%, KW=1); interrater agreement was substantial (85%; KW=0.76). Asynchronous clinical swallowing evaluations using standardized tools have acceptable levels of agreement with face-to-face evaluations, and can be an alternative for children with limited access to expert swallowing care. Copyright © 2016 Elsevier Ltd. All rights reserved.
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Malacarne, Mara; Gobbi, Giorgio; Pizzinelli, Paolo; Lesma, Alessandro; Castelli, Alberto; Lucini, Daniela; Pagani, Massimo
2009-01-01
Recent epidemiological evidence indicates that chronic degenerative diseases, notably cardiovascular, represent the major toll in terms of death and of impaired quality of life. Recent estimates indicate that a small increase in financial resources in a number of clinical cases may be sufficient to minimize the consequences of elevated cardiovascular risk per individual. The observation that lifestyle choices, and in particular increased physical exercise, might strongly impact cardiovascular risk, suggests a redesign of preventive strategies, based on the combination of pharmacological and behavioral interventions. Following our recent experience with the INteractive teleConsultation network for worldwide healthcAre Services (INCAS) system, we designed a simpler point-to-point telehealth infrastructure, to be employed in cardiovascular risk reduction programs, predicting a high level of acceptance from the population, at the cost of very limited investment. This model was tested on 181 subjects (ages 18-80 years) in the Italian mountain village of Esino Lario. These subjects underwent a screening test to evaluate arrhythmia and cardiometabolic risks (arrhythmias were found in 14% of subjects, systolic arterial pressure was observed in 43% of subjects above 140 mm Hg, diastolic arterial pressure in 31% above 90 mm Hg). This study demonstrates the feasibility of a scaled-down telehealth application particularly suited to cardiovascular prevention in remote areas, such as in mountain villages.
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Valdivieso, Bernardo; García-Sempere, Anibal; Sanfélix-Gimeno, Gabriel; Faubel, Raquel; Librero, Julian; Soriano, Elisa; Peiró, Salvador
2018-04-25
To assess the effect of home based telehealth or structured telephone support interventions with respect to usual care on quality of life, mortality and healthcare utilization in elderly high-risk multiple chronic condition patients. 472 elderly high-risk patients with plurimorbidity in the region of Valencia (Spain) were recruited between June 2012 and May 2013, and followed for 12 months from recruitment. Patients were allocated to either: (a) a structured telephone intervention, a nurse-led case management program with telephone follow up every 15 days; (b) telehealth, which adds technology for remote self-management and the exchange of clinical data; or (c) usual care. Main outcome measures was quality of life measured by the EuroQol (EQ-5D) instrument, cognitive impairment, functional status, mortality and healthcare resource use. Inadequate randomization process led us to used propensity scores for adjusted analyses to control for imbalances between groups at baseline. EQ-5D score was significantly higher in the telehealth group compared to usual care (diff: 0.19, 0.08-0.30), but was not different to telephone support (diff: 0.04, -0.05 to 0.14). In adjusted analyses, inclusion in the telehealth group was associated with an additional 0.18 points in the EQ-5D score compared to usual care at 12 months (p<0.001), and with a gain of 0.13 points for the telephone support group (p<0.001). No differences in mortality or utilization were found, except for a borderline significant increase in General Practitioner visits. Telehealth was associated with better quality of life. Important limitations of the study and similarity of effects to telephone intervention call for careful endorsement of telemedicine. Clinicaltrials.gov (identifier: NCT02447562). Copyright © 2018 Elsevier España, S.L.U. All rights reserved.
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Telehealth in older adults with cancer in the United States: The emerging use of wearable sensors.
Shen, John; Naeim, Arash
2017-11-01
As the aging and cancer populations in the world continue to increase, the need for complements to traditional geriatric assessments and the logical incorporation of fast and reliable telehealth tools have become interlinked. In the United States, studies examining the use of telehealth for chronic disease management have shown promising results in small groups. The implementation of health technology on a broader scale requires older adults to both accept and adapt such innovation into routine medical care. Though the commercial and recreational use of new technology has increased in older individuals, the transition into creating a smart and connected home that can interface with both patients and healthcare professionals is in its early phases. Current limitations include an inherent digital divide, as well as concerns regarding privacy, data volume, rapid change, cost and reimbursement. The emergence of low-cost, high-fidelity wearable sensors with a spectrum of clinical utility may be the key to increased use and adaptation by older adults. An opportunity to utilize wearable sensors for objective and real-time assessment of older patients with cancer for baseline functional status and treatment toxicity may be on the horizon. Copyright © 2017 Elsevier Inc. All rights reserved.
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Brennan-Jones, Christopher G; Eikelboom, Robert H; Swanepoel, De Wet
2017-02-01
Introduction Standard criteria exist for diagnosing different types of hearing loss, yet audiologists interpret audiograms manually. This pilot study examined the feasibility of standardised interpretations of audiometry in a telehealth model of care. The aim of this study was to examine diagnostic accuracy of automated audiometry in adults with hearing loss in an asynchronous telehealth model using pre-defined diagnostic protocols. Materials and methods We recruited 42 study participants from a public audiology and otolaryngology clinic in Perth, Western Australia. Manual audiometry was performed by an audiologist either before or after automated audiometry. Diagnostic protocols were applied asynchronously for normal hearing, disabling hearing loss, conductive hearing loss and unilateral hearing loss. Sensitivity and specificity analyses were conducted using a two-by-two matrix and Cohen's kappa was used to measure agreement. Results The overall sensitivity for the diagnostic criteria was 0.88 (range: 0.86-1) and overall specificity was 0.93 (range: 0.86-0.97). Overall kappa ( k) agreement was 'substantial' k = 0.80 (95% confidence interval (CI) 0.70-0.89) and significant at p loss. This method has the potential to improve synchronous and asynchronous tele-audiology service delivery.
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Simmons, Scott C.; Murphy, Timothy A.; Blanarovich, Adrian; Workman, Florence T.; Rosenthal, David A.; Carbone, Matthew
2003-01-01
Effective response to natural or man-made disasters (i.e., terrorism) is predicated on the ability to communicate among the many organizations involved. Disaster response exercises enable disaster planners and responders to test procedures and technologies and incorporate the lessons learned from past disasters or exercises. On May 31 and June 1, 2002, one such exercise event took place at the Camp Lejeune Marine Corps Base in Jacksonville, North Carolina. During the exercise, East Carolina University tested: (1) in-place Telehealth networks and (2) rapidly deployable communications, networking, and data collection technologies such as satellite communications, local wireless networking, on-scene video, and clinical and environmental data acquisition and telemetry. Exercise participants included local, county, state, and military emergency medical services (EMS), emergency management, specialized response units, and local fire and police units. The technologies and operations concepts tested at the exercise and recommendations for using telehealth to improve disaster response are described. PMID:12595406
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Daruwalla, Zubin Jimmy; Wong, Keng Lin; Thambiah, Joseph
2014-06-05
The application of telemedicine has been described for its use in medical training and education, management of stroke patients, urologic surgeries, pediatric laparoscopic surgeries, clinical outreach, and the field of orthopedics. However, the usefulness of a secure, mobile telehealth application, and messaging platform has not been well described. A pilot study was conducted to implement a health insurance portability and accountability act (HIPAA) compliant form of communication between doctors in an orthopedic clinical setting and determine their reactions to MyDoc, a secure, mobile telehealth application, and messaging platform. By replacing current methods of communication through various mobile applications and text messaging services with MyDoc over a six week period, we gained feedback and determined user satisfaction with this innovative system from questionnaires handed to the program director, program coordinator, one trauma consultant, all orthopedic residents, and six non-orthopedic residents at the National University Hospital in Singapore. Almost everyone who completed the questionnaire strongly agreed that MyDoc should replace current systems of peer to peer communication in the hospital. The majority also felt that the quality of images, videos, and sound were excellent. Almost everyone agreed that they could communicate easily with each other and would feel comfortable doing so routinely. The majority felt that virtual consults through MyDoc should be made available to inpatients as well as outpatients to potentially lessen clinic loads and provide a secure manner in which patients can communicate with their primary teams any time convenient to both. It was also agreed by most that the potential of telerounding had advantages, especially on weekends as a supplement to normal rounds. Potential uses of MyDoc in an orthopedic clinical setting include HIPAA-compliant peer to peer communication, clinical outreach in the setting of trauma, supervision
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Understanding Older People's Readiness for Receiving Telehealth: Mixed-Method Study.
van Houwelingen, Cornelis Tm; Ettema, Roelof Ga; Antonietti, Michelangelo Gef; Kort, Helianthe Sm
2018-04-06
The Dutch Ministry of Health has formulated ambitious goals concerning the use of telehealth, leading to subsequent changes compared with the current health care situation, in which 93% of care is delivered face-to-face. Since most care is delivered to older people, the prospect of telehealth raises the question of whether this population is ready for this new way of receiving care. To study this, we created a theoretical framework consisting of 6 factors associated with older people's intention to use technology. The objective of this study was to understand community-dwelling older people's readiness for receiving telehealth by studying their intention to use videoconferencing and capacities for using digital technology in daily life as indicators. A mixed-method triangulation design was used. First, a cross-sectional survey study was performed to investigate older people's intention to use videoconferencing, by testing our theoretical framework with a multilevel path analysis (phase 1). Second, for deeper understanding of older people's actual use of digital technology, qualitative observations of older people executing technological tasks (eg, on a computer, cell phone) were conducted at their homes (phase 2). In phase 1, a total of 256 people aged 65 years or older participated in the survey study (50.0% male; median age, 70 years; Q1-Q3: 67-76). Using a significance level of .05, we found seven significant associations regarding older people's perception of videoconferencing. Older people's (1) intention to use videoconferencing was predicted by their performance expectancy (odds ratio [OR] 1.26, 95% CI 1.13-1.39), effort expectancy (OR 1.23, 95% CI 1.07-1.39), and perceived privacy and security (OR 1.30, 95% CI 1.17-1.43); (2) their performance expectancy was predicted by their effort expectancy (OR 1.38, 95% CI 1.24-1.52); and (3) their effort expectancy was predicted by their self-efficacy (OR 1.55, 95% CI 1.42-1.68). In phase 2, a total of 6 men and 9
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Chiang, Li-Chi; Chen, Wan-Chou; Dai, Yu-Tzu; Ho, Yi-Lwun
2012-10-01
Telehealth care was developed to provide home-based monitoring and support for patients with chronic disease. The positive effects on physical outcome have been reported; however, more evidence is required concerning the effects on family caregivers and family function for heart failure patients transitioning from the hospital to home. To evaluate the effectiveness of nursing-led transitional care combining discharge plans and telehealth care on family caregiver burden, stress mastery and family function in family caregivers of heart failure patients compared to those receiving traditional discharge planning only. This is a quasi-experimental study design. Sixty-three patients with heart failure were assessed for eligibility and invited to participate in either telehealth care or standard care in a medical centre from May to October 2010. Three families refused to participate in data collection. Thirty families who chose telehealth care after discharge from the hospital to home comprised the experimental group; the others families receiving discharge planning only comprised the comparison group. Telenursing specialist provided the necessary family nursing interventions by 24-h remote monitoring of patients' health condition and counselling by telephone, helping the family caregivers successfully transition from hospital to home. Data on caregiver burden, stress mastery and family function were collected before discharge from the hospital and one month later at home. Effects of group, time, and group×time interaction were analysed using Mixed Model in SPSS (17.0). Family caregivers in both groups had significantly lower burden, higher stress mastery, and better family function at one-month follow-up compared to before discharge. The total score of caregiver burden, stress mastery and family function was significantly improved for the family caregivers in the experimental group compared to the comparison group at posttest. Two subscales of family function
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DEFF Research Database (Denmark)
Holm, Kristina Garne; Brødsgaard, Anne; Zachariassen, Gitte
2017-01-01
on the results obtained during the workshops and subsequent testing, we developed an application (app), which was integrated into the medical record at the neonatal unit. The app was used to initiate videoconferences and chat messages between the family at home and the neonatal unit, and to share information...... regarding infant growth and well-being. Conclusion: Results obtained from the workshops and testing demonstrated the importance of involving users when developing new telehealth applications. The workshops helped identify the challenges associated with delivery of the service, and helped instruct the design...
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Applying Evidence-Based Medicine in Telehealth: An Interactive Pattern Recognition Approximation
Directory of Open Access Journals (Sweden)
Carlos Fernández-Llatas
2013-10-01
Full Text Available Born in the early nineteen nineties, evidence-based medicine (EBM is a paradigm intended to promote the integration of biomedical evidence into the physicians daily practice. This paradigm requires the continuous study of diseases to provide the best scientific knowledge for supporting physicians in their diagnosis and treatments in a close way. Within this paradigm, usually, health experts create and publish clinical guidelines, which provide holistic guidance for the care for a certain disease. The creation of these clinical guidelines requires hard iterative processes in which each iteration supposes scientific progress in the knowledge of the disease. To perform this guidance through telehealth, the use of formal clinical guidelines will allow the building of care processes that can be interpreted and executed directly by computers. In addition, the formalization of clinical guidelines allows for the possibility to build automatic methods, using pattern recognition techniques, to estimate the proper models, as well as the mathematical models for optimizing the iterative cycle for the continuous improvement of the guidelines. However, to ensure the efficiency of the system, it is necessary to build a probabilistic model of the problem. In this paper, an interactive pattern recognition approach to support professionals in evidence-based medicine is formalized.
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Rutledge, Thomas; Atkinson, J Hampton; Holloway, Rachael; Chircop-Rollick, Tatiana; D'Andrea, John; Garfin, Steven R; Patel, Shetal; Penzien, Donald B; Wallace, Mark; Weickgenant, Anne L; Slater, Mark
2018-04-16
This study evaluated a nurse-delivered, telehealth intervention of cognitive behavioral therapy versus supportive psychotherapy for chronic back pain. Participants (N=61) had chronic back pain (pain "daily" ≥ 6 months at an intensity ≥4/10 scale) and were randomized to an 8-week, 12-session, Cognitive Behavioral Therapy (CBT) or to Supportive Care (SC) matched for frequency, format, and time, with each treatment delivered by a primary care nurse. The primary outcome was the Roland Morris Disability Questionnaire (RMDQ). Secondary outcomes included the Numerical Rating Scale (NRS) and the Patient Global Impressions Scale (CGI). CBT participants (n=30) showed significant improvements on the RMDQ (means=11.4[5.9] vs. 9.4[6.1] at baseline and post-treatment, respectively, p.10). The results suggest that telehealth, nurse-delivered CBT and SC treatments for chronic back pain can offer significant and relatively comparable benefits. ClinicalTrials.gov: NCT00608530. This article describes the benefits of training primary care nurses to deliver evidence-based behavioral therapies for low back pain. Due to the high prevalence of chronic pain and the growing emphasis on non-opioid therapies, training nurses to provide behavior therapies could be a cost-effective way to improve pain management. Copyright © 2018. Published by Elsevier Inc.
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Hobson, Esther V; Baird, Wendy O; Partridge, Rebecca; Cooper, Cindy L; Mawson, Susan; Quinn, Ann; Shaw, Pamela J; Walsh, Theresa; Wolstenholme, Daniel; Mcdermott, Christopher J
2018-08-01
Attendance at a specialist multidisciplinary motor neurone disease (MND) clinic is associated with improved survival and may also improve quality of life and reduce hospital admissions. However, patients struggle to travel to clinic and may experience difficulties between clinic visits that may not be addressed in a timely manner. We wanted to explore how we could improve access to specialist MND care. We adopted an iterative, user-centered co-design approach, collaborating with those with experience of providing and receiving MND care including patients, carers, clinicians, and technology developers. We explored the unmet needs of those living with MND, how they might be met through service redesign and through the use of digital technologies. We developed a new digital solution and performed initial testing with potential users including clinicians, patients, and carers. We used these findings to develop a telehealth system (TiM) using an Android app into which patients and carers answer a series of questions about their condition on a weekly basis. The questions aim to capture all the physical, emotional, and social difficulties associated with MND. This information is immediately uploaded to the internet for review by the MND team. The data undergoes analysis in order to alert clinicians to any changes in a patient or carer's condition. We describe the benefits of developing a novel digitally enabled service underpinned by participatory design. Future trials must evaluate the feasibility and acceptability of the TiM system within a clinical environment.
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Arduino Based Infant Monitoring System
Farhanah Mohamad Ishak, Daing Noor; Jamil, Muhammad Mahadi Abdul; Ambar, Radzi
2017-08-01
This paper proposes a system for monitoring infant in an incubator and records the relevant data into a computer. The data recorded by the system can be further referred by the neonatal intensive care unit (NICU) personnel for diagnostic or research purposes. The study focuses on designing the monitoring system that consists of an incubator equipped with humidity sensor to measure the humidity level, and a pulse sensor that can be attached on an infant placed inside the incubator to monitor infant’s heart pulse. The measurement results which are the pulse rate and humidity level are sent to the PC via Arduino microcontroller. The advantage of this system will be that in the future, it may also enable doctors to closely monitor the infant condition through local area network and internet. This work is aimed as an example of an application that contributes towards remote tele-health monitoring system.
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Thomaidis, P.
2014-01-01
This document conveys the results of the On-Site Customer Analytics and Reporting (OSCAR) project. This nine-month project started on January 2014 and was conducted at Philips Research in the Chronic Disease Management group as part of the H2H Analytics Project. Philips has access to telehealth data
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Mohan, Jai; Razali Raja Yaacob, Raja
2004-03-31
Telehealth refers to the integration of information, telecommunication, human-machine interface technologies and health technologies to deliver health care, to promote the heath status of the people and to create health. The Malaysian Telehealth Application will, on completion, provide every resident of the country an electronic Lifetime Health Record (LHR) and Lifetime Health Plan (LHP). He or she will also hold a smart card that will contain a subset of the data in the Lifetime Health Record. These will be the means by which Malaysians will receive "seamless continuous quality care" across a range of health facilities and health care providers, and by which Malaysia's health goal of a nation of "healthy individuals, families and communities" is achieved. The challenges to security and privacy in providing access to an electronic Lifetime Health Record at private and government health facilities and to the electronic Lifetime Health Plan at homes of consumers require not only technical mechanisms but also national policies and practices addressing threats while facilitating access to health data during health encounters in different care settings. Organisational policies establish the goals that technical mechanisms serve. They should outline appropriate uses and access to information, create mechanisms for preventing and detecting violations, and set sanctions for violations. Some interesting innovations have been used to address these issues against the background of the launching of the multimedia supercorridor (MSC) in Malaysia.
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Pickard, Katherine E.; Wainer, Allison L.; Bailey, Kathryn M.; Ingersoll, Brooke R.
2016-01-01
Research within the autism spectrum disorder field has called for the use of service delivery models that are able to more efficiently disseminate evidence-based practices into community settings. This study employed telehealth methods in order to deliver an Internet-based, parent training intervention for autism spectrum disorder, ImPACT Online.…
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Hung, Chi-Sheng; Lee, Jenkuang; Chen, Ying-Hsien; Huang, Ching-Chang; Wu, Vin-Cent; Wu, Hui-Wen; Chuang, Pao-Yu; Ho, Yi-Lwun
2018-01-24
Chronic kidney disease (CKD) is prevalent in Taiwan and it is associated with high all-cause mortality. We have shown in a previous paper that a fourth-generation telehealth program is associated with lower all-cause mortality compared to usual care with a hazard ratio of 0.866 (95% CI 0.837-0.896). This study aimed to evaluate the effect of renal function status on hospitalization among patients receiving this program and to evaluate the relationship between contract compliance rate to the program and risk of hospitalization in patients with CKD. We retrospectively analyzed 715 patients receiving the telehealth care program. Contract compliance rate was defined as the percentage of days covered by the telehealth service before hospitalization. Patients were stratified into three groups according to renal function status: (1) normal renal function, (2) CKD, or (3) end-stage renal disease (ESRD) and on maintenance dialysis. The outcome measurements were first cardiovascular and all-cause hospitalizations. The association between contract compliance rate, renal function status, and hospitalization risk was analyzed with a Cox proportional hazards model with time-dependent covariates. The median follow-up duration was 694 days (IQR 338-1163). Contract compliance rate had a triphasic relationship with cardiovascular and all-cause hospitalizations. Patients with low or very high contract compliance rates were associated with a higher risk of hospitalization. Patients with CKD or ESRD were also associated with a higher risk of hospitalization. Moreover, we observed a significant interaction between the effects of renal function status and contract compliance rate on the risk of hospitalization: patients with ESRD, who were on dialysis, had an increased risk of hospitalization at a lower contract compliance rate, compared with patients with normal renal function or CKD. Our study showed that there was a triphasic relationship between contract compliance rate to the
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A cross-platform solution for light field based 3D telemedicine.
Wang, Gengkun; Xiang, Wei; Pickering, Mark
2016-03-01
Current telehealth services are dominated by conventional 2D video conferencing systems, which are limited in their capabilities in providing a satisfactory communication experience due to the lack of realism. The "immersiveness" provided by 3D technologies has the potential to promote telehealth services to a wider range of applications. However, conventional stereoscopic 3D technologies are deficient in many aspects, including low resolution and the requirement for complicated multi-camera setup and calibration, and special glasses. The advent of light field (LF) photography enables us to record light rays in a single shot and provide glasses-free 3D display with continuous motion parallax in a wide viewing zone, which is ideally suited for 3D telehealth applications. As far as our literature review suggests, there have been no reports of 3D telemedicine systems using LF technology. In this paper, we propose a cross-platform solution for a LF-based 3D telemedicine system. Firstly, a novel system architecture based on LF technology is established, which is able to capture the LF of a patient, and provide an immersive 3D display at the doctor site. For 3D modeling, we further propose an algorithm which is able to convert the captured LF to a 3D model with a high level of detail. For the software implementation on different platforms (i.e., desktop, web-based and mobile phone platforms), a cross-platform solution is proposed. Demo applications have been developed for 2D/3D video conferencing, 3D model display and edit, blood pressure and heart rate monitoring, and patient data viewing functions. The demo software can be extended to multi-discipline telehealth applications, such as tele-dentistry, tele-wound and tele-psychiatry. The proposed 3D telemedicine solution has the potential to revolutionize next-generation telemedicine technologies by providing a high quality immersive tele-consultation experience. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.
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Alami, Hassane; Fortin, Jean-Paul; Gagnon, Marie-Pierre; Pollender, Hugo; Têtu, Bernard; Tanguay, France
2017-09-13
The Eastern Quebec Telepathology Network (EQTN) has been implemented in the province of Quebec (Canada) to support pathology and surgery practices in hospitals that are lack of pathologists, especially in rural and remote areas. This network includes 22 hospitals and serves a population of 1.7 million inhabitants spread over a vast territory. An evaluation of this network was conducted in order to identify and analyze the factors and issues associated with its implementation and deployment, as well as those related to its sustainability and expansion. Qualitative evaluative research based on a case study using: (1) historical analysis of the project documentation (newsletters, minutes of meetings, articles, ministerial documents, etc); (2) participation in meetings of the committee in charge of telehealth programs and the project; and (3) interviews, focus groups, and discussions with different stakeholders, including decision-makers, clinical and administrative project managers, clinicians (pathologists and surgeons), and technologists. Data from all these sources were cross-checked and synthesized through an integrative and interpretative process. The evaluation revealed numerous socio-political, regulatory, organizational, governance, clinical, professional, economic, legal and technological challenges related to the emergence and implementation of the project. In addition to technical considerations, the development of this network was associated with major changes and transformations of production procedures, delivery and organization of services, clinical practices, working methods, and clinicaladministrative processes and cultures (professional/organizational). The EQTN reflects the complex, structuring, and innovative projects that organizations and health systems are required to implement today. Future works should be more sensitive to the complexity associated with the emergence of telehealth networks and no longer reduce them to technological
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Clarke, M; Mars, M
2014-01-01
This article has been made available through the Brunel Open Access Publishing Fund. Abstract Background: We investigated the use of third-generation (3G) mobile communications to provide telehealth services in remote health clinics in rural KwaZulu-Natal, South Africa. Materials and Methods: We specified a minimal set of services as our use case that would be representative of typical activity and to provide a baseline for analysis of network performance. Services included database access...
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Relative risk of home hemodialysis attrition in patients using a telehealth platform.
Weinhandl, Eric D; Collins, Allan J
2017-12-06
Home hemodialysis (HHD) facilitates increased treatment frequency, which may improve patient outcomes. However, attrition due to technique failure limits the clinical effectiveness of the modality. Nx2me Connected Health is a telehealth platform that enables ongoing assessment of HHD patients using NxStage equipment, and that may reduce patient burden. We aimed to assess whether use of Nx2me was associated with risk of HHD attrition. We compared risks of all-cause attrition, dialysis cessation (i.e., death or transplant), and technique failure in Nx2me users and matched control patients, using a retrospective cohort study. We also compared the likelihood of HHD training graduation in patients who initiated use of Nx2me during training with the likelihood in matched control patients. Matching factors included date of HHD initiation, NxStage treatment duration at initiation of follow-up, and prescribed treatment frequency. We used stratified Fine-Gray and Cox regression to compare risks, with adjustment for demographic factors and vascular access modality, and stratification by matched cluster. We identified 606 Nx2me users; 49.5% initiated use of Nx2me in NxStage equipment. Adjusted hazard ratios (AHRs) of all-cause attrition, dialysis cessation, and technique failure were 0.80 (95% confidence interval, 0.68-0.95), 1.10 (0.86-1.41), and 0.71 (0.57-0.87), respectively, for Nx2me users vs. matched controls. AHRs were similar in patients who initiated use of Nx2me in <3 months after initiation of HHD. The AHR of HHD training graduation was 1.61 (1.10-2.36) in patients who initiated use of Nx2me within 2 weeks of training initiation vs. matched controls. Use of Nx2me was associated with lower risk of all-cause attrition, lower risk of technique failure, and higher likelihood of HHD training graduation. Further studies are needed to identify the mechanisms by which use of a telehealth platform may improve clinical outcomes and reduce patient burden. © 2017 The Authors
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Shaikh, U; Nettiksimmons, J; Joseph, JG; Tancredi, D; Romano, PS
2014-01-01
© 2013 by the American College of Medical Quality. This study assessed the impact of participation in a virtual quality improvement (QI) learning network on adherence to clinical guidelines for childhood obesity prevention in rural clinics. A total of 7 primary care clinics in rural California included in the Healthy Eating Active Living TeleHealth Community of Practice and 288 children seen in these clinics for well-child care participated in this prospective observational pre-post study. Cl...
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Directory of Open Access Journals (Sweden)
Angélica Baptista Silva
2012-01-01
Full Text Available Estudo de abordagem qualitativa sobre a concepção da política de telessaúde no Brasil baseado em modelos de avaliação em saúde e na análise de políticas públicas, mais especificamente na proposta analítica de múltiplos fluxos e no modelo lógico de avaliação de programas em saúde. As fontes de dados consistiram em documentos relacionados à criação da Rede Universitária de Telemedicina (Rute, artigos disponíveis na literatura sobre telessaúde e avaliação em saúde, atas e participações em reuniões de variados fóruns. O modelo de múltiplos fluxos se concentra nas fases iniciais do ciclo da política pública: a construção da agenda governamental e a escolha de alternativas de políticas. Buscou-se delinear a composição da Rute e responder quais condicionantes levaram os gestores federais de diversos setores a reconhecer a qualidade do sistema como problema na saúde pública e a escolha da implantação de programas de telessaúde como uma das alternativas para a solução. Os processos analisados demonstraram que, na convergência do fluxo de problemas com ambiente político favorável, abriu-se uma janela de oportunidade para a implantação da telessaúde como alternativa vir a ascender como política na agenda de decisão governamental. Porém, para isso, urge a necessidade de inclusão digital no território e identificar as tecnologias da informação e comunicação como inovação para o SUS.A qualitative study on the policy design of telehealth in Brazil based on valuation models in health and public policy analysis, specifically the proposed multiple streams of analytical and logical model for evaluating health programs. Data sources consisted of documents related to the creation of Telemedicine University Network (Rute, articles available in the literature on telehealth and health evaluation, minutes of meetings and participating in various forums. The model focuses multiple streams in the early stages of
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Cancela, Jorge; Fico, Giuseppe; Arredondo Waldmeyer, Maria T
2015-01-01
The assessment of a new health technology is a multidisciplinary and multidimensional process, which requires a complex analysis and the convergence of different stakeholders into a common decision. This task is even more delicate when the assessment is carried out in early stage of development processes, when the maturity of the technology prevents conducting a large scale trials to evaluate the cost effectiveness through classic health economics methods. This lack of information may limit the future development and deployment in the clinical practice. This work aims to 1) identify the most relevant user needs of a new medical technology for managing and monitoring Parkinson's Disease (PD) patients and to 2) use these user needs for a preliminary assessment of a specific system called PERFORM, as a case study. Analytic Hierarchy Process (AHP) was used to design a hierarchy of 17 needs, grouped into 5 categories. A total of 16 experts, 6 of them with a clinical background and the remaining 10 with a technical background, were asked to rank these needs and categories. On/Off fluctuations detection, Increase wearability acceptance, and Increase self-management support have been identified as the most relevant user needs. No significant differences were found between the clinician and technical groups. These results have been used to evaluate the PERFORM system and to identify future areas of improvement. First of all, the AHP contributed to the elaboration of a unified hierarchy, integrating the needs of a variety of stakeholders, promoting the discussion and the agreement into a common framework of evaluation. Moreover, the AHP effectively supported the user need elicitation as well as the assignment of different weights and priorities to each need and, consequently, it helped to define a framework for the assessment of telehealth systems for PD management and monitoring. This framework can be used to support the decision-making process for the adoption of new
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Design of a Real-Time and Continua-Based Framework for Care Guideline Recommendations
Directory of Open Access Journals (Sweden)
Yu-Feng Lin
2014-04-01
Full Text Available Telehealth is an important issue in the medical and healthcare domains. Although a number of systems have been developed to meet the demands of emerging telehealth services, the following problems still remain to be addressed: (1 most systems do not monitor/predict the vital signs states so that they are able to send alarms to caregivers in real-time; (2 most systems do not focus on reducing the amount of work that caregivers need to do, and provide patients with remote care; and (3 most systems do not recommend guidelines for caregivers. This study thus proposes a framework for a real-time and Continua-based Care Guideline Recommendation System (Cagurs which utilizes mobile device platforms to provide caregivers of chronic patients with real-time care guideline recommendations, and that enables vital signs data to be transmitted between different devices automatically, using the Continua standard. Moreover, the proposed system adopts the episode mining approach to monitor/predict anomalous conditions of patients, and then offers related recommended care guidelines to caregivers so that they can offer preventive care in a timely manner.
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The potential of telehealth for 'business as usual' in outpatient clinics.
Day, Karen; Kerr, Patricia
2012-04-01
A six-month pilot study was conducted to ascertain the value of using high-definition videoconferencing equipment in an outpatients' setting. The videoconferencing equipment, which included digital biometric equipment, was installed in the outpatient clinics of a remote health service in New Zealand. Use of the equipment was evaluated using action research techniques. Clinicians were interviewed about their assessment of the equipment's usefulness. Patients and their carers completed questionnaires about their clinic experience. During the pilot trial, 109 patients were seen in 25 clinics of six different specialities. Questionnaire results showed that patients and their companions had a good user experience, similar to a face-to-face appointment. Clinicians found that the large screen, sense of proximity, video clarity and definition, and lack of sound/picture lag worked well for certain types of outpatients' clinics, e.g. methadone maintenance clinics. The need for process changes made it difficult to turn telehealth into business as usual in an environment built for face-to-face appointments. We conclude that videoconference equipment has potential to become integral to outpatients' clinics.
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Proposed TFTR electrical system
International Nuclear Information System (INIS)
Bronner, G.; Murray, J.
1975-01-01
The development of controlled thermonuclear fusion has progressed to the stage where the present facilities and energy available for future devices are not sufficient and must be increased by about a factor of ten. This report describes the proposed TFTR ac utility power distribution system, an energy storage motor generator flywheel facility, and the rectifier conversion equipment for the Toroidal Field Confining System (TF), Ohmic Heating System (OH), Equilibrium Field System (EF) and the Neutral Beam Heating System (NB). The general requirements are described and the special design considerations identified
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African Journals Online (AJOL)
sciences regarding telehealth, as well as their views on suitable content areas for a telehealth module. A descriptive survey .... The mean square contingency coefficient, the ..... participate, and the small sample size, representing less than 50% of medical staff ... and demonstrations by companies selling telehealth systems.
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Differential Impact and Use of a Telehealth Intervention by Persons with MS or SCI.
Mercier, Hannah W; Ni, Pensheng; Houlihan, Bethlyn V; Jette, Alan M
2015-11-01
The objective of this study was to compare outcomes and patterns of engaging with a telehealth intervention (CareCall) by adult wheelchair users with severe mobility limitations with a diagnosis of multiple sclerosis (MS) or spinal cord injury (SCI). The design of this study is a secondary analysis from a pilot randomized controlled trial with 106 participants with SCI and 36 participants with MS. General linear model results showed that an interaction between baseline depression score and study group significantly predicted reduced depression at 6 mos for subjects with both diagnoses (P = 0.01). For those with MS, CareCall increased participants' physical independence (P SCI (P = 0.005). Those with SCI missed more calls (P SCI, and in increasing health care access and physical independence for those with a diagnosis of MS. Future research should aim to enhance the efficacy of such an intervention for participants with SCI.
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Higgins, William J; Luczynski, Kevin C; Carroll, Regina A; Fisher, Wayne W; Mudford, Oliver C
2017-04-01
Recent advancements in telecommunication technologies make it possible to conduct a variety of healthcare services remotely (e.g., behavioral-analytic intervention services), thereby bridging the gap between qualified providers and consumers in isolated locations. In this study, web-based telehealth technologies were used to remotely train direct-care staff to conduct a multiple-stimulus-without-replacement preference assessment. The training package included three components: (a) a multimedia presentation; (b) descriptive feedback from previously recorded baseline sessions; and (c) scripted role-play with immediate feedback. A nonconcurrent, multiple-baseline-across-participants design was used to demonstrate experimental control. Training resulted in robust and immediate improvements, and these effects maintained during 1- to 2-month follow-up observations. In addition, participants expressed high satisfaction with the web-based materials and the overall remote-training experience. © 2017 Society for the Experimental Analysis of Behavior.
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Telehealth solutions to enable global collaboration in rheumatic heart disease screening.
Lopes, Eduardo Lv; Beaton, Andrea Z; Nascimento, Bruno R; Tompsett, Alison; Dos Santos, Julia Pa; Perlman, Lindsay; Diamantino, Adriana C; Oliveira, Kaciane Kb; Oliveira, Cassio M; Nunes, Maria do Carmo P; Bonisson, Leonardo; Ribeiro, Antônio Lp; Sable, Craig
2018-02-01
Background The global burden of rheumatic heart disease is nearly 33 million people. Telemedicine, using cloud-server technology, provides an ideal solution for sharing images performed by non-physicians with cardiologists who are experts in rheumatic heart disease. Objective We describe our experience in using telemedicine to support a large rheumatic heart disease outreach screening programme in the Brazilian state of Minas Gerais. Methods The Programa de Rastreamento da Valvopatia Reumática (PROVAR) is a prospective cross-sectional study aimed at gathering epidemiological data on the burden of rheumatic heart disease in Minas Gerais and testing of a non-expert, telemedicine-supported model of outreach rheumatic heart disease screening. The primary goal is to enable expert support of remote rheumatic heart disease outreach through cloud-based sharing of echocardiographic images between Minas Gerais and Washington. Secondary goals include (a) developing and sharing online training modules for non-physicians in echocardiography performance and interpretation and (b) utilising a secure web-based system to share clinical and research data. Results PROVAR included 4615 studies that were performed by non-experts at 21 schools and shared via cloud-telemedicine technology. Latent rheumatic heart disease was found in 251 subjects (4.2% of subjects: 3.7% borderline and 0.5% definite disease). Of the studies, 50% were preformed on full functional echocardiography machines and transmitted via Digital Imaging and Communications in Medicine (DICOM) and 50% were performed on handheld echocardiography machines and transferred via a secure Dropbox connection. The average time between study performance date and interpretation was 10 days. There was 100% success in initial image transfer. Less than 1% of studies performed by non-experts could not be interpreted. Discussion A sustainable, low-cost telehealth model, using task-shifting with non-medical personal in low and middle
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Gas system proposal for the LHCb muon system
Hahn, F; Lindner, R
2001-01-01
This document describes the gas system proposed for the LHCb Muon system, following the Gas Working Group mandate to ensure the uniform approach to gas technology and controls across the LHC detectors. Standard technical design modules are employed as fas as possible, in order to minimise design overheads and long term support costs.
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Morony, Suzanne; Weir, Kristie; Duncan, Gregory; Biggs, Janice; Nutbeam, Don; Mccaffery, Kirsten J
2018-03-07
Telehealth professionals require advanced communication skills, in part to compensate for lack of visual cues. Teach-Back is a best practice communication technique that has been recommended but not previously evaluated for consumer telehealth. We aimed to implement Teach-Back at a national maternal and child health telephone helpline. We describe the intervention and report telenurse experiences learning to use Teach-Back. We identified barriers (time, knowledge, skills, beliefs) and enablers (self-reflection) to using Teach-Back, and developed a novel training program to address these, guided by the Theoretical Domains Framework. We engaged maternal and child health telenurses to participate in a "communication skills" study. The intervention had two key components: guided self-reflection and a Teach-Back skills workshop. For the duration of the 7-week study nurses completed brief online surveys following each call, reflecting on both the effectiveness of their communication and perceived caller understanding. At the end of each shift they reflected on what worked well. Teach-Back knowledge, skills, and beliefs were addressed in a 2-h workshop using videos, discussion, and role play. We explored nurses' experiences of the intervention in focus groups and interviews; and analysed transcripts and comments from the self-reflection surveys using the Framework method. This study forms part of a larger evaluation conducted in 2016. In total 16 nurses participated: 15 were trained in Teach-Back, and 13 participated in focus groups or interviews. All engaged with both self-reflection and Teach-Back, although to differing extents. Those who reported acquiring Teach-Back skills easily limited themselves to one or two Teach-Back phrases. Nurses reported that actively self-reflecting (including on what they did well) was useful both for developing Teach-Back skills and analysing effectiveness of the techniques. Most wanted more opportunity to learn how their colleagues
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78 FR 54660 - Agency Information Collection Activities; Proposed Collection; Public Comment Request
2013-09-05
... efficiency; and improve patient outcomes. In each of these categories, specific indicators were designed to be reported through a performance monitoring Web site. Likely Respondents: Telehealth Network... quality, utility, and clarity of the information to be collected, and (4) the use of automated collection...
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Supporting work practices through telehealth: impact on nurses in peripheral regions
Directory of Open Access Journals (Sweden)
Courcy François
2011-02-01
Full Text Available Abstract Background In Canada, workforce shortages in the health care sector constrain the ability of the health care system to meet the needs of its population and of its health care professionals. This issue is of particular importance in peripheral regions of Quebec, where significant inequalities in workforce distribution between regions has lead to acute nursing shortages and increased workloads. Information and communication technologies (ICTs are innovative solutions that can be used to develop strategies to optimise the use of available resources and to design new nursing work practices. However, current knowledge is still limited about the real impact of ICTs on nursing recruitment and retention. Our aim is to better understand how work practice reorganization, supported by ICTs, and particularly by telehealth, may influence professional, educational, and organizational factors relating to Quebec nurses, notably those working in peripheral regions. Methods/Design First, we will conduct a descriptive study on the issue of nursing recruitment. Stratified sampling will be used to select approximately twenty innovative projects relating to the reorganization of work practices based upon ICTs. Semi-structured interviews with key informants will determine professional, educational, and organizational recruitment factors. The results will be used to create a questionnaire which, using a convenience sampling method, will be mailed to 600 third year students and recent graduates of two Quebec university nursing faculties. Descriptive, correlation, and hierarchical regression analyses will be performed to identify factors influencing nursing graduates' intentions to practice in peripheral regions. Secondly, we will conduct five case studies pertaining to the issue of nursing retention. Five ICT projects in semi-urban, rural, and isolated regions have been identified. Qualitative data will be collected through field observation and approximately
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[The Telehealth Network of the Americas and its role in primary health care].
Bill, Guillermo; Crisci, Carlos D; Canet, Tomislav
2014-01-01
The need to guarantee equitable access to health regardless of geographic, economic, or technological barriers motivated the Member States of the Organization of American States to create the Telehealth Network of the Americas, coordinated by the Inter-American Telecommunication Committee. The Network focuses on the use of new information and communications technology applied to health, based on the values of respect, equity, and solidarity and mandated by the philosophy of primary health. Its members include government agencies, nongovernmental organizations, university forums, hospital federations, and telecommunications companies, and it has already extended its reach to other continents and to different fields in which telemedicine is being used. Among its first achievements, it has implemented an innovative tool to be used in cases of disaster or limited geographic access. This mobile telemedicine station is housed in a portable case that includes a computer, various digital devices (otoscope, ophthalmoscope, microscope, dermatoscope), a high-resolution digital camera, an X-ray film viewer, and a satellite antenna. With this tool, it is possible to provide specialized support for rural physicians and primary health care workers located far from large urban centers.
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Marsh, Aaron G
2008-10-01
Senator Barack Obama, the Democratic candidate for president, and Senator Joe Biden, the party's candidate for vice president, have made health care reform a central pillar of their campaign. The Democrats want to target the 12 percent of Americans who are responsible for 69 percent of health care costs. Such individuals generally have multiple and complex health care problems, which if left untreated, require them to seek care in hospital emergency rooms which are vastly overcrowded. In order to solve the problem, they believe first that universal coverage along the lines of the Federal Government Employees' health plan is necessary, followed by a shift away from institutionally-based care, making home and community-based care, which integrates telehealth and other technologies, the norm. The party's platform includes this committment to help solve the problem of long-term care, which affects not only the nation's 35 million elderly, but increasingly will affect the 78 million baby boomers who are entering their retirement years.
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Burridge, Jane H; Lee, Alan Chong W; Turk, Ruth; Stokes, Maria; Whitall, Jill; Vaidyanathan, Ravi; Clatworthy, Phil; Hughes, Ann-Marie; Meagher, Claire; Franco, Enrico; Yardley, Lucy
2017-07-01
Stroke, predominantly a condition of older age, is a major cause of acquired disability in the global population and puts an increasing burden on health care resources. Clear evidence for the importance of intensity of therapy in optimizing functional outcomes is found in animal models, supported by neuroimaging and behavioral research, and strengthened by recent meta-analyses from multiple clinical trials. However, providing intensive therapy using conventional treatment paradigms is expensive and sometimes not feasible because of social and environmental factors. This article addresses the need for cost-effective increased intensity of practice and suggests potential benefits of telehealth (TH) as an innovative model of care in physical therapy. We provide an overview of TH and present evidence that a web-supported program, used in conjunction with constraint-induced therapy (CIT), can increase intensity and adherence to a rehabilitation regimen. The design and feasibility testing of this web-based program, "LifeCIT," is presented. We describe how wearable sensors can monitor activity and provide feedback to patients and therapists. The methodology for the development of a wearable device with embedded inertial and mechanomyographic sensors, algorithms to classify functional movement, and a graphical user interface to present meaningful data to patients to support a home exercise program is explained. We propose that wearable sensor technologies and TH programs have the potential to provide most-effective, intensive, home-based stroke rehabilitation.
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New Directions in the NOAO Observing Proposal System
Gasson, David; Bell, Dave
For the past eight years NOAO has been refining its on-line observing proposal system. Virtually all related processes are now handled electronically. Members of the astronomical community can submit proposals through email, web form, or via the Gemini Phase I Tool. NOAO staff can use the system to do administrative tasks, scheduling, and compilation of various statistics. In addition, all information relevant to the TAC process is made available on-line, including the proposals themselves (in HTML, PDF and PostScript) and technical comments. Grades and TAC comments are entered and edited through web forms, and can be sorted and filtered according to specified criteria. Current developments include a move away from proprietary solutions, toward open standards such as SQL (in the form of the MySQL relational database system), Perl, PHP and XML.
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Kantarcigil, Cagla; Malandraki, Georgia A
2017-08-01
The need for developing effective telehealth tools for dysphagia management is high not only for people who live in rural areas, but also for individuals with mobility/access limitations. We aimed to develop an electronic case History Tool/form (thereafter, e-HiT) for dysphagia, and compare its effectiveness with its paper-based version (PBV) on completion time, completeness, independence, and patient perceptions/satisfaction. Secondarily, we examined associations between the aforementioned variables and predictor variables, such as age, cognition, and computer/internet use. Forty adults who expressed concerns with eating/swallowing participated. To compare both versions, a randomized, controlled two-period crossover design was used. In Visit 1, Group A completed the e-HiT and Group B completed the PBV. In Visit 2, Group A completed the PBV and Group B completed the e-HiT. A satisfaction survey was completed post visits. There were no statistically significant differences for completion time (p = 0.743), completeness (p = 0.486), and independence (p = 0.738). Patient perception/satisfaction was significantly higher with the e-HiT (p = 0.004). In addition, a significant association was found between completion time and age (p = 0.0063). Our results indicate that completing the e-HiT is as time efficient as completing the PBV and that both forms elicit the same amount of information with no or minimal support. Also, completion of the e-HiT yielded significantly higher satisfaction responses. This is the first study documenting the effectiveness of the e-HiT for outpatients with dysphagia, providing evidence that the first step of a swallowing assessment-case history completion-can be effectively completed via telehealth by individuals with reliable internet connection and basic computer literacy skills.
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Scott, John Carver
1991-01-01
During the course of recent years the frequency and magnitude of major disasters - of natural, technological, or ecological origin - have made the world community dramatically aware of the immense losses of human life and economic resources that are caused regularly by such calamities. Particularly hard hit are developing countries, for whom the magnitude of disasters frequently outstrips the ability of the society to cope with them. In many cases this situation can be prevented, and the recent trend in disaster management has been to emphasize the importance of preparedness and mitigation as a means of prevention. In cases of disaster, a system is needed to respond to relief requirements, particularly the delivery of medical care. There is no generic telecommunications infrastructure appropriate for the variety of applications in medical care and disaster management. The need to integrate telemedicine/telehealth into shared regional disaster management telecommunications networks is discussed. Focus is on the development of infrastructure designed to serve the needs of disaster prone regions of the developing world.
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A Telehealth System for Remote Auditory Evoked Potential Monitoring
Millan, Jorge; Yunda, Leonardo
2013-01-01
A portable, Internet-based EEG/Auditory Evoked Potential (AEP) monitoring system was developed for remote electrophysiological studies during sleep. The system records EEG/AEP simultaneously at the subject?s home for increased comfort and flexibility. The system provides simultaneous recording and remote viewing of EEG, EMG and EOG waves and allows on-line averaging of auditory evoked potentials. The design allows the recording of all major AEP components (brainstem, middle and late latency E...
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Curriculum Online Review System: Proposing Curriculum with Collaboration
Rhinehart, Marilyn; Barlow, Rhonda; Shafer, Stu; Hassur, Debby
2009-01-01
The Curriculum Online Review System (CORS) at Johnson County Community College (JCCC) uses SharePoint as a Web platform for the JCCC Curriculum Proposals Process. The CORS application manages proposals throughout the approval process using collaboration tools and workflows to notify all stakeholders. This innovative new program has changed the way…
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Evidence-based Practice. Findings from the Section on Education and Consumer Health Informatics.
Staccini, P; Douali, N
2013-01-01
To provide an overview of outstanding current research conducted in Education and Consumer Informatics. Synopsis of the articles on education and consumer health informatics published in 2012 and selected for the IMIA Yearbook of Medical Informatics 2013. Architecture of monitoring or telehealth information systems for patients with chronic disease must include wireless devices to aid in the collection of personal data. Data acquisition technologies have an impact on patients' willingness to participate in telehealth programmes. Patients are more likely to prefer mobile applications over web-based applications. Social media is widely used by clinicians. Especially younger clinicians use it for personal purposes and for reference materials retrieval. Questions remain on optimal training requirements and on the effects on clinician behavior and on patient outcomes. A high level of e-Health literacy by patients will promote increased adoption and utilization of personal health records. The selected articles highlight the need for training of clinicians to become aware of existing telehealth systems, in order to correctly inform and guide patients to take part in telehealth systems and adopt personal healthcare records (PHR).
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Liu, Winnie; Saxon, David R; McNair, Bryan; Sanagorski, Rebecca; Rasouli, Neda
2016-09-01
Rates of diabetes for veterans who receive health care through the Veterans Health Administration are higher than rates in the general population. Furthermore, many veterans live in rural locations, far from Veterans Affairs (VA) hospitals, thus limiting their ability to readily seek face-to-face endocrinology care for diabetes. Telehealth (TH) technologies present an opportunity to improve access to specialty diabetes care for such patients; however, there is a lack of evidence regarding the ability of TH to improve glycemic control in comparison to traditional face-to-face consultations. This was a retrospective cohort study of all new endocrinology diabetes consultations at the Denver VA Medical Center over a 1-year period. A total of 189 patients were included in the analysis. In all, 85 patients had received face-to-face (FTF) endocrinology consultation for diabetes and 104 patients had received TH consultation. Subjects were mostly males (94.7%) and the mean age was 62.8 ± 10.1 years old. HbA1c improved from 9.76% (9.40% to 10.11%) to 8.55% (8.20% to 8.91%) (P Endocrinology TH consultations improved short-term glycemic control as effectively as traditional FTF visits in a veteran population with diabetes. © 2016 Diabetes Technology Society.
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A proposed neutron spectrometer system for JET
International Nuclear Information System (INIS)
Elevant, T.; Hellbom, G.; Scheffel, J.; Malmskog, S.
1979-12-01
A neutron spectrometer system is proposed primarily for measurements of ion temperature and density and ion beam energy distribution in extended fusion plasmas like e.g. in JET. Three different spectrometers are involved: time of flight, proton recoil and 3 He. Energy resolutions of a few percent both for DD and DT neutrons are provided. Six order of magnitudes in flux ranges will be covered by the system when employing multi-target systems. A neutron collimator and shielding system will be desirable in order to obtain relevant information. Due to the entire differences in energy and fluxes for DD and DT plasmas a flexible collimator-shielding system is recommended
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Proposed tokamak poloidal field system development program
Energy Technology Data Exchange (ETDEWEB)
Rogers, J.D.; Vogel, H.F.; Warren, R.W.; Weldon, D.M.
1977-05-01
A program is proposed to develop poloidal field components for TNS and EPR size tokamak devices and to test these components in realistic circuits. Emphasis is placed upon the development of the most difficult component, the superconducting ohmic-heating coil. Switches must also be developed for testing the coils, and this switching technology is to be extended to meet the requirements for the large scale tokamaks. Test facilities are discussed; power supplies, including a homopolar to drive the coils, are considered; and poloidal field systems studies are proposed.
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Propose Reactor Control and Monitoring System for RTP
International Nuclear Information System (INIS)
Mohd Sabri Minhat; Izhar Abu Hussin; Mohd Idris Taib; Mohd Khairulezwan Abdul Manan; Nurfarhana Ayuni Joha
2011-01-01
Reactor control and monitoring system is a one of the important features used in reactor. The control and monitoring must come together to provide safety, excellent performance and reliable in nuclear reactor technology application. Objectives of this technical paper are to design and propose reactor control system and reactor monitoring system in Research Reactor (RTP) for Reactor Upgrading Project. (author)
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Evaluation and proposal of improvement for the measurement system in ATLAS
International Nuclear Information System (INIS)
Cho, Dong Woo; Kim, Jong Rok; Park, Jun Kwon
2007-03-01
The project independently evaluated the validities and reliability of measurement system in ATLAS, then proposed plans to improve the measurement system from evaluated results. For this objectives, we evaluated the design, technical backgrounds, verifying data of measurement system in ATLAS. From this evaluation, we proposed plans for improvement on parts which need improvement
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Proposing a Process-Oriented Systems Research for Systems Thinking Development
Directory of Open Access Journals (Sweden)
Jae Eon Yu
2017-04-01
Full Text Available This paper discusses systems thinking development from Churchman’s systems ideas related to critical systems practice that appreciates the use of systems methods from sociolinguistic perspectives and poststructuralist thought. Systems research enabled us to understand and reinterpret Churchman’s philosophy and systems approach through the works of Deleuze and Foucault. Based upon the interpretation of Churchman’s philosophy and systems approach, I propose ‘process-oriented systems research’ developed from the use of social appreciative process and Churchman’s metasystem approach. By applying a metasystem approach into practice, I basically appreciate Deleuzian ethics and Foucault’s theory of discourse in order to deal with issues of power and knowledge, and metaethics or moral epistemology, where the meaning of good or bad is discussed. A detailed account of an application of process-oriented systems research is given to demonstrate how I use systems methods to examine the usefulness of the systems research in practice.
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Benefit analysis of proposed information systems
Besore, Mark H.
1991-01-01
Approved for public release; distribution is unlimited This thesis reviewed two different approaches to benefit analysis, benefit comparison and user satisfaction, that could be applied to the evaluation of proposed information systems which are under consideration for acquisition by the federal government. Currently the General Services Administration only recommends that present value analysis methods be used in the analysis of alternatives even though the GSA specifies...
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Development and innovation of system resources to optimize patient care.
Johnson, Thomas J; Brownlee, Michael J
2018-04-01
Various incremental and disruptive healthcare innovations that are occurring or may occur are discussed, with insights on how multihospital health systems can prepare for the future and optimize the continuity of patient care provided. Innovation in patient care is occurring at an ever-increasing rate, and this is especially true relative to the transition of patients through the care continuum. Health systems must leverage their ability to standardize and develop electronic health record (EHR) systems and other infrastructure necessary to support patient care and optimize outcomes; examples include 3D printing of patient-specific medication dosage forms to enhance precision medicine, the use of drones for medication delivery, and the expansion of telehealth capabilities to improve patient access to the services of pharmacists and other healthcare team members. Disruptive innovations in pharmacy services and delivery will alter how medications are prescribed and delivered to patients now and in the future. Further, technology may also fundamentally alter how and where pharmacists and pharmacy technicians care for patients. This article explores the various innovations that are occurring and that will likely occur in the future, particularly as they apply to multihospital health systems and patient continuity of care. Pharmacy departments that anticipate and are prepared to adapt to incremental and disruptive innovations can demonstrate value in the multihospital health system through strategies such as optimizing the EHR, identifying telehealth opportunities, supporting infrastructure, and integrating services. Copyright © 2018 by the American Society of Health-System Pharmacists, Inc. All rights reserved.
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A proposed data base system for detection, classification and ...
African Journals Online (AJOL)
A proposed data base system for detection, classification and location of fault on electricity company of Ghana electrical distribution system. Isaac Owusu-Nyarko, Mensah-Ananoo Eugine. Abstract. No Abstract. Keywords: database, classification of fault, power, distribution system, SCADA, ECG. Full Text: EMAIL FULL TEXT ...
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Reforming EIA systems: A critical review of proposals in Brazil
Energy Technology Data Exchange (ETDEWEB)
Fonseca, Alberto, E-mail: albertof@em.ufop.br [Federal University of Ouro Preto, Minas Gerais (Brazil); Sánchez, Luis Enrique [University of São Paulo, São Paulo (Brazil); Ribeiro, José Claudio Junqueira [Escola Superior Dom Helder Câmara, Belo Horizonte, Minas Gerais (Brazil)
2017-01-15
Environmental Impact Assessment (EIA) systems are under pressure in many countries, driven by a call for efficiency and streamlining. Such a phenomenon is particularly clear in Brazil, where, in the past few years, a number of influential associations put forward documents proposing significant changes to environmental licensing and impact assessment regulations. So far, there is no publicly available information about any initiative towards scrutinizing those proposals. The objective of this study was to critically review the merits and drawbacks of the changes proposed in those documents. The analysis triangulated content analysis, focus group and online survey data. The focus group included ten seasoned Brazilian EIA specialists; the survey, based on Likert-scale and open-ended questions, resulted in 322 valid responses from EIA professionals. Results show that the proposals generally agree that the current EIA system, while playing a key role in mitigating impacts and enhancing project design, needs many changes. Nonetheless, the proposals neither offered solutions to overcome political, technical and budget barriers, nor established a sense of priority of the most urgent issues. Findings from the focus group and the survey signaled that a number of proposed actions might face public outcry, and that those changes that do not depend on legislative action are more likely to be implementable. Previous studies about EIA reform focused mostly on the context of developed countries after changes had taken place. This study, while addressing the perspective of a large developing country in a “before-reform” stage, shows that capacity-building is a key requirement in EIA reform. - Highlights: • Brazil's EIA system is under strong pressure for change. • Findings corroborate ineffectiveness in current system. • There are tensions as to the best approaches to overcome problems. • Exact effects of proposals are uncertain. • Low institutional capacity can
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Proposal for a level 0 calorimeter trigger system for LHCb
Bertin, A; Capponi, M; D'Antone, I; De Castro, S; Donà, R; Galli, D; Giacobbe, B; Marconi, U; Massa, I; Piccinini, M; Poli, M; Semprini-Cesari, N; Spighi, R; Vecchi, S; Villa, M; Vitale, A; Zoccoli, A; Zoccoli, Antonio
1999-01-01
In this note we present a complete system for the Level-0 LHCb calorimeter triggers. The system is derived from the electromagnetic calorimeter pre-trigger developed for the HERA-B experiment. The proposed system follows closely the Level-0 trigger algorithms presented in the LHCb Technical Proposal based on an electromagnetic and hadronic showers analysis performed on 3x3 calorimeter matrix. The general architecture presented is completely synchronous and quite flexible to allow adaptation to further improvements on the Level-0 trigger algorithms.
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A post-Bertalanffy Systemics Healthcare Competitive Framework Proposal.
Fiorini, Rodolfo A; Santacroce, Giulia F
2014-01-01
Health Information community can take advantage of a new evolutive categorization cybernetic framework. A systemic concept of principles organizing nature is proposed. It can be used as a multiscaling reference framework to develop successful and competitive antifragile system and new HRO information management strategies in advanced healthcare organization (HO) and high reliability organization (HRO) conveniently. Expected impacts are multifarious and quite articulated at different system scale level: major one is that, for the first time, Biomedical Engineering ideal system categorization levels can be matched exactly to practical system modeling interaction styles, with no paradigmatic operational ambiguity and information loss.
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Home telemonitoring of vital signs--technical challenges and future directions.
Celler, Branko G; Sparks, Ross S
2015-01-01
The telemonitoring of vital signs from the home is an essential element of telehealth services for the management of patients with chronic conditions, such as congestive heart failure (CHF), chronic obstructive pulmonary disease (COPD), diabetes, or poorly controlled hypertension. Telehealth is now being deployed widely in both rural and urban settings, and in this paper, we discuss the contribution made by biomedical instrumentation, user interfaces, and automated risk stratification algorithms in developing a clinical diagnostic quality longitudinal health record at home. We identify technical challenges in the acquisition of high-quality biometric signals from unsupervised patients at home, identify new technical solutions and user interfaces, and propose new measurement modalities and signal processing techniques for increasing the quality and value of vital signs monitoring at home. We also discuss use of vital signs data for the automated risk stratification of patients, so that clinical resources can be targeted to those most at risk of unscheduled admission to hospital. New research is also proposed to integrate primary care, hospital, personal genomic, and telehealth electronic health records, and apply predictive analytics and data mining for enhancing clinical decision support.
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Proposal and Implementation of SSH Client System Using Ajax
Kosuda, Yusuke; Sasaki, Ryoichi
Technology called Ajax gives web applications the functionality and operability of desktop applications. In this study, we propose and implement a Secure Shell (SSH) client system using Ajax, independent of the OS or Java execution environment. In this system, SSH packets are generated on a web browser by using JavaScript and a web server works as a proxy in communication with an SSH server to realize end-to-end SSH communication. We implemented a prototype program and confirmed by experiment that it runs on several web browsers and mobile phones. This system has enabled secure SSH communication from a PC at an Internet cafe or any mobile phone. By measuring the processing performance, we verified satisfactory performance for emergency use, although the speed was unsatisfactory in some cases with mobile phone. The system proposed in this study will be effective in various fields of E-Business.
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A Proposed Method for Solving Fuzzy System of Linear Equations
Directory of Open Access Journals (Sweden)
Reza Kargar
2014-01-01
Full Text Available This paper proposes a new method for solving fuzzy system of linear equations with crisp coefficients matrix and fuzzy or interval right hand side. Some conditions for the existence of a fuzzy or interval solution of m×n linear system are derived and also a practical algorithm is introduced in detail. The method is based on linear programming problem. Finally the applicability of the proposed method is illustrated by some numerical examples.
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76 FR 7239 - Proposed Privacy Act Systems of Records
2011-02-09
... property interests, identity theft or fraud, or harm to the security or integrity of this system or other... notice of a proposed system of records entitled, ``Treasury/DO .225 --TARP Fraud Investigation...: Supervisory Fraud Specialist, Office of Financial Stability, 1500 Pennsylvania Avenue, NW., Washington, DC...
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Borthakur, Debanjan; Dubey, Harishchandra; Constant, Nicholas; Mahler, Leslie; Mankodiya, Kunal
2017-01-01
The increasing use of wearables in smart telehealth generates heterogeneous medical big data. Cloud and fog services process these data for assisting clinical procedures. IoT based ehealthcare have greatly benefited from efficient data processing. This paper proposed and evaluated use of low resource machine learning on Fog devices kept close to the wearables for smart healthcare. In state of the art telecare systems, the signal processing and machine learning modules are deployed in the clou...
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Cook, Erica J; Randhawa, Gurch; Sharp, Chloe; Ali, Nasreen; Guppy, Andy; Barton, Garry; Bateman, Andrew; Crawford-White, Jane
2016-04-19
There is a political drive in the UK to use assistive technologies such as telehealth and telecare as an innovative and efficient approach to healthcare delivery. However, the success of implementation of such services remains dependent on the ability to engage the wider population to adopt these services. It has been widely acknowledged that low acceptance of technology, forms a key barrier to adoption although findings been mixed. Further, it remains unclear what, if any barriers exist between patients and how these compare to those who have declined or withdrawn from using these technologies. This research aims to address this gap focusing on the UK based Cambridgeshire Community Services Assistive Telehealth and Telecare service, an integrated model of telehealth and telecare. Qualitative semi-structured interviews were conducted between 1st February 2014 and 1st December 2014, to explore the views and experiences of 'users' and 'non-users' using this service. 'Users' were defined as patients who used the service (N = 28) with 'non-users' defined as either referred patients who had declined the service before allocation (N = 3) or had withdrawn after using the ATT service (N = 9). Data were analysed using the Framework Method. This study revealed that there are a range of barriers and facilitators that impact on the decision to adopt and continue to engage with this type of service. Having a positive attitude and a perceived need that could be met by the ATT equipment were influential factors in the decision to adopt and engage in using the service. Engagement of the service centred on 'usability', 'usefulness of equipment', and 'threat to identity and independence'. The paper described the influential role of referrers in decision-making and the need to engage with such agencies on a strategic level. The findings also revealed that reassurance from the onset was paramount to continued engagement, particularly in older patients who appeared to have more
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Experimental performance study of a proposed desiccant based air conditioning system.
Bassuoni, M M
2014-01-01
An experimental investigation on the performance of a proposed hybrid desiccant based air conditioning system referred as HDBAC is introduced in this paper. HDBAC is mainly consisted of a liquid desiccant dehumidification unit integrated with a vapor compression system (VCS). The VCS unit has a cooling capacity of 5.27 kW and uses 134a as refrigerant. Calcium chloride (CaCl2) solution is used as the working desiccant material. HDBAC system is used to serve low sensible heat factor applications. The effect of different parameters such as, process air flow rate, desiccant solution flow rate, evaporator box and condenser box solution temperatures, strong solution concentration and regeneration temperature on the performance of the system is studied. The performance of the system is evaluated using some parameters such as: the coefficient of performance (COPa), specific moisture removal and energy saving percentage. A remarkable increase of about 54% in the coefficient of performance of the proposed system over VCS with reheat is achieved. A maximum overall energy saving of about 46% is observed which emphasizes the use of the proposed system as an energy efficient air conditioning system.
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Application of superconducting coils to VAR control in electric power systems: a proposal
International Nuclear Information System (INIS)
Boenig, H.J.; Hassenzahl, W.V.
1979-11-01
During the last eight years, static VAR-control systems with thyristor-controlled, room-temperature reactors have been used in electrical systems for voltage control and system stabilization. In this proposal, we describe a new static VAR-control system that uses an asymmetrically controlled Graetz bridge and a superconducting dc coil. Preliminary studies indicate that the proposed system will have lower overall losses and that its capital cost and electrical characteristics are comparable to those of a conventional system. Three- and four-year programs for developing the electronic circuitry and superconducting coils for VAR control, culminating in the installation and testing of an approx. 40-MVAR system, are proposed
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A proposal of criteria for the classification of systemic sclerosis.
Nadashkevich, Oleg; Davis, Paul; Fritzler, Marvin J
2004-11-01
Sensitive and specific criteria for the classification of systemic sclerosis are required by clinicians and investigators to achieve higher quality clinical studies and approaches to therapy. A clinical study of systemic sclerosis patients in Europe and Canada led to a set of criteria that achieve high sensitivity and specificity. Both clinical and laboratory investigations of patients with systemic sclerosis, related conditions and diseases with clinical features that can be mistaken as part of the systemic sclerosis spectrum were undertaken. Laboratory investigations included the detection of autoantibodies to centromere proteins, Scl-70 (topoisomerase I), and fibrillarin (U3-RNP). Based on the investigation of 269 systemic sclerosis patients and 720 patients presenting with related and confounding conditions, the following set of criteria for the classification of systemic sclerosis was proposed: 1) autoantibodies to: centromere proteins, Scl-70 (topo I), fibrillarin; 2) bibasilar pulmonary fibrosis; 3) contractures of the digital joints or prayer sign; 4) dermal thickening proximal to the wrists; 5) calcinosis cutis; 6) Raynaud's phenomenon; 7) esophageal distal hypomotility or reflux-esophagitis; 8) sclerodactyly or non-pitting digital edema; 9) teleangiectasias. The classification of definite SSc requires at least three of the above criteria. Criteria for the classification of systemic sclerosis have been proposed. Preliminary testing has defined the sensitivity and specificity of these criteria as high as 99% and 100%, respectively. Testing and validation of the proposed criteria by other clinical centers is required.
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Data Storing Proposal from Heterogeneous Systems into a Specialized Repository
Directory of Open Access Journals (Sweden)
Václavová Andrea
2016-12-01
Full Text Available The aim of this paper is to analyze and to propose an appropriate system for processing and simultaneously storing a vast volume of structured and unstructured data. The paper consists of three parts. The first part addresses the issue of structured and unstructured data. The second part provides the detailed analysis of data repositories and subsequent evaluation indicating which system would be for the given type and volume of data optimal. The third part focuses on the use of gathered information to transfer data to the proposed repository.
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Proposed differential-frequency-readout system by hysteretic Josephson junctions
International Nuclear Information System (INIS)
Wang, L.Z.; Duncan, R.V.
1992-01-01
The Josephson relation V=nhν/2e has been verified experimentally to 3 parts in 10 19 [A. K. Jain, J. E. Lukens, and J.-S. Tsai, Phys. Rev. Lett. 58, 1165 (1987)]. Motivated by this result, we propose a differential-frequency-readout system by two sets of hysteretic Josephson junctions rf biased at millimeter wavelengths. Because of the Josephson relation, the proposed differential-frequency-readout system is not limited by photon fluctuation, which limits most photon-detection schemes. In the context of the Stewart-McCumber model [W. C. Stewart, Appl. Phys. Lett. 12, 277 (1968); D. E. McCumber, J. Appl. Phys. 39, 3113 (1968)] of Josephson junctions, we show theoretically that the differential frequency of the two milliwave biases can be read out by the proposed system to unprecedented accuracy. The stability of the readout scheme is also discussed. The measurement uncertainty of the readout system resulting from the intrinsic thermal noise in the hysteretic junctions is shown to be insignificant. The study of two single junctions can be extended to two sets of Josephson junctions connected in series (series array) in this measurement scheme provided that junctions are separated by at least 10 μm [D. W. Jillie, J. E. Lukens, and Y. H. Kao, Phys. Rev. Lett. 38, 915 (1977)]. The sensitivity for the differential frequency detection may be increased by biasing both series arrays to a higher constant-voltage step
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Woo, Christine; Seton, Jacinta M; Washington, Monique; Tomlinson, Suk C; Phrasavath, Douangmala; Farrell, Karen R; Goldstein, Barry
2016-01-01
A spinal cord injury disease management protocol (SCI DMP) was developed to address the unique medical, physical, functional, and psychosocial needs of those living with spinal cord injuries and disorders (SCI/D). The SCI DMP was piloted to evaluate DMP clinical content and to identify issues for broader implementation across the Veterans Affairs (VA) SCI System of Care. Thirty-three patients with SCI/D from four VA SCI centers participated in a 6-month pilot. Patients received customized SCI DMP questions through a data messaging device (DMD). Nurse home telehealth care coordinators (HTCC) monitored responses and addressed clinical alerts daily. One site administered the Duke Severity of Illness (DUSOI) Checklist and Short Form-8 (SF-8™) to evaluate the changes in comorbidity severity and health-related quality of life while on the SCI DMP. Patients remained enrolled an average of 116 days, with a mean response rate of 56%. The average distance between patient's home and their VA SCI center was 59 miles. Feedback on SCI DMP content and the DMD included requests for additional clinical topics, changes in administration frequency, and adapting the DMD for functional impairments. Improvement in clinical outcomes was seen in a subset of patients enrolled on the SCI DMP. SCI HTCCs and patients reported that the program was most beneficial for newly injured patients recently discharged from acute rehabilitation that live far from specialty SCI care facilities. SCI DMP content changes and broader implementation strategies are currently being evaluated based on lessons learned from the pilot.
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Referral system in rural Iran: improvement proposals
Directory of Open Access Journals (Sweden)
Mansour Naseriasl
2018-03-01
Full Text Available Because of insufficient communication between primary health care providers and specialists, which leads to inefficiencies and ineffectiveness in rural population health outcomes, to implement a well-functioning referral system is one of the most important tasks for some countries. Using purposive and snowballing sampling methods, we included health experts, policy-makers, family physicians, clinical specialists, and experts from health insurance organizations in this study according to pre-determined criteria. We recorded all interviews, transcribed and analyzed their content using qualitative methods. We extracted 1,522 individual codes initially. We also collected supplementary data through document review. From reviews and summarizations, four main themes, ten subthemes, and 24 issues emerged from the data. The solutions developed were: care system reform, education system reform, payment system reform, and improves in culture-building and public education. Given the executive experience, the full familiarity, the occupational and geographical diversity of participants, the solutions proposed in this study could positively affect the implementation and improvement of the referral system in Iran. The suggested solutions are complementary to each other and have less interchangeability.
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A Proposed RTN Officer Performance Evaluation System
1989-12-01
Taa& No. WokI Unlit Acca ~def 11¶. TITLE (biclde Securiy ClassifiCation) A PROPOSED ROYAL THAI NAVY OFIICER PERFORM NCE EVALUATION SYSTEM 12. PERSONAL...all aspects of performance into account , the commanding officer uses his opinion to decide who is "the best." There are no standard guidelines for...ftequently used in orgunsadozn as a bais for adminiardstive decisions such as employee promotion., tuufer, and allocation of financial reward; employee
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Proposal for a district heat supply system
International Nuclear Information System (INIS)
Alefeld, G.
1976-01-01
A district heating scheme is proposed which makes it possible to use the waste heat from power stations for the supply of households and industry. The heat is stored by evaporation of ammonia salts or liquids with dissolved salts. Both substances are transported on existing rail- or waterways to heating stations near the consumers, and the heat recovered by reaction of the two components. Then the product of reaction is transported back to the power stations, and reactivated by heat again. Based on a cost estimation, it can be shown that the proposed heat transport with heat trains or ships, at distances up to 100 km, results in heat costs which are to-day already below that of heat from fuel oil. The investment required for the heat transport system is unusually low due to the use of transport ways which already exist. The district heating system is not only favourable in respect of the environment, but actually reduces its present strain, both at the consumer and at the power stations. The technical advantages of the suggested concept, especially the possibility of introducing it in stages, are discussed. The consequences for the national economy regarding the safety of supply and the trade balance, as well as for the public transport undertakings, are obvious, and therefore not included in the paper. (orig.) [de
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A proposed phase equilibrium diagram for Pt-Zr system
International Nuclear Information System (INIS)
Arias, D.E.; Gribaudo, L.
1993-01-01
A revision of the phase diagram of the Pt-Zr system is presented using up to date information from recent publications. The proposed change concerning the invariant transformation in the Pt-rich zone is supported by simplified thermodynamic evaluations. (author). 12 refs., 1 fig
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A Proposal for an Integrated TDC for the ALICE TOF System
Earle, W E; CERN. Geneva; Hazen, E; Miller, J P
1994-01-01
An architecture for an integrated Time-to-Digital (TDC) converter is proposed in this note for a Time-of-Flight (TOF) system, used as the Particle Identification Device (PID) of the ALICE experiment. The proposed 16-channel, 25 ps resolution ASIC chip-set is described, suitable for high-density, on-detector mounting of the required Å 169 k channels.
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Proposal for a new staging system for osteoradionecrosis of the mandible
Karagozoglu, K.H.; Dekker, H.; Rietveld, D.H.F.; de Bree, R.; Schulten, E.A.J.M.; Kantola, S.; Forouzanfar, T.; van der Waal, I.
2014-01-01
The presented staging system seems well reproducible, facilitating the comparison of study groups dealing with the various issues of osteoradionecrosis of the mandible. It is yet to be evaluated whether the presently proposed staging system is useful for management purposes.
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Proposal for Construction/Demonstration/Implementation of A Material Handling System
International Nuclear Information System (INIS)
Jim Jnatt
2001-01-01
Vortec Corporation, the United States Enrichment Corporation (USEC) and DOE/Paducah propose to complete the technology demonstration and the implementation of the Material Handling System developed under Contract Number DE-AC21-92MC29120. The demonstration testing and operational implementation will be done at the Paducah Gaseous Diffusion Plant. The scope of work, schedule and cost for the activities are included in this proposal. A description of the facility to be constructed and tested is provided in Exhibit 1, attached. The USEC proposal for implementation at Paducah is presented in Exhibit 2, and the commitment letters from the site are included in Exhibit 3. Under our agreements with USEC, Bechtel Jacobs Corporation and DOE/Paducah, Vortec will be responsible for the construction of the demonstration facility as documented in the engineering design package submitted under Phase 4 of this contract on August 9, 2001. USEC will have responsibility for the demonstration testing and commercial implementation of the plant. The demonstration testing and initial commercial implementation of the technology will be achieved by means of a USEC work authorization task with the Bechtel Jacobs Corporation. The initial processing activities will include the processing of approximately 4,250 drums of LLW. Subsequent processing of LLW and TSCA/LLW will be done under a separate contract or work authorization task. To meet the schedule for commercial implementation, it is important that the execution of the Phase 4 project option for construction of the demonstration system be executed as soon as possible. The schedule we have presented herein assumes initiation of the construction phase by the end of September 2001. Vortec proposes to complete construction of the demonstration test system for an estimated cost of $3,254,422. This price is based on the design submitted to DOE/NETL under the Phase 4 engineering design deliverable (9 august 2001). The cost is subject to the
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A mobile network-based multimedia teleconference system for homecare services.
Zhang, Zhaomin; He, Aiguo; Wei, Daming
2008-03-01
Because most research and development for homecare services have focused on providing connections between home and service centers, the goal of the present work is to develop techniques and create realtime communications to connect service centers and homecare workers in mobile environments. A key technical issue for this research is how to overcome the limitation of bandwidth in mobile media and networks. An effort has been made to balance performance of communication and basic demands in telehealth through optimized system design and technical implementation. Implementations using third generation (3G) Freedom Of Mobile multimedia Access (FOMA) and Personal Handyphone System (PHS) were developed and evaluated. We conclude that the system we developed based on 3G FOMA provides sufficient and satisfactory functions for use in homecare services.
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Proposal of programming standards for a computerized protection system
International Nuclear Information System (INIS)
Ehrenberger, W.; Voges, U.
1975-05-01
In process computer systems with high safety and reliability requirements, correctness of the software has to be proved. During the development of a program specific guidelines should be met in order to facilitate the verification of its correctness. This paper is a collection of relevant proposals. (orig.) [de
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Proposed advanced satellite applications utilizing space nuclear power systems
International Nuclear Information System (INIS)
Bailey, P.G.; Isenberg, L.
1990-01-01
A review of the status of space nuclear reactor systems and their possible applications is presented. Such systems have been developed over the past twenty years and are capable of use in various military and civilian applications in the 5-1000 kWe power range. The capabilities and limitations of the currently proposed nuclear reactor systems are summarized. Safety issues are shown to be identified, and if properly addressed should not pose a hindrance. Applications are summarized for the federal and civilian community. These applications include both low and high altitude satellite surveillance missions, communications satellites, planetary probes, low and high power lunar and planetary base power systems, broad-band global telecommunications, air traffic control, and high-definition television
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Proposed data acquisition system for the Fermilab Booster
International Nuclear Information System (INIS)
Bharadwaj, V.; Peggs, S.; Wu, G.; Saltmarsh, C.
1991-01-01
At present, studies involving the FNAL Booster (or in fact most accelerators) depend on knowing exactly what detector one has to look at and at what time. Because of this, most studies are done 'on-line' and involve looking for repetitive effects using a limited number of detectors. In this paper the authors propose to design a Booster Data Acquisition System (BDAQ) for the FNAL Booster. In essence this system consists of a large number of digitizers with circular memory buffers. After a machine cycle of interest, these buffers are frozen and then read out into a mass storage device. This paper discusses the hardware and software capabilities needed to make such a data acquisition system a powerful tool for doing accelerator physics studies and improving machine performance
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Study protocol: home-based telehealth stroke care: a randomized trial for veterans
Directory of Open Access Journals (Sweden)
McGee-Hernandez Nancy
2010-06-01
Full Text Available Abstract Background Stroke is one of the most disabling and costly impairments of adulthood in the United States. Stroke patients clearly benefit from intensive inpatient care, but due to the high cost, there is considerable interest in implementing interventions to reduce hospital lengths of stay. Early discharge rehabilitation programs require coordinated, well-organized home-based rehabilitation, yet lack of sufficient information about the home setting impedes successful rehabilitation. This trial examines a multifaceted telerehabilitation (TR intervention that uses telehealth technology to simultaneously evaluate the home environment, assess the patient's mobility skills, initiate rehabilitative treatment, prescribe exercises tailored for stroke patients and provide periodic goal oriented reassessment, feedback and encouragement. Methods We describe an ongoing Phase II, 2-arm, 3-site randomized controlled trial (RCT that determines primarily the effect of TR on physical function and secondarily the effect on disability, falls-related self-efficacy, and patient satisfaction. Fifty participants with a diagnosis of ischemic or hemorrhagic stroke will be randomly assigned to one of two groups: (a TR; or (b Usual Care. The TR intervention uses a combination of three videotaped visits and five telephone calls, an in-home messaging device, and additional telephonic contact as needed over a 3-month study period, to provide a progressive rehabilitative intervention with a treatment goal of safe functional mobility of the individual within an accessible home environment. Dependent variables will be measured at baseline, 3-, and 6-months and analyzed with a linear mixed-effects model across all time points. Discussion For patients recovering from stroke, the use of TR to provide home assessments and follow-up training in prescribed equipment has the potential to effectively supplement existing home health services, assist transition to home and
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Proposals for enhanced health risk assessment and stratification in an integrated care scenario
Dueñas-Espín, Ivan; Vela, Emili; Pauws, Steffen; Bescos, Cristina; Cano, Isaac; Cleries, Montserrat; Contel, Joan Carles; de Manuel Keenoy, Esteban; Garcia-Aymerich, Judith; Gomez-Cabrero, David; Kaye, Rachelle; Lahr, Maarten M H; Lluch-Ariet, Magí; Moharra, Montserrat; Monterde, David; Mora, Joana; Nalin, Marco; Pavlickova, Andrea; Piera, Jordi; Ponce, Sara; Santaeugenia, Sebastià; Schonenberg, Helen; Störk, Stefan; Tegner, Jesper; Velickovski, Filip; Westerteicher, Christoph; Roca, Josep
2016-01-01
Objectives Population-based health risk assessment and stratification are considered highly relevant for large-scale implementation of integrated care by facilitating services design and case identification. The principal objective of the study was to analyse five health-risk assessment strategies and health indicators used in the five regions participating in the Advancing Care Coordination and Telehealth Deployment (ACT) programme (http://www.act-programme.eu). The second purpose was to elaborate on strategies toward enhanced health risk predictive modelling in the clinical scenario. Settings The five ACT regions: Scotland (UK), Basque Country (ES), Catalonia (ES), Lombardy (I) and Groningen (NL). Participants Responsible teams for regional data management in the five ACT regions. Primary and secondary outcome measures We characterised and compared risk assessment strategies among ACT regions by analysing operational health risk predictive modelling tools for population-based stratification, as well as available health indicators at regional level. The analysis of the risk assessment tool deployed in Catalonia in 2015 (GMAs, Adjusted Morbidity Groups) was used as a basis to propose how population-based analytics could contribute to clinical risk prediction. Results There was consensus on the need for a population health approach to generate health risk predictive modelling. However, this strategy was fully in place only in two ACT regions: Basque Country and Catalonia. We found marked differences among regions in health risk predictive modelling tools and health indicators, and identified key factors constraining their comparability. The research proposes means to overcome current limitations and the use of population-based health risk prediction for enhanced clinical risk assessment. Conclusions The results indicate the need for further efforts to improve both comparability and flexibility of current population-based health risk predictive modelling approaches
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A proposal for off-grid photovoltaic systems with non-controllable loads using fuzzy logic
International Nuclear Information System (INIS)
Yahyaoui, Imene; Sallem, Souhir; Kamoun, M.B.A.; Tadeo, Fernando
2014-01-01
Highlights: • An energy management system is proposed for off-grid PV systems, based on fuzzy logic. • The proposal guarantees the energy balance and battery protection. • The approach is demonstrated using data measured at the target location. - Abstract: A fuzzy-logic based methodology is proposed and evaluated for energy management in off-grid installations with photovoltaic panels as the source of energy and a limited storage capacity in batteries. The decision on the connection or disconnection of components is based on fuzzy rules on the basis of the Photovoltaic Panel Generation measurement, the measured power required by the load, and the estimation of the stored energy in the batteries (this last is obtained from the estimation of the Depth-of-Discharge). The algorithm aims to ensure the system’s autonomy by controlling the switches linking the system components with respect to a multi-objective management criterion developed from the requirements (supply of the load, protection of the battery, etc.). Detailed tests of the proposed system are carried out using data (irradiation, temperature, power consumption, etc.) measured in a household at the target area at several days of the year. The results demonstrate that the proposed approach achieves the objectives of system autonomy, battery protection and power supply stability. Compared with a basic algorithm, the proposed algorithm is not sensitive to sudden changes in atmospheric parameters and avoids overcharging the battery
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Directory of Open Access Journals (Sweden)
Fernando B
2012-11-01
Full Text Available Annmarie Ruston,1 Alison Smith,1 Bernard Fernando21Centre for Health and Social Care Research, Faculty of Health and Social Care, Canterbury Christ Church University, Chatham Maritime, United Kingdom; 2Thames Avenue Surgery, Rainham, United KingdomPurpose: Diabetes represents one of the greatest health challenges facing the UK. Telehealth is seen to have the potential to revolutionize health care provision by improving access for patients with chronic disease, reducing health care costs, and improving efficiency. There have been many trials of telehealth in the UK but these have typically failed to become part of routine health care, particularly for diabetics. Program design and implementation has not been grounded in an understanding about the ways in which patients manage their disease and perceive these new technologies. This study addresses this gap by gaining an understanding of the perceptions of patients with type 1 diabetes about how telehealth could be used as part of their health care.Patients and methods: Thirty-two people with type 1 diabetes were recruited from a database of insulin pump users, and in-depth telephone interviews were undertaken, tape recorded, and transcribed. Analysis was conducted using a constant comparative approach.Results: Although respondents used technology as part of their diabetes self-management, they considered that the use of telehealth, as part of their health care, was potentially of limited value. Three themes emerged from their discourses: (1 a need to be in control of their disease themselves and a lack of trust of health care professionals in this process; (2 the belief that the National Health Service routine IT systems were unable to support telehealth; and (3 the belief that face-to-face communication was vital in providing them with high-quality care.Conclusion: Telehealth is considered to be revolutionizing health care and shifting power between patients and health professionals; however
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Magnetic System for the CLAS12 Proposal
International Nuclear Information System (INIS)
Statera, Marco; Contalbrigo, Marco M.; Pappalardo, Luciano Libero; Barion, Luca; Bertelli, S.; Ciullo, Giuseppe; Lenisa, Paolo
2013-01-01
The conceptual design of a magnetic system for an experiment to measure the transverse spin effects in semi-inclusive Deep Inelastic Scattering (SIDIS) at 11 GeV with a transversely polarized target using the CLAS12 detector at Jefferson Lab is presented. A proposal has been submitted to study spin azimuthal asymmetries in SIDIS using an 11-GeV polarized electron beam from the upgraded CEBAF facility and the CLAS12 detector equipped with a transversely polarized target. The main focus of the experiment will be the measurement of transverse target single and double spin asymmetries in the reaction ep↑ -> ehX, where e is an electron, p↑ is transversely polarized proton, h is a meson (e.g., a pion or a kaon) and X is the undetected final state. The details of the conceptual design of the shielding magnetic system and transverse dipole are reported
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Enhance Criminal Investigation by Proposed Fingerprint Recognition System
International Nuclear Information System (INIS)
Hashem, S.H.; Maolod, A.T.; Mohammad, A.A.
2014-01-01
Law enforcement officers and forensic specialists spend hours thinking about how fingerprints solve crimes, and trying to find, collect, record and compare these unique identifiers that can connect a specific person to a specific crime. These individuals understand that a basic human feature that most people take for granted, can be one of the most effective tools in crime solving.This research exploits our previous work to be applicable in criminal investigation field. The present study aims to solve the advance crime by strength fingerprint’s criminal investigation to control the alterations happen intentionally to criminals’ fingerprint. That done by suggest strategy introduce an optimal fingerprint image feature’s vector to the person and then considers it to be stored in database for future matching. Selecting optimal fingerprint feature’s vector strategy deal with considering 10 fingerprints for each criminal person (take the fingerprint in different time and different circumstance of criminal such as finger is dirty, wet, trembling, etc.). Proposal begun with apply a proposed enrollment on all 10 fingerprint for each criminal, the enrollment include the following consequence steps; begin with preprocessing step for each of 10 images including enhancement, then two level of feature extraction (first level to extract arches, whorls, and loops, where second level extract minutiae), after that applying proposed Genetic Algorithm to select optimal fingerprint, master fingerprint, which in our point of view present the most universal image which include more detailed features to recognition. Master fingerprint will be feature’s vector which stored in database. Then apply the proposed matching by testing fingerprints with these stored in database.While, measuring of criminal fingerprint investigation performance by calculating False Reject Rate (FRR)and False Accept Rate (FAR) for the traditional system and the proposed in criminal detection field. The
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Energy Technology Data Exchange (ETDEWEB)
Kataoka, N.; Koizumi, H.; Shimizu, H. [Mitsubishi Electric Power Corp., Tokyo (Japan)
1998-03-01
Conventional host-based central-processing type logistics information systems collect all information about stocked products (sales results, inventory, out-of-stock items) on a single host computer, and based on this information perform ordering, shipping, receiving, and other processing. In a client/server architecture, the system is not simply downsized: in order to ensure more effective use of logistics information and closer coordination with manufacturing information systems, the logistics information system must be configured as a distributed system specific to a given factory and its various products. Such distributed systems each function acts independently, but at the same time the overall system of which they is part must operate in harmony to perform cost optimization, adjust allocation of resources among different factories and business locations, and present a single monolithic interface to retailers and sales agents. In this paper, we propose a logistics information system with a distributed architecture as well as agents whose role is to coordinate operation of the overall system, as one means of realizing this combination of component autonomy and overall system harmony. The methodology proposed here was applied to a proving system, and its effectiveness was verified. 9 refs., 12 figs.
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A constructive critique to the ICRP's system and counter proposal
International Nuclear Information System (INIS)
Katoh, K.
1998-01-01
In the author's opinion, there is a need for continuous efforts in revising the systems of radiation protection designed and operated according to ICRP recommendations. The fundamentals of the ICRP system of radiation protection are analyzed and classified into scientific and political or strategic features. Several proposals for changes are presented, concerning the restoration of the causality relation for radiation protection, the criteria for safety controlling, and the methodology of exposure control. (A.K.)
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Proposal of Integrated Safety Assessment Methodology for Embedded System
International Nuclear Information System (INIS)
Sun, Wei; Kageyama, Makoto; Kanemoto, Shigeru
2011-01-01
To do risk analysis and risk evaluation for complicated safety critical embedded systems, there are three things should be paid a good attention: 1) an efficient and integrated model expression of embedded systems: 2) systematic risk analysis based on integrated system model: 3) quantitative risk evaluation for software and hardware integrated system. In this paper, taken electric water boiler as a target system, a proposal of risk analysis and risk evaluation for the embedded system is presented to meet these three purposes. In risk analysis, MFM is used and FT is generated automatically from MFM following some rules: And in risk evaluation, GO-FLOW is used to evaluate the reliability of sensors. And furthermore, FIT is applied to evaluate the safety software logic based on the diversity design concept. Although the electric water boiler is a simple example, it includes the key components of the embedded system like sensors, actuators, and software component. So, the process of modeling, analysis, and evaluation could be applied to other kinds of complicated embedded systems
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A Proposed Business Intelligent Framework for Recommender Systems
Directory of Open Access Journals (Sweden)
Sitalakshmi Venkatraman
2017-11-01
Full Text Available In this Internet age, recommender systems (RS have become popular, offering new opportunities and challenges to the business world. With a continuous increase in global competition, e-businesses, information portals, social networks and more, websites are required to become more user-centric and rely on the presence and role of RS in assisting users in better decision making. However, with continuous changes in user interests and consumer behavior patterns that are influenced by easy access to vast information and social factors, raising the quality of recommendations has become a challenge for recommender systems. There is a pressing need for exploring hybrid models of the five main types of RS, namely collaborative, demographic, utility, content and knowledge based approaches along with advancements in Big Data (BD to become more context-aware of the technology and social changes and to behave intelligently. There is a gap in literature with a research focus in this direction. This paper takes a step to address this by exploring a new paradigm of applying business intelligence (BI concepts to RS for intelligently responding to user changes and business complexities. A BI based framework adopting a hybrid methodology for RS is proposed with a focus on enhancing the RS performance. Such a business intelligent recommender system (BIRS can adopt On-line Analytical Processing (OLAP tools and performance monitoring metrics using data mining techniques of BI to enhance its own learning, user profiling and predictive models for making a more useful set of personalised recommendations to its users. The application of the proposed framework to a B2C e-commerce case example is presented.
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77 FR 18791 - Proposed Information Collection; Comment Request; NIST Associates Information System
2012-03-28
... DEPARTMENT OF COMMERCE National Institute of Standards and Technology Proposed Information Collection; Comment Request; NIST Associates Information System AGENCY: National Institute of Standards and... access to the NIST campuses or NIST resources. The NIST Associates Information System (NAIS) information...
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Proposal of development of an advanced IORT system
International Nuclear Information System (INIS)
Ronsivalle, C.; Casali, F.; Colavita, E.; Lamanna, E.
2005-07-01
In the last years there has been an increasing interest on IORT (Intraoperative Radiation Therapy), also because of the development of dedicated accelerators. This technique represents a very effective oncological treatment consisting in delivering a single high dose on a tumour bed soon after surgery resection. In the following we present the proposal of development of a last generation IORT system based on the use of a linear accelerator with variable energy in the range 3-15 MeV, operating in C band (5712 MHz). Respect to the accelerator used in the commercial IORT systems operating at a typical frequency of 2998 MHz (S band) limited to a maximum energy of 12 MeV, the use of a higher RF frequency allows an increase of the maximum energy. This extends the use of the IORT technique to a wider field of tumors and an improvement of the system in terms of compactness and weight reduction. In addition the machine will be provided with a devoted absolute dosimetry system that will strongly simplify the procedures of dosimetric characterization. We intend to develop the system by a collaboration between ENEA, some Universities (Bologna, Catanzaro and Cosenza) and the national industry [it
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Proposal for a Similar Question Search System on a Q&A Site
Directory of Open Access Journals (Sweden)
Katsutoshi Kanamori
2014-06-01
Full Text Available There is a service to help Internet users obtain answers to specific questions when they visit a Q&A site. A Q&A site is very useful for the Internet user, but posted questions are often not answered immediately. This delay in answering occurs because in most cases another site user is answering the question manually. In this study, we propose a system that can present a question that is similar to a question posted by a user. An advantage of this system is that a user can refer to an answer to a similar question. This research measures the similarity of a candidate question based on word and dependency parsing. In an experiment, we examined the effectiveness of the proposed system for questions actually posted on the Q&A site. The result indicates that the system can show the questioner the answer to a similar question. However, the system still has a number of aspects that should be improved.
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Developing a new syndromic surveillance system for the London 2012 Olympic and Paralympic Games.
Harcourt, S E; Fletcher, J; Loveridge, P; Bains, A; Morbey, R; Yeates, A; McCloskey, B; Smyth, B; Ibbotson, S; Smith, G E; Elliot, A J
2012-12-01
Syndromic surveillance is vital for monitoring public health during mass gatherings. The London 2012 Olympic and Paralympic Games represents a major challenge to health protection services and community surveillance. In response to this challenge the Health Protection Agency has developed a new syndromic surveillance system that monitors daily general practitioner out-of-hours and unscheduled care attendances. This new national system will fill a gap identified in the existing general practice-based syndromic surveillance systems by providing surveillance capability of general practice activity during evenings/nights, over weekends and public holidays. The system will complement and supplement the existing tele-health phone line, general practitioner and emergency department syndromic surveillance systems. This new national system will contribute to improving public health reassurance, especially to meet the challenges of the London 2012 Olympic and Paralympic Games.
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A proposed intracortical visual prosthesis image processing system.
Srivastava, N R; Troyk, P
2005-01-01
It has been a goal of neuroprosthesis researchers to develop a system, which could provide artifical vision to a large population of individuals with blindness. It has been demonstrated by earlier researches that stimulating the visual cortex area electrically can evoke spatial visual percepts, i.e. phosphenes. The goal of visual cortex prosthesis is to stimulate the visual cortex area and generate a visual perception in real time to restore vision. Even though the normal working of the visual system is not been completely understood, the existing knowledge has inspired research groups to develop strategies to develop visual cortex prosthesis which can help blind patients in their daily activities. A major limitation in this work is the development of an image proceessing system for converting an electronic image, as captured by a camera, into a real-time data stream for stimulation of the implanted electrodes. This paper proposes a system, which will capture the image using a camera and use a dedicated hardware real time image processor to deliver electrical pulses to intracortical electrodes. This system has to be flexible enough to adapt to individual patients and to various strategies of image reconstruction. Here we consider a preliminary architecture for this system.
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Gur, Michal; Nir, Vered; Teleshov, Anna; Bar-Yoseph, Ronen; Manor, Eynav; Diab, Gizelle; Bentur, Lea
2017-05-01
Background Poor communications between cystic fibrosis (CF) patients and health-care providers may result in gaps in knowledge and misconceptions about medication usage, and can lead to poor adherence. We aimed to assess the feasibility of using WhatsApp and Skype to improve communications. Methods This single-centre pilot study included CF patients who were older than eight years of age assigned to two groups: one without intervention (control group), and one with intervention. Each patient from the intervention group received Skype-based online video chats and WhatsApp messages from members of the multidisciplinary CF team. CF questionnaires, revised (CFQ-R) scores, knowledge and adherence based on CF My Way and patients satisfaction were evaluated before and after three months. Feasibility was assessed by session attendance, acceptability and satisfaction survey. Descriptive analysis and paired and non-paired t-tests were used as applicable. Results Eighteen patients were recruited to this feasibility study (nine in each group). Each intervention group participant had between four and six Skype video chats and received 22-45 WhatsApp messages. In this small study, CFQ-R scores, knowledge, adherence and patient satisfaction were similar in both groups before and after the three-month intervention. Conclusions A telehealth-based approach, using Skype video chats and WhatsApp messages, was feasible and acceptable in this pilot study. A larger and longer multi-centre study is warranted to examine the efficacy of these interventions to improve knowledge, adherence and communication.
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Proposal of secure camera-based radiation warning system for nuclear detection
International Nuclear Information System (INIS)
Tsuchiya, Ken'ichi; Kurosawa, Kenji; Akiba, Norimitsu; Kakuda, Hidetoshi; Imoto, Daisuke; Hirabayashi, Manato; Kuroki, Kenro
2016-01-01
Counter-terrorisms against radiological and nuclear threat are significant issues toward Tokyo 2020 Olympic and Paralympic Games. In terms of cost benefit, it is not easy to build a warning system for nuclear detection to prevent a Dirty Bomb attack (dispersion of radioactive materials using a conventional explosive) or a Silent Source attack (hidden radioactive materials) from occurring. We propose a nuclear detection system using the installed secure cameras. We describe a method to estimate radiation dose from noise pattern in CCD images caused by radiation. Some dosimeters under neutron and gamma-ray irradiations (0.1mSv-100mSv) were taken in CCD video camera. We confirmed amount of noise in CCD images increased in radiation exposure. The radiation detection using CMOS in secure cameras or cell phones has been implemented. However, in this presentation, we propose a warning system including neutron detection to search shielded nuclear materials or radiation exposure devices using criticality. (author)
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Mirzoev, Tolib; Kane, Sumit
2017-01-01
Responsiveness is a key objective of national health systems. Responsive health systems anticipate and adapt to existing and future health needs, thus contributing to better health outcomes. Of all the health systems objectives, responsiveness is the least studied, which perhaps reflects lack of comprehensive frameworks that go beyond the normative characteristics of responsive services. This paper contributes to a growing, yet limited, knowledge on this topic. Herewith, we review the current frameworks for understanding health systems responsiveness and drawing on these, as well as key frameworks from the wider public services literature, propose a comprehensive conceptual framework for health systems responsiveness. This paper should be of interest to different stakeholders who are engaged in analysing and improving health systems responsiveness. Our review shows that existing knowledge on health systems responsiveness can be extended along the three areas. First, responsiveness entails an actual experience of people’s interaction with their health system, which confirms or disconfirms their initial expectations of the system. Second, the experience of interaction is shaped by both the people and the health systems sides of this interaction. Third, different influences shape people’s interaction with their health system, ultimately affecting their resultant experiences. Therefore, recognition of both people and health systems sides of interaction and their key determinants would enhance the conceptualisations of responsiveness. Our proposed framework builds on, and advances, the core frameworks in the health systems literature. It positions the experience of interaction between people and health system as the centrepiece and recognises the determinants of responsiveness experience both from the health systems (eg, actors, processes) and the people (eg, initial expectations) sides. While we hope to trigger further thinking on the conceptualisation of health
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Mirzoev, Tolib; Kane, Sumit
2017-01-01
Responsiveness is a key objective of national health systems. Responsive health systems anticipate and adapt to existing and future health needs, thus contributing to better health outcomes. Of all the health systems objectives, responsiveness is the least studied, which perhaps reflects lack of comprehensive frameworks that go beyond the normative characteristics of responsive services. This paper contributes to a growing, yet limited, knowledge on this topic. Herewith, we review the current frameworks for understanding health systems responsiveness and drawing on these, as well as key frameworks from the wider public services literature, propose a comprehensive conceptual framework for health systems responsiveness. This paper should be of interest to different stakeholders who are engaged in analysing and improving health systems responsiveness. Our review shows that existing knowledge on health systems responsiveness can be extended along the three areas. First, responsiveness entails an actual experience of people's interaction with their health system, which confirms or disconfirms their initial expectations of the system. Second, the experience of interaction is shaped by both the people and the health systems sides of this interaction. Third, different influences shape people's interaction with their health system, ultimately affecting their resultant experiences. Therefore, recognition of both people and health systems sides of interaction and their key determinants would enhance the conceptualisations of responsiveness. Our proposed framework builds on, and advances, the core frameworks in the health systems literature. It positions the experience of interaction between people and health system as the centrepiece and recognises the determinants of responsiveness experience both from the health systems (eg, actors, processes) and the people (eg, initial expectations) sides. While we hope to trigger further thinking on the conceptualisation of health system
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Proposed development programme for a temporary containment system for alpha active decommissioning
International Nuclear Information System (INIS)
Pengelly, M.G.A.; Burnett, R.C.
1983-06-01
This report makes a proposal to design, develop and test a containment of modular construction under plutonium active conditions. While this proposal contemplates work with plutonium, the system, when fully developed, has obvious applications wherever a temporary containment of radioactive or toxic materials is required. The fundamental feature of the proposal is that strippable coatings are used to prevent the inner surfaces of the working area from becoming contaminated. It is envisaged that this method of protecting the surfaces will enable the modular containment structure to be disassembled and re-used. (author)
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A model for mHealth skills training for clinicians: meeting the future now
Malvey, Donna M.; Neigel, Alexis R.
2017-01-01
We describe the current state of mHealth skills acquisition, education, and training available to clinical professionals in educational programs. We discuss how telemedicine experienced exponential growth due in large part to the ubiquity of the mobile phone. An outcome of this unprecedented growth has been the emergence of the need for technology skills training programs for clinicians that address extant curricula gaps. We propose a model to guide the development of future training programs that incorporate effective training strategies across five domains: (I) digital communication skills; (II) technology literacy and usage skills; (III) deploying telehealth products and services; (VI) regulatory and compliance issues; and (V) telehealth business case. These domains are discussed within the context of interprofessional teams and broader organizational factors. PMID:28736733
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2010-07-13
...: Economic Recovery List (ERL) Database, Social Security Administration. SYSTEM CLASSIFICATION: None. SYSTEM... SOCIAL SECURITY ADMINISTRATION Privacy Act of 1974, as Amended; Proposed System of Records and Routine Use Disclosures AGENCY: Social Security Administration (SSA). ACTION: Proposed System of Records...
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Prioritization Scheme for Proposed Road Weather Information System Sites: Montana Case Study
Directory of Open Access Journals (Sweden)
Ahmed Al-Kaisy
2017-08-01
Full Text Available A model for prioritization of new proposed environmental sensor station (ESS sites is developed and presented in this paper. The model assesses the overall merit (OM of a proposed ESS site as part of a Road Weather Information System (RWIS using weather, traffic, and safety data among other variables. The purpose of the proposed model is to help in selecting optimum sites for new ESS locations, which is important in guiding RWIS system expansion. Inputs to the OM model include weather index (WI, traffic index (TI, crash index, geographic coverage, and opportunistic factors. The WI at a proposed site is determined using multiple indicators of weather severity and variability. The crash index, another major input to the OM model, incorporates crash rate along the route and the percentage of weather-related crashes over the analysis period. The TI, in turn, reflects the amount of travel on the highway network in the area surrounding the proposed ESS site. The fourth input to the merit model accounts for the ESS existing coverage in the area where the proposed site is located, while the fifth and last input is concerned with the availability and ease of access to power and communications. Model coefficients are represented by weights that reflect the contribution of each input (variable to the OM of the ESS site. Those weights are user-specified and should be selected to reflect the agency preferences and priorities. The application of the proposed merit model on sample sites in Montana demonstrated the utility of the model in ranking candidate sites using data readily available to highway agencies.
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A passive cooling system proposal for multifunction and high-power displays
Tari, Ilker
2013-03-01
Flat panel displays are conventionally cooled by internal natural convection, which constrains the possible rate of heat transfer from the panel. On one hand, during the last few years, the power consumption and the related cooling requirement for 1080p displays have decreased mostly due to energy savings by the switch to LED backlighting and more efficient electronics. However, on the other hand, the required cooling rate recently started to increase with new directions in the industry such as 3D displays, and ultra-high-resolution displays (recent 4K announcements and planned introduction of 8K). In addition to these trends in display technology itself, there is also a trend to integrate consumer entertainment products into displays with the ultimate goal of designing a multifunction device replacing the TV, the media player, the PC, the game console and the sound system. Considering the increasing power requirement for higher fidelity in video processing, these multifunction devices tend to generate very high heat fluxes, which are impossible to dissipate with internal natural convection. In order to overcome this obstacle, instead of active cooling with forced convection that comes with drawbacks of noise, additional power consumption, and reduced reliability, a passive cooling system relying on external natural convection and radiation is proposed here. The proposed cooling system consists of a heat spreader flat heat pipe and aluminum plate-finned heat sink with anodized surfaces. For this system, the possible maximum heat dissipation rates from the standard size panels (in 26-70 inch range) are estimated by using our recently obtained heat transfer correlations for the natural convection from aluminum plate-finned heat sinks together with the surface-to-surface radiation. With the use of the proposed passive cooling system, the possibility of dissipating very high heat rates is demonstrated, hinting a promising green alternative to active cooling.
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Directory of Open Access Journals (Sweden)
Suzanne Martin
2013-12-01
Full Text Available Strategies to support people living with dementia are broad in scope, proposing both pharmacological and non-pharmacological interventions as part of the care pathway. Assistive technologies form part of this offering as both stand-alone devices to support particular tasks and the more complex offering of the “smart home” to underpin ambient assisted living. This paper presents a technology-based system, which expands on the smart home architecture, orientated to support people with daily living. The system, NOCTURNAL, was developed by working directly with people who had dementia, and their carers using qualitative research methods. The research focused primarily on the nighttime needs of people living with dementia in real home settings. Eight people with dementia had the final prototype system installed for a three month evaluation at home. Disturbed sleep patterns, night-time wandering were a focus of this research not only in terms of detection by commercially available technology but also exploring if automated music, light and visual personalized photographs would be soothing to participants during the hours of darkness. The NOCTURNAL platform and associated services was informed by strong user engagement of people with dementia and the service providers who care for them. NOCTURNAL emerged as a holistic service offering a personalised therapeutic aspect with interactive capabilities.
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Martin, Suzanne; Augusto, Juan Carlos; McCullagh, Paul; Carswell, William; Zheng, Huiru; Wang, Haiying; Wallace, Jonathan; Mulvenna, Maurice
2013-12-04
Strategies to support people living with dementia are broad in scope, proposing both pharmacological and non-pharmacological interventions as part of the care pathway. Assistive technologies form part of this offering as both stand-alone devices to support particular tasks and the more complex offering of the "smart home" to underpin ambient assisted living. This paper presents a technology-based system, which expands on the smart home architecture, orientated to support people with daily living. The system, NOCTURNAL, was developed by working directly with people who had dementia, and their carers using qualitative research methods. The research focused primarily on the nighttime needs of people living with dementia in real home settings. Eight people with dementia had the final prototype system installed for a three month evaluation at home. Disturbed sleep patterns, night-time wandering were a focus of this research not only in terms of detection by commercially available technology but also exploring if automated music, light and visual personalized photographs would be soothing to participants during the hours of darkness. The NOCTURNAL platform and associated services was informed by strong user engagement of people with dementia and the service providers who care for them. NOCTURNAL emerged as a holistic service offering a personalised therapeutic aspect with interactive capabilities.
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Energy Technology Data Exchange (ETDEWEB)
NONE
1996-03-04
Part 2 of this manual provides the electric utility engineer with detailed technical information on some of the major mechanical equipment used in the FGD system. The objectives of Part 2 are the following: to provide the electric utility engineer with information on equipment that may be unfamiliar to him, including ball mills, vacuum filters, and mist eliminators; and to identify the unique technique considerations imposed by an FGD system on more familiar electric utility equipment such as fans, gas dampers, piping, valves, and pumps. Part 3 provides an overview of the recommended procedures for evaluating proposals received from FGD system vendors. The objectives are to provide procedures for evaluating the technical aspects of proposals, and to provide procedures for determining the total costs of proposals considering both initial capital costs and annual operating and maintenance costs. The primary objective of Part 4 of this manual is to provide the utility engineer who has a special interest in the capabilities of FGDPRISM [Flue Gas Desulfurization PRocess Integration and Simulation Model] with more detailed discussions of its uses, requirements, and limitations. Part 5 is a case study in using this manual in the preparation of a purchase specification and in the evaluation of proposals received from vendors. The objectives are to demonstrate how the information contained in Parts 1 and 2 can be used to improve the technical content of an FGD system purchase specification; to demonstrate how the techniques presented in Part 3 can be used to evaluate proposals received in response to the purchase specification; and to illustrate how the FGDPRISM computer program can be used to establish design parameters for the specification and evaluate vendor designs.
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International Nuclear Information System (INIS)
2006-03-01
In order to develop the system to affect more advanced and rational regulations of nuclear fuels and earlier introduction of new technologies in nuclear power plants, domestic and overseas safety regulation systems and state of their implementation for water cooled reactor fuel and safety analysis code had been investigated and new regulation system to affect nuclear fuel type authorization and analysis code certification was proposed. Topical report system for common parts related with nuclear fuel type authorization and analysis code certification was firstly proposed for knowledge base. Maintaining consistent safety examination supported by experts, introduction of domestic efficient system for lead irradiation test fuel, and analysis code certification and quality assurance were also proposed. (T. Tanaka)
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Energy Technology Data Exchange (ETDEWEB)
Krasae-in, Songwut [Norwegian University of Science and Technology, Kolbjorn Hejes vei 1d, NO-7491 Trondheim (Norway); Stang, Jacob H.; Neksa, Petter [SINTEF Energy Research AS, Kolbjorn Hejes vei 1d, NO-7465 Trondheim (Norway)
2010-11-15
A proposed liquid hydrogen plant using a multi-component refrigerant (MR) refrigeration system is explained in this paper. A cycle that is capable of producing 100 tons of liquid hydrogen per day is simulated. The MR system can be used to cool feed normal hydrogen gas from 25 C to the equilibrium temperature of -193 C with a high efficiency. In addition, for the transition from the equilibrium temperature of the hydrogen gas from -193 C to -253 C, the new proposed four H{sub 2} Joule-Brayton cascade refrigeration system is recommended. The overall power consumption of the proposed plant is 5.35 kWh/kg{sub LH2}, with an ideal minimum of 2.89 kWh/kg{sub LH2}. The current plant in Ingolstadt is used as a reference, which has an energy consumption of 13.58 kWh/kg{sub LH2} and an efficiency of 21.28%: the efficiency of the proposed system is 54.02% or more, where this depends on the assumed efficiency values for the compressors and expanders. Moreover, the proposed system has some smaller-size heat exchangers, much smaller compressor motors, and smaller crankcase compressors. Thus, it could represent a plant with the lowest construction cost with respect to the amount of liquid hydrogen produced in comparison to today's plants, e.g., in Ingolstadt and Leuna. Therefore, the proposed system has many improvements that serve as an example for future hydrogen liquefaction plants. (author)
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Voltage and Frequency Control for Future Power Systems: the ELECTRA IRP Proposal
DEFF Research Database (Denmark)
D’hulst, R.; Merino Fernandez, J.; Rikos, E.
2015-01-01
In this paper a high level functional architecture for frequency and voltage control for the future (2030+) power system is presented. The proposal suggests a decomposition of the present organization of power system operation into a ”web of cells”. Each cell in this web is managed by a single...
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2013-12-17
...-0392] Proposed Enhancements to the Motor Carrier Safety Measurement System (SMS) Public Web Site AGENCY... proposed enhancements to the display of information on the Agency's Safety Measurement System (SMS) public Web site. On December 6, 2013, Advocates [[Page 76392
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Institutionalizing dissent: a proposal for an adversarial system of pharmaceutical research.
Biddle, Justin
2013-12-01
There are serious problems with the way in which pharmaceutical research is currently practiced, many of which can be traced to the influence of commercial interests on research. One of the most significant is inadequate dissent, or organized skepticism. In order to ameliorate this problem, I develop a proposal that I call the "Adversarial Proceedings for the Evaluation of Pharmaceuticals," to be instituted within a regulatory agency such as the Food and Drug Administration for the evaluation of controversial new drugs and controversial drugs already in the market. This proposal is an organizational one based upon the "science court" proposal by Arthur Kantrowitz in the 1960s and 1970s. The primary benefit of this system is its ability to institutionalize dissent, thereby ensuring that one set of interests does not dominate all others.
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The Proposed Heating and Cooling System in the CH2 Building and Its Impact on Occupant Productivity
Directory of Open Access Journals (Sweden)
Lu Aye
2012-11-01
Full Text Available Melbourne's climatic conditions demand that its buildings require both heating and cooling systems. In a multi-storey office building , however, cooling requirements will dominate. How the internal space is cooled and ventilation air is delivered will significantly impact on occupant comfort. This paper discusses the heating and cooling systems proposed for the CH2building. The paper critiques the proposed systems against previous experience, both internationally and in Australia. While the heating system employs proven technologies, less established techniques are proposed for the cooling system. Air movement in the shower towers, for example, is to be naturally induced and this has not always been successful elsewhere. Phase change material for storage of "coolth" does not appear to have been demonstrated previously in a commercial building, so the effectiveness of the proposed system is uncertain. A conventional absorption chiller backs up the untried elements of the cooling system, so that ultimately occupant comfort should not be compromised .
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Product/Service-Systems: Proposal for models and terminology
DEFF Research Database (Denmark)
Matzen, Detlef; Tan, Adrian; Andreasen, Mogens Myrup
2005-01-01
very blurred and ill defined. This paper will try to identify the fundamental characteristics of PSS and propose a system of concepts that can be used to describe and discuss the phenomenon, for the purpose of developing new PSS solutions. Coming from a tradition of product development research......Over recent years a growing number of studies and research programmes have been conducted on the issue of product/service-systems (PSS) [1, 2] and results have been presented at this row of symposia [3, 4]. These studies usually analyse the potential of integrated solutions to reduce...... the environmental impacts of human consumption activity or optimise a company’s ability to cope with the influences arising from the emerging globalisation of economic and business activities. Since there has not been worked on a coherent terminology for the terms and concepts used in PSS research, the area remains...
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Proposal of a national system to supervise nuclear installations out of international safeguards
International Nuclear Information System (INIS)
Rosa, L.P.
1990-01-01
It is proposed a national system to safeguard, supervise and inspect nuclear facilities in Brazil, apart from international safeguards. It discusses also the military nuclear activities and the uranium enrichment plants. The system should be controlled by Brazilian CNEN. (A.C.A.S.)
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Proposals for enhanced health risk assessment and stratification in an integrated care scenario.
Dueñas-Espín, Ivan; Vela, Emili; Pauws, Steffen; Bescos, Cristina; Cano, Isaac; Cleries, Montserrat; Contel, Joan Carles; de Manuel Keenoy, Esteban; Garcia-Aymerich, Judith; Gomez-Cabrero, David; Kaye, Rachelle; Lahr, Maarten M H; Lluch-Ariet, Magí; Moharra, Montserrat; Monterde, David; Mora, Joana; Nalin, Marco; Pavlickova, Andrea; Piera, Jordi; Ponce, Sara; Santaeugenia, Sebastià; Schonenberg, Helen; Störk, Stefan; Tegner, Jesper; Velickovski, Filip; Westerteicher, Christoph; Roca, Josep
2016-04-15
Population-based health risk assessment and stratification are considered highly relevant for large-scale implementation of integrated care by facilitating services design and case identification. The principal objective of the study was to analyse five health-risk assessment strategies and health indicators used in the five regions participating in the Advancing Care Coordination and Telehealth Deployment (ACT) programme (http://www.act-programme.eu). The second purpose was to elaborate on strategies toward enhanced health risk predictive modelling in the clinical scenario. The five ACT regions: Scotland (UK), Basque Country (ES), Catalonia (ES), Lombardy (I) and Groningen (NL). Responsible teams for regional data management in the five ACT regions. We characterised and compared risk assessment strategies among ACT regions by analysing operational health risk predictive modelling tools for population-based stratification, as well as available health indicators at regional level. The analysis of the risk assessment tool deployed in Catalonia in 2015 (GMAs, Adjusted Morbidity Groups) was used as a basis to propose how population-based analytics could contribute to clinical risk prediction. There was consensus on the need for a population health approach to generate health risk predictive modelling. However, this strategy was fully in place only in two ACT regions: Basque Country and Catalonia. We found marked differences among regions in health risk predictive modelling tools and health indicators, and identified key factors constraining their comparability. The research proposes means to overcome current limitations and the use of population-based health risk prediction for enhanced clinical risk assessment. The results indicate the need for further efforts to improve both comparability and flexibility of current population-based health risk predictive modelling approaches. Applicability and impact of the proposals for enhanced clinical risk assessment require
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Recent and proposed changes in criticality alarm system requirements
International Nuclear Information System (INIS)
Putman, V.L.
1998-01-01
Various changes in criticality alarm system (CAS) requirements of American Nuclear Society (ANS) standards, US Department of Energy (DOE) orders, US Nuclear Regulatory Commission (NRC) regulations and guidance, and Occupational Safety and Health Administration (OSHA) standards or regulations were approved or proposed in the last 5 yr. Many changes interpreted or clarified existing requirements or accommodated technological or organizational developments. However, some changes could substantively affect CAS programs, including several changes originally thought to be editorial. These changes are discussed here
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Studies and Proposals for an Automatic Crystal Control System
Drobychev, Gleb; Khruschinsky, A A; Korzhik, Mikhail; Missevitch, Oleg; Oriboni, André; Peigneux, Jean-Pierre; Schneegans, Marc
1997-01-01
This document presents the status of the studies for an Automatic Crystal Control System ( ACCOS) performed since autumn 1995 for the CMS collaboration. Evaluation of a startstop method for light yield, light uniformity and decay time measurements of PbWO4 crystals is presented, as well as the first results obtained with a compact double-beam spectrophotometer for transverse transmission. Various overall schemes are proposed for an integrated set-up including crystal dimension measurement. The initial financial evaluationperformed is also given.
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Proposed high voltage power supply for the ITER relevant lower hybrid current drive system
International Nuclear Information System (INIS)
Sharma, P.K.; Kazarian, F.; Garibaldi, P.; Gassman, T.; Artaud, J.F.; Bae, Y.S.; Belo, J.; Berger-By, G.; Bernard, J.M.; Cara, Ph.; Cardinali, A.; Castaldo, C.; Ceccuzzi, S.; Cesario, R.; Decker, J.; Delpech, L.; Ekedahl, A.; Garcia, J.; Goniche, M.; Guilhem, D.
2011-01-01
In the framework of the EFDA task HCD-08-03-01, the ITER lower hybrid current drive (LHCD) system design has been reviewed. The system aims to generate 24 MW of RF power at 5 GHz, of which 20 MW would be coupled to the plasmas. The present state of the art does not allow envisaging a unitary output of the klystrons exceeding 500 kW, so the project is based on 48 klystron units, leaving some margin when the transmission lines losses are taken into account. A high voltage power supply (HVPS), required to operate the klystrons, is proposed. A single HVPS would be used to feed and operate four klystrons in parallel configuration. Based on the above considerations, it is proposed to design and develop twelve HVPS, based on pulse step modulator (PSM) technology, each rated for 90 kV/90 A. This paper describes in details, the typical electrical requirements and the conceptual design of the proposed HVPS for the ITER LHCD system.
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Proposed 14-MeV neutron spectrometer system for jet
International Nuclear Information System (INIS)
Elevant, T.
1983-09-01
In order to cover a broad range of neutron spectra and fluxes during D-T operation in JET we propose the use of two different detector techniques neutron induced reactions in a silicon surface barrier detector and neutron-proton elastic scattering in a liquid scintillator. Experimental investigations of 28 Si(n,α) 25 Mg reactions have resulted in resolutions of ΔE(FWHM)/E=0.02 with intrinsic efficiency equal to 10 -4 and a maximum useful countrate equal to 1600 c.p.s. However, due to overlap of adjacent peaks, caused by excited states of 25 Mg, this spectrometer has an operation range limited to FWHM/E=0.04. For broader neutron distributions we propose the use of a conventional liquid scintillator system with a light guide, photomultiplier tube and modified conventional electronics. Experiments have demonstrated a resolution equal to 0.05 and a n/γ separation better than 90percent at total countrates equal to 2times10 5 c.p.s. (author)
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Energy Technology Data Exchange (ETDEWEB)
1978-02-01
An analysis of major concerns with regard to the effects on radio and electronic systems by the proposed Microwave Power Transmission System for transmitting power from a satellite solar power station to earth is presented. (LCL)
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A Proposed Concentration Curriculum Design for Big Data Analytics for Information Systems Students
Molluzzo, John C.; Lawler, James P.
2015-01-01
Big Data is becoming a critical component of the Information Systems curriculum. Educators are enhancing gradually the concentration curriculum for Big Data in schools of computer science and information systems. This paper proposes a creative curriculum design for Big Data Analytics for a program at a major metropolitan university. The design…
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Proposed Georgia-Alabama-South Carolina system power marketing policy and subsequent contracts
International Nuclear Information System (INIS)
1994-01-01
This is an Environmental Assessment (Assessment) (DOE/EA-0935) evaluating the Power Marketing Policy and Subsequent Contracts between Southeastern and its customers. The Assessment evaluates two alternatives and the no action alternative. The proposed action is to market the power and energy available in the Georgia-Alabama-South Carolina System during the next ten years, with new power sales contracts of ten-year durations, to the customers set forth in Appendix A of the Assessment. In addition to the proposed alternative, the Assessment evaluates the alternative of extending existing contracts under the current marketing policy
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Chang, Chi-Ping
2015-06-01
Many technology developments hold the potential to improve the quality of life of people and make life easier and more comfortable. New technologies have been well accepted by most people. Information sharing in particular is a major catalyst of change in our current technology-based society. Technology has widely innovated life and drastically changed lifestyles. The Technology Acceptance Model (TAM), a model developed to address the rapid advances in computer technology, is used to explain and predict user acceptance of new information technology. In the past, businesses have used the TAM as an assessment tool to predict user acceptance when introducing new technology products. They have also used external factors in the model to influence user perceptions and beliefs and to ensure the successful spread of new technologies. Informatization plays a critical role in healthcare services. Due to the rapid aging of populations and upward trends in the incidence of chronic illness, requirements for long-term care have increased in both quality and quantity. Therefore, there has been an increased emphasis on integrating healthcare and information technology. However, most elderly are significantly less adept at technology use than the general population. Therefore, we reexamined the effect that the essential concepts in a TAM exerted on technology acceptance. In the present study, the technology acceptance experience with regard to telehealth of the elderly was used as an example to explain how the revised technology acceptance model (TAM 2) may be effectively applied to enhance the understanding of technology care among nurses. The results may serve as a reference for future research on healthcare-technology use in long-term care or in elderly populations.
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International Nuclear Information System (INIS)
Rearden, Bradley T.; Hopper, Calvin M.; Elam, Karla R.
2005-01-01
The applicability of proposed critical experiments for the criticality code validation of a series of prototypic reactor-grade and weapons-grade mixed-oxide systems has been assessed with the TSUNAMI methodology from SCALE 5. The application systems were proposed by the Nuclear Energy Agency (NEA) Organization for Economic Cooperation and Development (OECD) Working Party on Nuclear Criticality Safety MOX Experimental Needs Working Group. Forty-eight application systems were conceived to envelope the range of conditions in processing and fabrication of reactor-grade and weapons-grade MOX fuel. The applicability of 303 existing critical benchmarks to each of the 48 applications was assessed, and validation coverage was found to be lacking for certain applications. Two series of proposed critical experiments were also considered in this analysis. The TSUNAMI analysis has revealed that both series of proposed experiments are applicable to numerous configurations of the reactor-grade and weapons-grade systems. A detailed assessment of which experiments were revealed by TSUNAMI to be most applicable to specific prototypic fuel processing systems has been performed. (author)
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Data Curation in the World Data System: Proposed Framework
Directory of Open Access Journals (Sweden)
P Laughton
2013-09-01
Full Text Available The value of data in society is increasing rapidly. Organisations that work with data should have standard practices in place to ensure successful curation of data. The World Data System (WDS consists of a number of data centres responsible for curating research data sets for the scientific community. The WDS has no formal data curation framework or model in place to act as a guideline for member data centres. The objective of this research was to develop a framework for the curation of data in the WDS. A multiple-case case study was conducted. Interviews were used to gather qualitative data and analysis of the data, which led to the development of this framework. The proposed framework is largely based on the Open Archival Information System (OAIS functional model and caters for the curation of both analogue and digital data.
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Proposal of a molten-salt system for long-term energy production
International Nuclear Information System (INIS)
Berthou, V.; Slessarev, I.; Salvatores, M.
2002-01-01
Within the framework of nuclear waste management studies, the 'ose-composent' concept is considered to be an attractive option for the long-term perspective. This paper proposes a new system called TASSE ('Thorium-based Accelerator-drives System with Simplified fuel cycle for long-term Energy production') destined for the current French park renewal. The main idea of the TASSE concept is to simplify both the front end and the back end of the fuel cycle. Its major goal is to provide electricity with low waste production and economical competitiveness. (author)
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Directory of Open Access Journals (Sweden)
A.Y. Hatata
2018-03-01
Full Text Available Sandia frequency shift (SFS is one of the active anti-islanding detection methods that depend on frequency drift to detect an islanding condition for inverter-based distributed generation. The non-detection zone (NDZ of the SFS method depends to a great extent on its parameters. Improper adjusting of these parameters may result in failure of the method. This paper presents a proposed artificial immune system (AIS-based technique to obtain optimal parameters of SFS anti-islanding detection method. The immune system is highly distributed, highly adaptive, and self-organizing in nature, maintains a memory of past encounters, and has the ability to continually learn about new encounters. The proposed method generates less total harmonic distortion (THD than the conventional SFS, which results in faster island detection and better non-detection zone. The performance of the proposed method is derived analytically and simulated using Matlab/Simulink. Two case studies are used to verify the proposed method. The first case includes a photovoltaic (PV connected to grid and the second includes a wind turbine connected to grid. The deduced optimized parameter setting helps to achieve the “non-islanding inverter” as well as least potential adverse impact on power quality. Keywords: Anti-islanding detection, Sandia frequency shift (SFS, Non-detection zone (NDZ, Total harmonic distortion (THD, Artificial immune system (AIS, Clonal selection algorithm
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A natural language query system for Hubble Space Telescope proposal selection
Hornick, Thomas; Cohen, William; Miller, Glenn
1987-01-01
The proposal selection process for the Hubble Space Telescope is assisted by a robust and easy to use query program (TACOS). The system parses an English subset language sentence regardless of the order of the keyword phases, allowing the user a greater flexibility than a standard command query language. Capabilities for macro and procedure definition are also integrated. The system was designed for flexibility in both use and maintenance. In addition, TACOS can be applied to any knowledge domain that can be expressed in terms of a single reaction. The system was implemented mostly in Common LISP. The TACOS design is described in detail, with particular attention given to the implementation methods of sentence processing.
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Analysis of the new architecture proposal for the CMM control system
International Nuclear Information System (INIS)
Heikkilae, L.; Saarinen, H.; Aha, L.; Viinikainen, M.; Mattila, J.; Hahto, A.; Siuko, M.; Semeraro, L.
2011-01-01
While developing divertor remote handling maintenance systems at the Divertor Test Platform 2 facility, some risks and sensitivity points related to the Cassette Multifunctional Mover control system software were discovered and evaluated. The control system architecture has to simultaneously fulfill the demanding ITER remote handling requirements and to face new requirements being uncovered during the trials. Especially evolving non-functional requirements such as reliability and safety have an effect on the control system architecture as it is getting more mature. An evaluation of the implications from architectural decisions is necessary before implementation efforts, as an architecture left to develop without evaluation may lead to a dead end and therefore soaring development costs. After studying existing architecture analysis methods an analysis method was developed to gain confidence to carry out the proposed changes.
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Goodman, J.; McKay, J.; Evans, W.; Gadsden, S. Andrew
2016-05-01
This paper is based on a proposed unmanned aerial system platform that is to be outfitted with high-resolution sensors. The proposed system is to be tethered to a moveable ground station, which may be a research vessel or some form of ground vehicle (e.g., car, truck, or rover). The sensors include, at a minimum: camera, infrared sensor, thermal, normalized difference vegetation index (NDVI) camera, global positioning system (GPS), and a light-based radar (LIDAR). The purpose of this paper is to provide an overview of existing methods for pollution detection of failing septic systems, and to introduce the proposed system. Future work will look at the high-resolution data from the sensors and integrating the data through a process called information fusion. Typically, this process is done using the popular and well-published Kalman filter (or its nonlinear formulations, such as the extended Kalman filter). However, future work will look at using a new type of strategy based on variable structure estimation for the information fusion portion of the data processing. It is hypothesized that fusing data from the thermal and NDVI sensors will be more accurate and reliable for a multitude of applications, including the detection of pollution entering the Chesapeake Bay area.
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2011-07-13
... Prospective Payment Systems for Acute Care Hospitals and the Long-Term Care Hospital Prospective Payment...; Proposed Changes to the Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the Long-Term Care Hospital Prospective Payment System and Fiscal Year 2012 Rates'' which appeared in the...
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Proposed patient motion monitoring system using feature point tracking with a web camera.
Miura, Hideharu; Ozawa, Shuichi; Matsuura, Takaaki; Yamada, Kiyoshi; Nagata, Yasushi
2017-12-01
Patient motion monitoring systems play an important role in providing accurate treatment dose delivery. We propose a system that utilizes a web camera (frame rate up to 30 fps, maximum resolution of 640 × 480 pixels) and an in-house image processing software (developed using Microsoft Visual C++ and OpenCV). This system is simple to use and convenient to set up. The pyramidal Lucas-Kanade method was applied to calculate motions for each feature point by analysing two consecutive frames. The image processing software employs a color scheme where the defined feature points are blue under stable (no movement) conditions and turn red along with a warning message and an audio signal (beeping alarm) for large patient movements. The initial position of the marker was used by the program to determine the marker positions in all the frames. The software generates a text file that contains the calculated motion for each frame and saves it as a compressed audio video interleave (AVI) file. We proposed a patient motion monitoring system using a web camera, which is simple and convenient to set up, to increase the safety of treatment delivery.
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Directory of Open Access Journals (Sweden)
Farhad Faghani
2013-01-01
Full Text Available In various applications, such as speech recognition and automatic teleconferencing, the recorded speech signals may be corrupted by both noise and reverberation. Reverberation causes a noticeable change in speech intelligibility and quality. In this research, firstly reverberation is described. There are some de-reverberation enhancement algorithms that use only one microphone. They mostly use inverse filtering and spectral subtraction as their sub-systems. On the other hand, there are many multi-microphone speech enhancement systems; Delay-and-sum beam former is the most famous amongst them. Moreover, several efficient approaches have been also reported that use linear prediction (LP residual signal, inverse filtering, and phase error. Despite the improvements and benefits gained by the use of several input microphones, considering the tradeoff between these gains and the complexity and computational cost forced by the use of more microphones, many researchers have focused on dual-microphones systems. So, a review on Microphone array signal processing is explained and then an arrangement for two microphones systems is proposed. As we want to evaluate these algorithms for Farsi speech signals, the problem of speech intelligibility assessment has been explained and a Farsi word list for Diagnostic Rhyme Test (DRT is presented.The structure of presented word list is similar to that of English DRT words. In this research, after a brief study of above-mentioned methods, we propose and implement some hybrid techniques to benefit from the advantages of several methods and achieve significant improvement in output signals. It will be shown that the proposed method performs superior to the state-of-the-art dereverberation algorithms.
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Miranda, Diogo Julien; Chao, Lung Wen
2018-03-01
Preliminary studies suggest the need of a global vision in academic reform, leading to education re-invention. This would include problem-based education using transversal topics, developing of thinking skills, social interaction, and information-processing skills. We aimed to develop a new educational model in health with modular components to be broadcast and applied as a tele-education course. We developed a systematic model based on a "Skills and Goals Matrix" to adapt scientific contents on fictional screenplays, three-dimensional (3D) computer graphics of the human body, and interactive documentaries. We selected 13 topics based on youth vulnerabilities in Brazil to be disseminated through a television show with 15 episodes. We developed scientific content for each theme, naturally inserting it into screenplays, together with 3D sequences and interactive documentaries. The modular structure was then adapted to a distance-learning course. The television show was broadcast on national television for two consecutive years to an estimated audience of 30 million homes, and ever since on an Internet Protocol Television (IPTV) channel. It was also reorganized as a tele-education course for 2 years, reaching 1,180 subscriptions from all 27 Brazilian states, resulting in 240 graduates. Positive results indicate the feasibility, acceptability, and effectiveness of a model of modular entertainment audio-visual productions using health and education integrated concepts. This structure also allowed the model to be interconnected with other sources and applied as tele-education course, educating, informing, and stimulating the behavior change. Future works should reinforce this joint structure of telehealth, communication, and education.
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Proposal of modification of the Atucha I nuclear power plant's emergency power supply system
International Nuclear Information System (INIS)
Palacio, Pedro; Dabove, Mario
1989-01-01
The emergency power supply system of Atucha I N.P.P. consists of three 50% diesel generators. During the transient from normal power supply to emergency power supply (approximately 15 seconds) an hydraulic generator takes care of the emergency system. By this way, the emergency busbars constitute themselves an interruption free system. The two emergency busbars work normally coupled. This proposal consists of the following modifications: 1) Add a new diesel generator in order to allow the operation with two diesel generators per busbar. 2) To work with the two emergency busbars not coupled as normal operation mode. 3) To eliminate the hydraulic generator from the emergency power supply system, in order to simplify the operation and to reduce the failure possibility. Without the hydraulic turbine generator, the emergency busbars loose the interruption free condition. For this reason, for the loads that are not able for this mode of operation and are connected to the emergency power supply system, two additional low-voltage interruption free busbars are necessary. Finally, this proposal is compared with the Atucha II N.P.P. emergency power supply system. (Author)
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Directory of Open Access Journals (Sweden)
Abdulmohsen Al-Thubaity
2014-01-01
Full Text Available Despite the accessibility of numerous online corpora, students and researchers engaged in the fields of Natural Language Processing (NLP, corpus linguistics, and language learning and teaching may encounter situations in which they need to develop their own corpora. Several commercial and free standalone corpora processing systems are available to process such corpora. In this study, we first propose a framework for the evaluation of standalone corpora processing systems and then use it to evaluate seven freely available systems. The proposed framework considers the usability, functionality, and performance of the evaluated systems while taking into consideration their suitability for Arabic corpora. While the results show that most of the evaluated systems exhibited comparable usability scores, the scores for functionality and performance were substantially different with respect to support for the Arabic language and N-grams profile generation. The results of our evaluation will help potential users of the evaluated systems to choose the system that best meets their needs. More importantly, the results will help the developers of the evaluated systems to enhance their systems and developers of new corpora processing systems by providing them with a reference framework.
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Al-Thubaity, Abdulmohsen; Al-Khalifa, Hend; Alqifari, Reem; Almazrua, Manal
2014-01-01
Despite the accessibility of numerous online corpora, students and researchers engaged in the fields of Natural Language Processing (NLP), corpus linguistics, and language learning and teaching may encounter situations in which they need to develop their own corpora. Several commercial and free standalone corpora processing systems are available to process such corpora. In this study, we first propose a framework for the evaluation of standalone corpora processing systems and then use it to evaluate seven freely available systems. The proposed framework considers the usability, functionality, and performance of the evaluated systems while taking into consideration their suitability for Arabic corpora. While the results show that most of the evaluated systems exhibited comparable usability scores, the scores for functionality and performance were substantially different with respect to support for the Arabic language and N-grams profile generation. The results of our evaluation will help potential users of the evaluated systems to choose the system that best meets their needs. More importantly, the results will help the developers of the evaluated systems to enhance their systems and developers of new corpora processing systems by providing them with a reference framework.
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The proposed combustion standards and DOE thermal treatment systems
International Nuclear Information System (INIS)
McFee, J.; Hinman, M.B.; Eaton, D.; NcNeel, K.
1997-01-01
Under the provisions of the Clean Air Act (CAA) concerning emission of hazardous air pollutants (HAPs), the Environmental Protection Agency (EPA) published the proposed Revised Standards for Hazardous Waste Combustors on April 19, 1996 (EPA, 1996). These standards would apply to the existing Department of Energy (DOE) radioactive and mixed waste incinerators, and may be applied to several developing alternatives to incineration. The DOE has reviewed the basis for these regulations and prepared extensive comments to present concerns about the bases and implications of the standards. DOE is now discussing compliance options with the EPA for regulation of radioactive and mixed waste thermal treatment systems
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International Nuclear Information System (INIS)
Radder, J.A.; Cramer, D.S.
1997-01-01
In order to meet Department of Energy (DOE) Defense Program requirements for tritium in the 2005-2007 time frame, new production capability must be made available. The Accelerator Production of Tritium (APT) Plant is being considered as an alternative to nuclear reactor production of tritium, which has been the preferred method in the past. The proposed APT plant will use a high-power proton accelerator to generate thermal neutrons that will be captured in 3 He to produce tritium (3H). It is expected that the APT Plant will be built and operated at the DOE's Savannah River Site (SRS) in Aiken, South Carolina. Discussion is focused on Reliability, Availability, Maintainability, and Inspectability (RAMI) modeling of recent conceptual designs for balance of plant (BOP) systems in the proposed APT Plant. In the conceptual designs for balance of plant (BOP) systems in the proposed APT Plant. In the conceptual design phase, system RAMI estimates are necessary to identify the best possible system alternative and to provide a valid picture of the cost effectiveness of the proposed system for comparison with other system alternatives. RAMI estimates in the phase must necessarily be based on generic data. The objective of the RAMI analyses at the conceptual design stage is to assist the designers in achieving an optimum design which balances the reliability and maintainability requirements among the subsystems and components
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Wong, Wai Keat; Shetty, Subhaschandra
2017-08-01
Parotidectomy remains the mainstay of treatment for both benign and malignant lesions of the parotid gland. There exists a wide range of possible surgical options in parotidectomy in terms of extent of parotid tissue removed. There is increasing need for uniformity of terminology resulting from growing interest in modifications of the conventional parotidectomy. It is, therefore, of paramount importance for a standardized classification system in describing extent of parotidectomy. Recently, the European Salivary Gland Society (ESGS) proposed a novel classification system for parotidectomy. The aim of this study is to evaluate this system. A classification system proposed by the ESGS was critically re-evaluated and modified to increase its accuracy and its acceptability. Modifications mainly focused on subdividing Levels I and II into IA, IB, IIA, and IIB. From June 2006 to June 2016, 126 patients underwent 130 parotidectomies at our hospital. The classification system was tested in that cohort of patient. While the ESGS classification system is comprehensive, it does not cover all possibilities. The addition of Sublevels IA, IB, IIA, and IIB may help to address some of the clinical situations seen and is clinically relevant. We aim to test the modified classification system for partial parotidectomy to address some of the challenges mentioned.
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From systems biology to dynamical neuropharmacology: proposal for a new methodology.
Erdi, P; Kiss, T; Tóth, J; Ujfalussy, B; Zalányi, L
2006-07-01
The concepts and methods of systems biology are extended to neuropharmacology in order to test and design drugs for the treatment of neurological and psychiatric disorders. Computational modelling by integrating compartmental neural modelling techniques and detailed kinetic descriptions of pharmacological modulation of transmitter-receptor interaction is offered as a method to test the electrophysiological and behavioural effects of putative drugs. Even more, an inverse method is suggested as a method for controlling a neural system to realise a prescribed temporal pattern. In particular, as an application of the proposed new methodology, a computational platform is offered to analyse the generation and pharmacological modulation of theta rhythm related to anxiety.
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A Proposed Analytical Model for Integrated Pick-and-Sort Systems
Directory of Open Access Journals (Sweden)
Recep KIZILASLAN
2013-11-01
Full Text Available In this study we present an analytical approach for integration of order picking and sortation operations which are the most important, labour intensive and costly activity for warehouses. Main aim is to investigate order picking and sorting efficiencies under different design issues as a function of order wave size. Integrated analytical model is proposed to estimate the optimum order picking and order sortation efficiency. The model, which has been tested by simulations with different illustrative examples, calculates the optimum wave size that solves the trade-off between picking and sorting operations and makes the order picking and sortations efficiency maximum. Our model also allow system designer to predict the order picking and sorting capacity for different system configurations. This study presents an innovative approach for integrated warehouse operations.
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Proposed improvement of the Accounting System of Non-Agricultural Cooperatives
Directory of Open Access Journals (Sweden)
Yamira Mirabal González
2017-12-01
Full Text Available The improvement of the accounting system of the cooperatives should contribute to the consolidation of the cooperative role as a way of economic and social development, in the sphere of agricultural production, and in other sectors of the economy, raising the levels of efficiency and economic efficiency, productive and social. The research is aimed at: Perfecting the accounting system of the non-agricultural cooperative "Café Pinar", based on a set of tools for each of the subsystems that comprise it, which contributes to the improvement of the accounting information generated as part of its management process. The results of the research focus on: the theoretical and methodological foundations of Accounting and Accounting Systems, the results of the diagnosis of the Accounting System of the non-agricultural Cooperative "Café Pinar" and the tools for each of the subsystems that make up the Accounting system of the cooperative. In the development of the research, theoretical methods such as the historical and the logical ones were applied, among these the systemic, the modeling and the axiomatic-deductive. In addition to empirical methods such as scientific observation and measurement. Based on the diagnosis made, the existing deficiencies in the Accounting System of the cooperative object of study were determined. On this basis, the proposal was made to improve its Accounting System that will contribute to the improvement of the accounting information that the cooperative generates as part of its management.
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2010-12-02
... DEPARTMENT OF JUSTICE Office of Justice Programs [OJP (NIJ) Docket No. 1534] Interview Room Video System Standard Special Technical Committee Request for Proposals for Certification and Testing Expertise... Interview Room Video System Standard and corresponding certification program requirements. This work is...
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Proposal for a cryogenic magnetic field measurement system for SSC dipole magnets
International Nuclear Information System (INIS)
Green, M.I.; Hansen, L.
1991-03-01
This proposal describes the research and development required, and the subsequent fabrication of, a system capable of making integrated magnetic multipole measurements of cryogenic 40-mm-bore SSC dipole magnets utilizing a cryogenic probe. Our experience and some preliminary studies indicate that it is highly unlikely that a 16-meter-long probe can be fabricated that will have a twist below several milliradians at cryogenic temperatures. We would anticipate a twist of several milliradians just as a result of cooldown stresses. Consequently, this proposal describes a segmented 16-meter-long probe, for which we intend to calibrate the phase of each segment to within 0.1 milliradians. The data for all segments will be acquired simultaneously, and integrated data will be generated from the vector sums of the individual segments. The calibration techniques and instrumentation required to implement this system will be described. The duration of an integral measurement at one current is expected to be under 10 seconds. The system is based on an extrapolation of the techniques used at LBL to measure cryogenic 1-meter models of SSC magnets with a cryogenic probe. It should be noted that the expansion of the dipole bore from 40 to 50 mm may make a warm-finger device practical at a cost of approximately one quarter of the cryogenic probe. A warm quadrupole measurement system can be based upon the same principles. 5 refs., 9 figs., 1 tab
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mHealth: Mobile Technologies to Virtually Bring the Patient Into an Oncology Practice.
Pennell, Nathan A; Dicker, Adam P; Tran, Christine; Jim, Heather S L; Schwartz, David L; Stepanski, Edward J
2017-01-01
Accompanied by the change in the traditional medical landscape, advances in wireless technology have led to the development of telehealth or mobile health (mHealth), which offers an unparalleled opportunity for health care providers to continually deliver high-quality care. This revolutionary shift makes the patient the consumer of health care and empowers patients to be the driving force of management of their own health through mobile devices and wearable technology. This article presents an overview of technology as it pertains to clinical practice considerations. Telemedicine is changing the way clinical care is delivered without regard for proximity to the patient, whereas nonclinical telehealth applications affect distance education for consumers or clinicians, meetings, research, continuing medical education, and health care management. Technology has the potential to reduce administrative burdens and improve both efficiency and quality of care delivery in the clinic. Finally, the potential for telehealth approaches as cost-effective ways to improve adherence to treatment is explored. As telehealth advances, health care providers must understand the fundamental framework for applying telehealth strategies to incorporate into successful clinical practice.
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Type 2 diabetes patients assessment of the COMODITY12 mHealth system
Directory of Open Access Journals (Sweden)
Przemyslaw Kardas
2015-11-01
Full Text Available Background: Patient acceptance is one of the major barriers toward widespread use of mHealth. The aim of this study was to assess patients’ experience with their use of COMMODITY12 telehealth system. Methods: DM2 patients assessed COMMODITY12 system after its 6 weeks’ long use within clinical trial. Patients opinions were collected with 7-item questionnaire, assessing different aspects of system use, as well as EuroQol-5D-5L generic questionnaire, assessing health-related quality of life. Results: Thirty patients (female, 13, male, 17, mean age +/- SD 59.9 +/- 5.3 completed study. All dimensions of experience with system use were assessed well, with maximum values for clearness of instructions, and ease of use (4.80, and 4.63, respectively. Health related quality of life, as assessed with general utility measure, improved significantly (P<0.05. Conclusions: Study proved that the COMODITY12 system is accepted well by type 2 diabetes patients taking part in clinical trial. Nevertheless, before future commercialisation of the system, several minor problems identified during the study need to be addressed.
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Horn, Brady P; Barragan, Gary N; Fore, Chis; Bonham, Caroline A
2016-01-01
The purpose of this study was to model the cost of delivering behavioural health services to rural Native American populations using telecommunications and compare these costs with the travel costs associated with providing equivalent care. Behavioural telehealth costs were modelled using equipment, transmission, administrative and IT costs from an established telecommunications centre. Two types of travel models were estimated: a patient travel model and a physician travel model. These costs were modelled using the New Mexico resource geographic information system program (RGIS) and ArcGIS software and unit costs (e.g. fuel prices, vehicle depreciation, lodging, physician wages, and patient wages) that were obtained from the literature and US government agencies. The average per-patient cost of providing behavioural healthcare via telehealth was US$138.34, and the average per-patient travel cost was US$169.76 for physicians and US$333.52 for patients. Sensitivity analysis found these results to be rather robust to changes in imputed parameters and preliminary evidence of economies of scale was found. Besides the obvious benefits of increased access to healthcare and reduced health disparities, providing behavioural telehealth for rural Native American populations was estimated to be less costly than modelled equivalent care provided by travelling. Additionally, as administrative and coordination costs are a major component of telehealth costs, as programmes grow to serve more patients, the relative costs of these initial infrastructure as well as overall per-patient costs should decrease. © The Author(s) 2015.
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Directory of Open Access Journals (Sweden)
Catalin STRIMBEI
2006-01-01
Full Text Available Our approach tries to overcome the limitations of so called “flat nature” of relational systems, in the actual context of actual relational database theories, database systems technologies and object oriented methodologies by proposing an MDA framework to map an object oriented (UML formalized model to object-relational structures of today’s database systems.
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International Nuclear Information System (INIS)
2013-01-01
The objective of the TM on “Existing and proposed experimental facilities for fast neutron systems” is threefold: first, it is intended for presenting and exchanging information about existing and planned experimental facilities in support of the development of innovative fast neutron systems; second, it will allow to create a catalogue of existing and planned experimental facilities currently operated/developed within national or international fast reactors programmes; third, once a clear picture of the existing experimental infrastructures is defined, new experimental facilities will be discussed and proposed, on the basis of the identified R&D needs
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Dondeyne, Stefaan; Juilleret, Jérôme; Vancampenhout, Karen; Deckers, Jozef; Hissler, Christophe
2017-04-01
Classification of soils in both World Reference Base for soil resources (WRB) and Soil Taxonomy hinges on the identification of diagnostic horizons and characteristics. However as these features often occur within the first 100 cm, these classification systems convey little information on subsoil characteristics. An integrated knowledge of the soil, soil-to-substratum and deeper substratum continuum is required when dealing with environmental issues such as vegetation ecology, water quality or the Critical Zone in general. Therefore, we recently proposed a classification system of the subsolum complementing current soil classification systems. By reflecting on the structure of the subsoil classification system which is inspired by WRB, we aim at fostering a discussion on some potential future developments of WRB. For classifying the subsolum we define Regolite, Saprolite, Saprock and Bedrock as four Subsolum Reference Groups each corresponding to different weathering stages of the subsoil. Principal qualifiers can be used to categorize intergrades of these Subsoil Reference Groups while morphologic and lithologic characteristics can be presented with supplementary qualifiers. We argue that adopting a low hierarchical structure - akin to WRB and in contrast to a strong hierarchical structure as in Soil Taxonomy - offers the advantage of having an open classification system avoiding the need for a priori knowledge of all possible combinations which may be encountered in the field. Just as in WRB we also propose to use principal and supplementary qualifiers as a second level of classification. However, in contrast to WRB we propose to reserve the principal qualifiers for intergrades and to regroup the supplementary qualifiers into thematic categories (morphologic or lithologic). Structuring the qualifiers in this manner should facilitate the integration and handling of both soil and subsoil classification units into soil information systems and calls for paying
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Takahashi, Masakazu; Nanba, Reiji; Fukue, Yoshinori
This paper proposes operational Risk Management (RM) method using Failure Mode and Effects Analysis (FMEA) for drug manufacturing computerlized system (DMCS). The quality of drug must not be influenced by failures and operational mistakes of DMCS. To avoid such situation, DMCS has to be conducted enough risk assessment and taken precautions. We propose operational RM method using FMEA for DMCS. To propose the method, we gathered and compared the FMEA results of DMCS, and develop a list that contains failure modes, failures and countermeasures. To apply this list, we can conduct RM in design phase, find failures, and conduct countermeasures efficiently. Additionally, we can find some failures that have not been found yet.
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Directory of Open Access Journals (Sweden)
Jana Cason
2014-09-01
Full Text Available The spring 2014 issue of the International Journal of Telerehabilitation (IJT contains four informative and timely policy articles: (1 an invited commentary describing the exploratory process underway within physical therapy to create licensure portability for physical therapists, (2 an analysis of state telehealth laws and regulations for occupational therapy and physical therapy, (3 an overview of telehealth evidence and key telehealth policy issues in occupational therapy, and (4 the World Federation of Occupational Therapists’ (WFOT Position Statement on Telehealth. This issue also contains original research evaluating the feasibility of providing pediatric dysphagia treatment via telepractice, a clinical report of student learning outcomes associated with an innovative experiential learning assignment involving (international teleconsultation in a Master of Science in Occupational Therapy (MSOT curriculum, a book review, and announcements from the American Telemedicine Association.
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Evaluating Cloud Computing in the Proposed NASA DESDynI Ground Data System
Tran, John J.; Cinquini, Luca; Mattmann, Chris A.; Zimdars, Paul A.; Cuddy, David T.; Leung, Kon S.; Kwoun, Oh-Ig; Crichton, Dan; Freeborn, Dana
2011-01-01
The proposed NASA Deformation, Ecosystem Structure and Dynamics of Ice (DESDynI) mission would be a first-of-breed endeavor that would fundamentally change the paradigm by which Earth Science data systems at NASA are built. DESDynI is evaluating a distributed architecture where expert science nodes around the country all engage in some form of mission processing and data archiving. This is compared to the traditional NASA Earth Science missions where the science processing is typically centralized. What's more, DESDynI is poised to profoundly increase the amount of data collection and processing well into the 5 terabyte/day and tens of thousands of job range, both of which comprise a tremendous challenge to DESDynI's proposed distributed data system architecture. In this paper, we report on a set of architectural trade studies and benchmarks meant to inform the DESDynI mission and the broader community of the impacts of these unprecedented requirements. In particular, we evaluate the benefits of cloud computing and its integration with our existing NASA ground data system software called Apache Object Oriented Data Technology (OODT). The preliminary conclusions of our study suggest that the use of the cloud and OODT together synergistically form an effective, efficient and extensible combination that could meet the challenges of NASA science missions requiring DESDynI-like data collection and processing volumes at reduced costs.
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2010-07-16
... Information Collection for Public Comment; LOCCS Voice Response System Payment Vouchers for Public and Indian... lists the following information: Title of Proposal: LOCCS Voice Response System Payment Vouchers for... system. The information collected on the payment voucher will also be used as an internal control measure...
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Catalin STRIMBEI
2006-01-01
Our approach tries to overcome the limitations of so called “flat nature†of relational systems, in the actual context of actual relational database theories, database systems technologies and object oriented methodologies by proposing an MDA framework to map an object oriented (UML formalized) model to object-relational structures of today’s database systems.
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Research Article Special Issue
African Journals Online (AJOL)
pc
2018-05-01
May 1, 2018 ... quantitative method used, data analysis and findings of Telehealth ... The users' acceptance of wireless sensor devise (Motes) for ..... access to specialized health care: the Telehealth Network of Minas Gerais, Brazil. Bulletin ...
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2013-08-16
... DEPARTMENT OF THE INTERIOR Bureau of Safety and Environmental Enforcement [Docket ID BSEE-2013-0005; OMB Control Number 1014-0017: 134E1700D2 EEEE500000 ET1SF0000.DAQ000] Information Collection Activities: Safety and Environmental Management Systems (SEMS); Proposed Collection; Comment Request...
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Proposal of a torus pumping and fuel recycling system for ITER
International Nuclear Information System (INIS)
Perinic, D.; Mack, A.; Perinic, G.; Murdoch, D.
1995-01-01
A universal torus pumping and fuel recycling system is proposed for all operation modes of ITER. It comprises primary cryopumps and secondary fuel separating cryopumps located inside the cryostat and a common mechanical forepump station located outside the cryostat. In this paper two different primary cryopump options are compared. The results of Monte Carlo calculations of pumping probabilities for helium show a significant difference leading to a distinct preference for the concept of a co-pumping cryopump. (orig.)
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Liu, Chunfeng; Lim, Renee L; McCabe, Kathryn L; Taylor, Silas; Calvo, Rafael A
2016-09-12
In the interests of patient health outcomes, it is important for medical students to develop clinical communication skills. We previously proposed a telehealth communication skills training platform (EQClinic) with automated nonverbal behavior feedback for medical students, and it was able to improve medical students' awareness of their nonverbal communication. This study aimed to evaluate the effectiveness of EQClinic to improve clinical communication skills of medical students. We conducted a 2-group randomized crossover trial between February and June 2016. Participants were second-year medical students enrolled in a clinical communication skills course at an Australian university. Students were randomly allocated to complete online EQClinic training during weeks 1-5 (group A) or to complete EQClinic training during weeks 8-11 (group B). EQClinic delivered an automated visual presentation of students' nonverbal behavior coupled with human feedback from a standardized patient (SP). All students were offered two opportunities to complete face-to-face consultations with SPs. The two face-to-face consultations were conducted in weeks 6-7 and 12-13 for both groups, and were rated by tutors who were blinded to group allocation. Student-Patient Observed Communication Assessment (SOCA) was collected by blinded assessors (n=28) at 2 time points and also by an SP (n=83). Tutor-rated clinical communications skill in face-to-face consultations was the primary outcome and was assessed with the SOCA. We used t tests to examine the students' performance during face-to-face consultations pre- and postexposure to EQClinic. We randomly allocated 268 medical students to the 2 groups (group A: n=133; group B: n=135). SOCA communication skills measures (score range 4-16) from the first face-to-face consultation were significantly higher for students in group A who had completed EQClinic training and reviewed the nonverbal behavior feedback, compared with group B, who had completed
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2016-01-01
Background In the interests of patient health outcomes, it is important for medical students to develop clinical communication skills. We previously proposed a telehealth communication skills training platform (EQClinic) with automated nonverbal behavior feedback for medical students, and it was able to improve medical students’ awareness of their nonverbal communication. Objective This study aimed to evaluate the effectiveness of EQClinic to improve clinical communication skills of medical students. Methods We conducted a 2-group randomized crossover trial between February and June 2016. Participants were second-year medical students enrolled in a clinical communication skills course at an Australian university. Students were randomly allocated to complete online EQClinic training during weeks 1–5 (group A) or to complete EQClinic training during weeks 8–11 (group B). EQClinic delivered an automated visual presentation of students’ nonverbal behavior coupled with human feedback from a standardized patient (SP). All students were offered two opportunities to complete face-to-face consultations with SPs. The two face-to-face consultations were conducted in weeks 6–7 and 12–13 for both groups, and were rated by tutors who were blinded to group allocation. Student-Patient Observed Communication Assessment (SOCA) was collected by blinded assessors (n=28) at 2 time points and also by an SP (n=83). Tutor-rated clinical communications skill in face-to-face consultations was the primary outcome and was assessed with the SOCA. We used t tests to examine the students’ performance during face-to-face consultations pre- and postexposure to EQClinic. Results We randomly allocated 268 medical students to the 2 groups (group A: n=133; group B: n=135). SOCA communication skills measures (score range 4–16) from the first face-to-face consultation were significantly higher for students in group A who had completed EQClinic training and reviewed the nonverbal behavior
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2011-03-21
... FEDERAL TRADE COMMISSION [File No. 102 3055] Legacy Learning Systems, Inc.; Analysis of Proposed... electronically or in paper form. Comments should refer to ``Legacy Learning Systems, File No. 102 3055'' to... it. A comment filed in paper form should include the ``Legacy Learning Systems, File No. 102 3055...
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The proposed alignment system for the Final Focus Test Beam at SLAC
International Nuclear Information System (INIS)
Ruland, R.E.; Fischer, G.E.
1990-09-01
This report describes the current state of work in progress with respect to the geometry, alignment requirements, scenarios, and hardware for meeting the tolerances of the Final Focus Test Beam (FFTB) at SLAC. The methods and systems proposed acknowledge that component motion at the micron level, from whatever cause (ground motion, thermal effects, etc.) must be measured on-line and compensated for on relatively short time scales. To provide an integrated alignment/positioning package, some unique designs for reference systems, calibration of effect electric and magnetic centers, and component movers are introduced. 24 refs., 28 figs
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Recommendations for a proposed standard for performing systems analysis
International Nuclear Information System (INIS)
LaChance, J.; Whitehead, D.; Drouin, M.
1998-01-01
In August 1995, the Nuclear Regulatory Commission (NRC) issued a policy statement proposing improved regulatory decisionmaking by increasing the use of PRA [probabilistic risk assessment] in all regulatory matters to the extent supported by the state-of-the-art in PRA methods and data. A key aspect in using PRA in risk-informed regulatory activities is establishing the appropriate scope and attributes of the PRA. In this regard, ASME decided to develop a consensus PRA Standard. The objective is to develop a PRA Standard such that the technical quality of nuclear plant PRAs will be sufficient to support risk-informed regulatory applications. This paper presents examples recommendations for the systems analysis element of a PRA for incorporation into the ASME PRA Standard
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A proposal for the ITER remote participation system in Japan
International Nuclear Information System (INIS)
Nagayama, Y.; Emoto, M.; Kozaki, Y.; Nakanishi, H.; Sudo, S.; Yamamoto, T.; Hiraki, K.; Urushidani, S.
2010-01-01
This paper presents a proposal of the remote participation system for the international thermonuclear experimental reactor (ITER). The object of this paper is to clarify technical issues to analyze the ITER data safely and conveniently. The Japanese case is considered as an example, but technologies presented here can be used worldwide. Major technical issues are as follows: (1) the long distance data transfer; (2) the massive data server; (3) the secure network; (4) the convenient and fast data analysis system. Raw data of ITER can be transferred from France to Japan in a short time by optimizing TCP/IP parameters. The virtual private network (VPN) technology provides a secure environment of the data mirroring and the distributed computation. The analysis server with the WEB user interface enables physicists to analyze the ITER data from the Internet. Streaming data, such as plasma parameters in the steady state, video and sound of the ITER plasma and the status of experiment, which provides feeling of reality, are delivered by using the multi-cast technology. These technologies are being developed in SNET, which is a virtual laboratory for Japanese fusion community. International collaboration is required to develop a global distributed file system and a data analysis system further.
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A proposal for the ITER remote participation system in Japan
Energy Technology Data Exchange (ETDEWEB)
Nagayama, Y., E-mail: nagayama.yoshio@nifs.ac.j [National Institute for Fusion Science, 322-6 Oroshi, Toki 509-5292 (Japan); Emoto, M.; Kozaki, Y.; Nakanishi, H.; Sudo, S.; Yamamoto, T. [National Institute for Fusion Science, 322-6 Oroshi, Toki 509-5292 (Japan); Hiraki, K. [Graduate School of Information Science and Technology, University of Tokyo, 7-3-1 Hongo, Tokyo 113-8656 (Japan); Urushidani, S. [National Institute of Informatics, 2-1-2 Hitotsubashi, Chiyoda-ku, Tokyo 101-8430 (Japan)
2010-07-15
This paper presents a proposal of the remote participation system for the international thermonuclear experimental reactor (ITER). The object of this paper is to clarify technical issues to analyze the ITER data safely and conveniently. The Japanese case is considered as an example, but technologies presented here can be used worldwide. Major technical issues are as follows: (1) the long distance data transfer; (2) the massive data server; (3) the secure network; (4) the convenient and fast data analysis system. Raw data of ITER can be transferred from France to Japan in a short time by optimizing TCP/IP parameters. The virtual private network (VPN) technology provides a secure environment of the data mirroring and the distributed computation. The analysis server with the WEB user interface enables physicists to analyze the ITER data from the Internet. Streaming data, such as plasma parameters in the steady state, video and sound of the ITER plasma and the status of experiment, which provides feeling of reality, are delivered by using the multi-cast technology. These technologies are being developed in SNET, which is a virtual laboratory for Japanese fusion community. International collaboration is required to develop a global distributed file system and a data analysis system further.
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A web application to support telemedicine services in Brazil.
Barbosa, Ana Karina P; de A Novaes, Magdala; de Vasconcelos, Alexandre M L
2003-01-01
This paper describes a system that has been developed to support Telemedicine activities in Brazil, a country that has serious problems in the delivery of health services. The system is a part of the broader Tele-health Project that has been developed to make health services more accessible to the low-income population in the northeast region. The HealthNet system is based upon a pilot area that uses fetal and pediatric cardiology. This article describes both the system's conceptual model, including the tele-diagnosis and second medical opinion services, as well as its architecture and development stages. The system model describes both collaborating tools used asynchronously, such as discussion forums, and synchronous tools, such as videoconference services. Web and free-of-charge tools are utilized for implementation, such as Java and MySQL database. Furthermore, an interface with Electronic Patient Record (EPR) systems using Extended Markup Language (XML) technology is also proposed. Finally, considerations concerning the development and implementation process are presented.
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International Nuclear Information System (INIS)
Nada, S.A.; Elattar, H.F.; Fouda, A.
2015-01-01
Highlights: • Integrative air-conditioning (A/C) and humidification–dehumidification desalination systems are proposed. • Effects of operating parameters on the proposed systems are investigated. • System configurations that have the highest fresh water production rate, power saving and total cost saving are identified. - Abstract: Performance of integrative air-conditioning (A/C) and humidification–dehumidification desalination systems proposed for hot and dry climatic regions is theoretically investigated. The proposed systems aim to energy saving and systems utilization in fresh water production. Four systems with evaporative cooler and heat recovery units located at different locations are proposed, analyzed and evaluated at different operating parameters (fresh air ratio, supply air temperature and outside air wet bulb temperature). Other two basic systems are used as reference systems in proposed systems assessment. Fresh water production rate, A/C cooling capacity, A/C electrical power consumption, saving in power consumptions and total cost saving (TCS) parameters are used for systems evaluations and comparisons. The results show that (i) the fresh water production rates of the proposed systems increase with increasing fresh air ratio, supply air temperature and outdoor wet bulb temperature, (ii) powers saving of the proposed systems increase with increasing fresh air ratio and supply air temperature and decreasing of the outdoor air wet bulb temperature, (iii) locating the evaporative cooling after the fresh air mixing remarkably increases water production rate, and (vi) incorporating heat recovery in the air conditioning systems with evaporative cooling may adversely affect both of the water production rate and the total cost saving of the system. Comparison study has been presented to identify systems configurations that have the highest fresh water production rate, highest power saving and highest total cost saving. Numerical correlations for
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Directory of Open Access Journals (Sweden)
Danny Ochoa
2018-04-01
Full Text Available Wind-diesel hybridization has been emerging as common practice for electricity generation in many isolated power systems due to its reliability and its contribution in mitigating environmental issues. However, the weakness of these kind of power systems (due to their small inertia makes the frequency regulation difficult, particularly under high wind conditions, since part of the synchronous generation has to be set offline for ensuring a suitable tracking of the power demand. This reduces the power system’s ability to absorb wind power variations, leading to pronounced grid frequency fluctuations under normal operating conditions. This paper proposes some corrective actions aimed at enhancing the frequency control capability in weak and isolated power systems: a procedure for evaluating the system stability margin intended for readjusting the diesel-generator control gains, a new wind power curtailment strategy, and an inertial control algorithm implemented in the wind turbines. These proposals are tested in the San Cristobal (Galapagos Islands-Ecuador hybrid wind-diesel power system, in which many power outages caused by frequency relays tripping were reported during the windiest season. The proposals benefits have been tested in a simulation environment by considering actual operating conditions based on measurement data recorded at the island.
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International Nuclear Information System (INIS)
Jusnan Hasim; Mohamad Suhaimi Yahaya; Abdul Razak Hashim
2015-01-01
Nuclear Malaysia has 2 complex located in Bangi and Jalan Dengkil. The utility in Nuclear Malaysia consists of civil, mechanical and electrical system that has been managed by Bahagian Kejuruteraan (BKJ). The mechanical utilities system has been divided to three main groups which are the main system, supporting system and safety equipment's. The objectives of this paper are to propose and plan the rehabilitation works of mechanical utility system in Nuclear Malaysia and also to explain working procedures in maintaining and repairing the mechanical utility system. The study suggest the rehabilitation works on the mechanical utilities system especially on Thermal Energy Storage (TES) and domestic water system needs to be done which involve process of design, procurement, installation and commissioning. (author)
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Oddsson, Lars I E; Radomski, Mary V; White, Matthew; Nilsson, Daniel
2009-01-01
Well-known difficulties of making patients adhere to assigned treatments have made engineers and clinicians look towards technology for possible solutions. Recent studies have found that cell phone-based text messaging can help drive positive changes in patients' disease management and preventive health behavior. Furthermore, work in the area of assistive robotics indicates benefits for patients although robotic solutions tend to become expensive. However, continued improvement in sensor, computer and wireless technologies combined with decreases in cost is paving the way for development of affordable robotic systems that can help improve patient care and potentially add value to the healthcare system. This paper provides a high-level design overview of SKOTEE, the Sister Kenny hOme ThErapy systEm, an inexpensive robotic platform system designed to provide adherence support for home exercise programs, taking medication, appointment reminders and clinician communication. SKOTEE will also offer companionship as well as entertainment and social networking opportunities to the patient in their home. A video of the system is presented at the conference.
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2010-12-13
...; Proposed New System of Records; Veterinary Medicine Loan Repayment Program AGENCY: National Institute of..., ``Veterinary Medicine Loan Repayment Program Records System, USDA/NIFA-1.'' This newly established system will... Sherman; National Program Leader, Veterinary Science; National Institute of Food and Agriculture...
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K P White; A P Sage; F A Rodammer; C T Peters
1985-01-01
The Environmental Advisory Service (EASe) is a decision support system which can provide assistance to local planning agencies in selecting land-development alternatives or in formulating land-use plans. EASe offers a comprehensive and consistent procedure for rating either a development proposal or a proposed plan. This procedure is based upon qualitative assessments of the impact of developments or plans on the natural environment, zoning and land use. public and private services, transport...
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DEFF Research Database (Denmark)
Sørensen, Jan Corfixen; Jørgensen, Bo Nørregaard
2010-01-01
The resource contention problem in control systems based on software agents occurs when agents with different goals compete with each other, to control a shared resource. In this paper we propose the counter-proposal protocol, a negotiation protocol that resolves the resource contention problem...
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2010-10-19
... SOCIAL SECURITY ADMINISTRATION [Docket No. SSA-2010-0066] Proposed Recommendation to the Social Security Administration for Occupational Information System (OIS) Development Planning; Request for Comment...) to provide independent advice and recommendations on plans and activities to create an occupational...
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International Nuclear Information System (INIS)
2013-01-01
The objective of the TM on “Existing and proposed experimental facilities for fast neutron systems” was threefold: 1) presenting and exchanging information about existing and planned experimental facilities in support of the development of innovative fast neutron systems; 2) allow creating a catalogue of existing and planned experimental facilities currently operated/developed within national or international fast reactors programmes; 3) once a clear picture of the existing experimental infrastructures is defined, new experimental facilities are discussed and proposed, on the basis of the identified R&D needs
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International Nuclear Information System (INIS)
Mohd Khairulezwan Abdul Manan; Mohd Idris Taib; Mohd Dzul Aiman Aslan
2010-01-01
Reactor Monitoring System is one of very important part of Reactor Instrumentation and Control system. Current monitoring system is using analog system whereby all circuits are discrete circuit and all displays and indicators are not digitalized. The proposed new system will use using a Commercial Off-The-Shelf, state of the art, Supervisory Control and Data Acquisition system such as Programmable Logic Controller as well as Computer System. The implementations of Programmable Logic Controller are used for Data Acquisition System and as a sub-system for Computer System where all the activities involved are stored for operation record and report as well as use for research purposes. Programmable Logic Controller receives galvanised or optically isolated signal from Reactor Protection System. Programmable Logic Controller also receives signal from other parameters as a digital and analog input related to reactor system. (author)
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PROPOSAL REGARDING THE REFORMATION OF THE ROMANIAN PUBLIC PENSION SYSTEM
Directory of Open Access Journals (Sweden)
Nicolae ECOBICI
2016-06-01
Full Text Available The social insurance system from Romania, reformed continuously since the 90`s, is undergoing a period of serious crisis, with huge and growing deficits, while being far from the principle of social reasonability. Similar situations are found also internationally. The paper aims to answer the following question: how could we implement the principle "equality between present and future generations"? Taking into account the data provided by the National Institute of Statistics from Romania, Eurostat, the World Bank and EU regarding: developments in the birth rate, the number of contributors, life expectancy, the forecasts made in Romania, but also internationally, on sustainability and reasonability of public pension systems, are pessimistic. This paper proposes a solution as simple as it is effective. Why could it not exist in Romania a decent unique minimum pension linked to a decent minimum wage through the mandatory pension contribution rates? Why the welfare of pensioners in 2065 must depend on the existing number of employees in 2065, particularly given the pessimistic demographic forecasts that indicate a population decrease of 20% since 2060? The current PAYG pension system it will not be sustainable in future. Therefore it has to be changed.
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Dependability analysis of proposed I and C architecture for safety systems of a large PWR
International Nuclear Information System (INIS)
Kabra, Ashutosh; Karmakar, G.; Tiwari, A.P.; Manoj Kumar; Marathe, P.P.
2014-01-01
Instrumentation and Control (I and C) systems in a reactor provide protection against unsafe operation during steady-state and transient power operations. Indian reactors traditionally adopted 2-out-of-3 (2oo3) architecture for safety systems. But, contemporary reactor safety systems are employing 2-out-of-4 (2oo4) architecture in spite of the increased cost due to the additional channel. This motivated us to carry out a comparative study of 2oo3 and 2oo4 architecture, especially for their dependability attributes - safety and availability. Quantitative estimation of safety and availability has been used to adjudge the worthiness of adopting 2oo4 architecture in I and C safety systems of a large PWR. Our analysis using Markov model shows that 2oo4 architecture, even with lower diagnostic coverage and longer proof test interval, can provide better safety and availability in comparison of 2oo3 architecture. This reduces total life cycle cost of system during development phase and complexity and frequency of surveillance test during operational phase. The paper also describes the proposed architecture for Reactor Protection System (RPS), a representative safety system, and determines its dependability using Markov analysis and Failure Mode Effect Analysis (FMEA). The proposed I and C safety system architecture also has been qualitatively analyzed for their effectiveness against common cause failures (CCFs). (author)
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Fast reactor primary cover gas system proposals for CDFR
International Nuclear Information System (INIS)
Harrison, L.M.T.
1987-01-01
A primary sodium gas cover has been designed for CDFR, it comprises plant to maintain and control; cover gas pressure for all reactor operating at fault conditions, cover gas purity by both blowdown and by a special clean-up facility and the clean argon supply for the failed fuel detection system and the primary pump seal purge. The design philosophy is to devise a cover gas system that can be specified for any LMFBR where only features like vessel and pipework size need to be altered to suit different design and operating conditions. The choice of full power and shutdown operating pressures is derived and the method chosen to control these values is described. A part active/part passive system is proposed for this duty, a surge volume of 250 m 3 gives passive control between full power and hot shutdown. Pressure control operation criteria is presented for various reactor operating conditions. A design for a sodium aerosol filter, based on that used on PFR is presented, it is specifically designed so that it can be fitted with an etched disc type particulate filter and maintenance is minimised. Two methods that maintain cover gas purity are described. The first, used during normal reactor operation with a small impurities ingress, utilises the continuous blowdown associated with the inevitable clean argon purge through the various reactor component seals. The second method physically removes the impurities xenon and krypton from the cover gas by their adsorption, at cryogenic temperature, onto a bed of activated carbon. The equipment required for these two duties and their mode of operation is described with the aid of a system flow diagram. The primary pump seals requires a gas purge to suppress aerosol migration. A system where the argon used for this task is recirculated and partially purified is described. (author)
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Proposal for development of a system for planning radiotherapy of gliomas
International Nuclear Information System (INIS)
Caldeira, Alexandre D.
2015-01-01
In the last three years, discussions were held on several topics in Nuclear Medicine area, starting with the nuclear data processing, passing by deterministic and stochastic mathematical methods, and finalizing with computer simulations of the following phenomena: neutron transport, applied to boron neutron capture therapy, and neutron diffusion, to study growth of tumor cells. From a mathematical model applied to radiotherapy of gliomas available in literature, it is proposed a strategy for development of a computer system to assist the planning radiotherapy of gliomas. (author)
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Sadey, David J.; Taylor, Linda M.; Beach, Raymond F.
2017-01-01
The development of ultra-efficient commercial vehicles and the transition to low-carbon emission propulsion are seen as strategic thrust paths within NASA Aeronautics. A critical enabler to these paths comes in the form of hybrid electric propulsion systems. For megawatt-class systems, the best power system topology for these hybrid electric propulsion systems is debatable. Current proposals within NASA and the Aero community suggest using a combination of alternating current (AC) and direct current (DC) for power generation, transmission, and distribution. This paper proposes an alternative to the current thought model through the use of a primarily high voltage AC power system, supported by the Convergent Aeronautics Solutions (CAS) Project. This system relies heavily on the use of doubly-fed induction machines (DFIMs), which provide high power densities, minimal power conversion, and variable speed operation. The paper presents background on the activity along with the system architecture, development status, and preliminary results.
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Reif-Lehrer, Liane
1992-09-01
Good communication skills require: (1) an understanding of one's audience and the subtle interactions between writer and reader, (2) organizational skills to methodically progress through the necessary stages of a project (e.g., writing a proposal), and (3) certain basic communication (writing/speaking) skills, i.e., a facility with the basic elements of transmitting information clearly. The task of writing a grant proposal in response to a specific set of instructions is used to illustrate the analysis and responses necessary to complete a major written communication project. The concept of focusing on—and writing for—the reader (in this case, the proposal reviewer) is emphasized. Although good communication skills affect life-styles, productivity, and economics in our society, the communication skills of the American pubic are sorely lacking—even among people with high levels of education—because students receive little training in these skills in the United States educational system. However, such skills can be taught to younger students as well as to adults.
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A proposed orbit and vertical dispersion correction system for PEP
International Nuclear Information System (INIS)
Close, E.; Cornacchia, M.; King, A.S.; Lee, M.J.
1978-07-01
The proposed arrangement of position monitors and dipole magnets for the closed orbit correction system in PEP is described. The computer code ALIGN, which simulates and corrects closed orbit displacements, has been used to study the most effective layout of monitors and correctors. The vertical dispersion function has been computed before and after closed orbit correction. The results indicate that the residual vertical dispersion after the orbit is corrected could exceed the tolerable values. A correction procedure for the vertical dispersion has been studied with the compute code CO-OP and this scheme of correction has been verified experimentally in SPEAR. 9 refs., 8 figs., 2 tabs
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Gallagher, Ryan; Giles, Michelle; Morison, Jane; Henderson, Judith
2018-03-23
To develop and implement a telehealth-based model of care for spinal fractures requiring management with thoracic lumbar sacral orthoses that eliminates the need for transfer to a metropolitan tertiary referral hospital. Pre-post design observational study evaluating model of care implementation. Rural referral hospitals in a large NSW region covering metropolitan, rural and remote hospitals. Patients presenting with a thoracic or lumbar spine fracture requiring thoracic lumbar sacral orthoses management and rural clinicians caring for them. Number of patients managed in rural hospitals without transfer to a metropolitan tertiary referral hospital; length of stay and related cost efficiencies; clinicians' perceived skills, knowledge and confidence levels. Model of care was implemented with clinical and system governance processes; and educational workshops across eight rural hospitals. A total of 81 patients managed in rural hospitals under this model between July 2013 and June 2016 without transfer were included in this study. Mean length of stay reduced from nine to four days. Hospital transfers were eliminated from the patient journey, totalling 24 324 km. Workshops were attended by 71 clinicians from nine rural hospitals and survey findings indicated a significant increase in staff knowledge, skill and confidence post education. Cost efficiencies were gained by eliminating 162 inter-hospital transfers and 405 patient bed days. This model has streamlined patient journeys and reduced transfers and travel, enabling rural clinicians to provide specialised services in local communities and facilitating timely evidence-based care in local communities without any adverse events. © 2018 National Rural Health Alliance Ltd.
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Imam, Bita; Miller, William C; Finlayson, Heather C; Eng, Janice J; Payne, Michael Wc; Jarus, Tal; Goldsmith, Charles H; Mitchell, Ian M
2014-12-22
The number of older adults living with lower limb amputation (LLA) who require rehabilitation for improving their walking capacity and mobility is growing. Existing rehabilitation practices frequently fail to meet this demand. Nintendo Wii Fit may be a valuable tool to enable rehabilitation interventions. Based on pilot studies, we have developed "Wii.n.Walk", an in-home telehealth Wii Fit intervention targeted to improve walking capacity in older adults with LLA. The objective of this study is to determine whether the Wii.n.Walk intervention enhances walking capacity compared to an attention control group. This project is a multi-site (Vancouver BC, London ON), parallel, evaluator-blind randomized controlled trial. Participants include community-dwelling older adults over the age of 50 years with unilateral transtibial or transfemoral amputation. Participants will be stratified by site and block randomized in triplets to either the Wii.n.Walk intervention or an attention control group employing the Wii Big Brain cognitive software. This trial will include both supervised and unsupervised phases. During the supervised phase, both groups will receive 40-minute sessions of supervised group training three times per week for a duration of 4 weeks. Participants will complete the first week of the intervention in groups of three at their local rehabilitation center with a trainer. The remaining 3 weeks will take place at participants' homes using remote supervision by the trainer using Apple iPad technology. At the end of 4 weeks, the supervised period will end and the unsupervised period will begin. Participants will retain the Wii console and be encouraged to continue using the program for an additional 4 weeks' duration. The primary outcome measure will be the "Two-Minute Walk Test" to measure walking capacity. Outcome measures will be evaluated for all participants at baseline, after the end of both the supervised and unsupervised phases, and after 1-year follow up
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Dynamic Response of Dam-Reservoir Systems: Review and a Semi-Analytical Proposal
Directory of Open Access Journals (Sweden)
Paulo Marcelo Vieira Ribeiro
Full Text Available Abstract This paper presents a review of current techniques employed for dynamic analysis of concrete gravity dams under seismic action. Traditional procedures applied in design bureaus, such as the Pseudo-Static method, often neglect structural dynamic properties, as well as ground amplification effects. A practical alternative arises with the Pseudo-Dynamic method, which considers a simplified spectrum response in the fundamental mode. The authors propose a self-contained development and detailed examples of this latter method, including a comparison with finite element models using transient response of fluid-structure systems. It is verified that application of the traditional procedure should be done carefully and limited to extremely rigid dams. On the other hand, the proposed development is straightforward and in agreement with finite element results for general cases where dam flexibility plays an important role.
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Interaction Cross Sections and Survival Rates for Proposed Solar System Member Planet Nine
Li, Gongjie; Adams, Fred C.
2016-05-01
Motivated by the report of a possible new planetary member of the solar system, this work calculates cross sections for interactions between passing stars and this proposed Planet Nine. Evidence for the new planet is provided by the orbital alignment of Kuiper belt objects, and other solar system properties, which suggest a Neptune-mass object on an eccentric orbit with a semimajor axis {a}9 ≈ 400-1500 au. With such a wide orbit, Planet Nine has a large interaction cross section and is susceptible to disruption by passing stars. Using a large ensemble of numerical simulations (several million) and Monte Carlo sampling, we calculate the cross sections for different classes of orbit-altering events: (A) scattering the planet into its proposed orbit from a smaller orbit, (B) ejecting it from the solar system from its current orbit, (C) capturing the planet from another system, and (D) capturing a free-floating planet. Results are presented for a range of orbital elements with planetary mass {m}9 = 10 M ⊕. Removing Planet Nine from the solar system is the most likely outcome. Specifically, we obtain ejection cross sections {σ }{int} ˜ 5 × 106 au2 (5 × 104 au2) for environments corresponding to the birth cluster (field). With these cross sections, Planet Nine is likely to be ejected if the Sun resides within its birth cluster longer than Δt ≳ 100 Myr. The probability of ejecting Planet Nine due to passing field stars is ≲3% over the age of the Sun. Probabilities for producing the inferred Planet Nine orbit are low (≲5%).
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2010-07-01
... water system obtain EPA review of a State proposed small system variance? 142.310 Section 142.310... PRIMARY DRINKING WATER REGULATIONS IMPLEMENTATION Variances for Small System Public Participation § 142.310 How can a person served by the public water system obtain EPA review of a State proposed small...
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Energy Technology Data Exchange (ETDEWEB)
Shakib-Manesh, T.E.; Hirvonen, K.O.; Jalava, K.J.; Ålander, T.; Kuitunen, M.T., E-mail: markku.kuitunen@jyu.fi
2014-11-15
Environmental impacts of small scale projects are often assessed poorly, or not assessed at all. This paper examines the usability of the Rapid Impact Assessment Matrix (RIAM) as a tool to prioritize project proposals for small scale water restoration projects in relation to proposals' potential to improve the environment. The RIAM scoring system was used to assess and rank the proposals based on their environmental impacts, the costs of the projects to repair the harmful impacts, and the size of human population living around the sites. A four-member assessment group (The expert panel) gave the RIAM-scores to the proposals. The assumed impacts of the studied projects at the Eastern Finland water systems were divided into the ecological and social impacts. The more detailed assessment categories of the ecological impacts in this study were impacts on landscape, natural state, and limnology. The social impact categories were impacts to recreational use of the area, fishing, industry, population, and economy. These impacts were scored according to their geographical and social significance, their magnitude of change, their character, permanence, reversibility, and cumulativeness. The RIAM method proved to be an appropriate and recommendable method for the small-scale assessment and prioritizing of project proposals. If the assessments are well documented, the RIAM can be a method for easy assessing and comparison of the various kinds of projects. In the studied project proposals there were no big surprises in the results: the best ranks were received by the projects, which were assumed to return watersheds toward their original state.
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International Nuclear Information System (INIS)
Shakib-Manesh, T.E.; Hirvonen, K.O.; Jalava, K.J.; Ålander, T.; Kuitunen, M.T.
2014-01-01
Environmental impacts of small scale projects are often assessed poorly, or not assessed at all. This paper examines the usability of the Rapid Impact Assessment Matrix (RIAM) as a tool to prioritize project proposals for small scale water restoration projects in relation to proposals' potential to improve the environment. The RIAM scoring system was used to assess and rank the proposals based on their environmental impacts, the costs of the projects to repair the harmful impacts, and the size of human population living around the sites. A four-member assessment group (The expert panel) gave the RIAM-scores to the proposals. The assumed impacts of the studied projects at the Eastern Finland water systems were divided into the ecological and social impacts. The more detailed assessment categories of the ecological impacts in this study were impacts on landscape, natural state, and limnology. The social impact categories were impacts to recreational use of the area, fishing, industry, population, and economy. These impacts were scored according to their geographical and social significance, their magnitude of change, their character, permanence, reversibility, and cumulativeness. The RIAM method proved to be an appropriate and recommendable method for the small-scale assessment and prioritizing of project proposals. If the assessments are well documented, the RIAM can be a method for easy assessing and comparison of the various kinds of projects. In the studied project proposals there were no big surprises in the results: the best ranks were received by the projects, which were assumed to return watersheds toward their original state
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International Nuclear Information System (INIS)
Martins, Marcelo M.; Mauricio, Claudia L.P.; Pereira, Walsan W.; Fonseca, Evaldo S. da; Silva, Ademir X.
2009-01-01
This work presents a criteria and conditions proposal for the regulations in Brazil of individual monitoring systems for neutrons applying the albedo technique with thermoluminescent detectors. Tests are proposed for the characterization performance of the system based on the Regulation ISO 21909 and on the experience of the authors
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Olcay, Ayhan; Emren, Sadık Volkan; Babür Güler, Gamze; Güler, Ekrem; Ertunç, Vedat; Berilgen, Rida; Aslan, Abdullah; Şimşek, Ersin Çağrı; Gölcük, Şükriye Ebru; Yalın, Kıvanç
2017-10-01
Cardiologists participate in the diagnosis and interventional treatment of numerous high-risk patients. The goal of this study was to investigate how the current malpractice system in Turkey influences cardiologists' diagnostic and interventional behavior and to obtain their opinions about an alternative patient compensation system. The present cross-sectional study assessed the practice of defensive medicine among cardiologists who are actively working in various types of workplace within the Turkish healthcare system. A 24-item questionnaire was distributed to cardiology residents, specialists, and academics in Turkey in print format, by electronic mail, or via cell phone message. A total of 253 cardiologists responded to the survey. Among them, 29 (11.6%) had been sued for malpractice claims in the past. Of the cardiologists who had been sued, 2 (6.9%) had been ordered to pay financial compensation, and 1 (3.4%) was given a sentence of imprisonment due to negligence. In all, 132 (52.8%) of the surveyed cardiologists reported that they had changed their practices due to fear of litigation, and 232 (92.8%) reported that they would prefer the new proposed patient compensation system to the current malpractice system. Among the cardiologists surveyed, 78.8% indicated that malpractice fear had affected their decision-making with regard to requesting computed tomography angiography or thallium scintigraphy, 71.6% for coronary angiography, 20% for stent implantation, and 83.2% for avoiding treating high-risk patients. The results of this survey demonstrated that cardiologists may request unnecessary tests and perform unneeded interventions due to the fear of malpractice litigation fear. Many also avoid high-risk patients and interventions. The majority indicated that they would prefer the proposed alternative patient compensation system to the current malpractice system.
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International Nuclear Information System (INIS)
Wang Chuanying; Chen Shiqi
2001-01-01
U.S. proposed 'Generation IV Nuclear Power System' concept. Its origin and proposed goals for it are analyzed; goals are compared with requirements of URD. In particular, discussed issues on nuclear fuel cycle and Non-proliferation. A well-considered nuclear power development plan, paying close attention to international trend and considering comprehensively domestic situation, is expected
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Mutale, Wilbroad; Balabanova, Dina; Chintu, Namwinga; Mwanamwenge, Margaret Tembo; Ayles, Helen
2016-02-01
The current drive to strengthen health systems provides an opportunity to develop new strategies that will enable countries to achieve targets for millennium development goals. In this paper, we present a proposed framework for evaluating a new health system strengthening intervention in Zambia known as Better Health Outcomes through Mentoring and Assessment. We briefly describe the intervention design and focus on the proposed evaluation approach through the lens of systems thinking. In this paper, we present a proposed framework to evaluate a complex health system intervention applying systems thinking concepts. We hope that lessons learnt from this process will help to adapt the intervention and limit unintended negative consequences while promoting positive effects. Emphasis will be paid to interaction and interdependence between health system building blocks, context and the community. © 2014 The Authors. Journal of Evaluation in Clinical Practice published by John Wiley & Sons, Ltd.
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Directory of Open Access Journals (Sweden)
Manel Hlaili
2016-01-01
Full Text Available Photovoltaic (PV energy is one of the most important energy sources since it is clean and inexhaustible. It is important to operate PV energy conversion systems in the maximum power point (MPP to maximize the output energy of PV arrays. An MPPT control is necessary to extract maximum power from the PV arrays. In recent years, a large number of techniques have been proposed for tracking the maximum power point. This paper presents a comparison of different MPPT methods and proposes one which used a power estimator and also analyses their suitability for systems which experience a wide range of operating conditions. The classic analysed methods, the incremental conductance (IncCond, perturbation and observation (P&O, ripple correlation (RC algorithms, are suitable and practical. Simulation results of a single phase NPC grid connected PV system operating with the aforementioned methods are presented to confirm effectiveness of the scheme and algorithms. Simulation results verify the correct operation of the different MPPT and the proposed algorithm.
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Proposal for Holistic Assessment of Urban System Resilience to Natural Disasters
Koren, David; Kilar, Vojko; Rus, Katarina
2017-10-01
Urban system is a complex mix of interdependent components and dynamic interactions between them that enable it to function effectively. Resilience of urban system indicates the ability of a system to resist, absorb, accommodate to and recover from the effects of a hazard in a timely and efficient manner. In the relevant literature, most studies consider individual components separately. On the other hand, the purpose of this paper is to assess the urban system as a whole, considering all relevant components and their interactions. The goal is a study of possibilities for holistic evaluation of urban system resilience to natural disasters. Findings from the preliminary study are presented: (i) the definition of urban system and categorization of its components, (ii) a set of attributes of individual components with impact on disaster resilience of the entire system and (iii) review of different methods and approaches for resilience assessment. Based on literature review and extensive preliminary studies a new conceptual framework for urban resilience assessment is proposed. In the presented paper, a conceptual model of urban system by abstraction of its components as nodes (buildings), patches - specific nodes with spatial properties (open space), links (infrastructures) and base layer (community) is created. In the suggested model, each component is defined by its own quantitative attributes, which have been identified to have an important impact on the urban system resilience to natural disasters. System is presented as a mathematical graph model. Natural disaster is considered an external factor that affects the existing system and leads to some system distortion. In further analyses, mathematical simulation of various natural disasters scenarios is going to be carried out, followed by comparison of the system functionality before and after the accident. Various properties of the system (accessibility, transition, complexity etc.) are going to be analysed with
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Directory of Open Access Journals (Sweden)
E. Weiss
2012-07-01
Full Text Available The aim of the paper is to evaluate return of investment (ROI and cost savings from proposed use of solar systems for residents funded by government grants. The paper deals with proposals for solar energy systems for various use, simple calculations of payback periods of solar systems financed with subsidy and without subsidy. Apart from climatic conditions, chemical composition the of the absorber and structural elements that are made of copper, respectively aluminum and Al-Mg alloy play an important role in assessing the payback period of the investment in solar panels.
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Directory of Open Access Journals (Sweden)
Bijan Rahmani
2016-08-01
Full Text Available Available photovoltaic (PV systems show a prolonged transient response, when integrated into the power grid via active filters. On one hand, the conventional low-pass filter, employed within the integrated PV system, works with a large delay, particularly in the presence of system’s low-order harmonics. On the other hand, the switching of the DC (direct current–DC converters within PV units also prolongs the transient response of an integrated system, injecting harmonics and distortion through the PV-end current. This paper initially develops a wavelet-based low-pass filter to improve the transient response of the interconnected PV systems to grid lines. Further, a damped input filter is proposed within the PV system to address the raised converter’s switching issue. Finally, Matlab/Simulink simulations validate the effectiveness of the proposed wavelet-based low-pass filter and damped input filter within an integrated PV system.
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A proposal to design a Location-based Mobile Cardiac Emergency System (LMCES).
Keikhosrokiani, Pantea; Mustaffa, Norlia; Zakaria, Nasriah; Sarwar, Muhammad Imran
2012-01-01
Healthcare for elderly people has become a vital issue. The Wearable Health Monitoring System (WHMS) is used to manage and monitor chronic disease in elderly people, postoperative rehabilitation patients and persons with special needs. Location-aware healthcare is achievable as positioning systems and telecommunications have been developed and have fulfilled the technology needed for this kind of healthcare system. In this paper, the researchers propose a Location-Based Mobile Cardiac Emergency System (LMCES) to track the patient's current location when Emergency Medical Services (EMS) has been activated as well as to locate the nearest healthcare unit for the ambulance service. The location coordinates of the patients can be retrieved by GPS and sent to the healthcare centre using GPRS. The location of the patient, cell ID information will also be transmitted to the LMCES server in order to retrieve the nearest health care unit. For the LMCES, we use Dijkstra's algorithm for selecting the shortest path between the nearest healthcare unit and the patient location in order to facilitate the ambulance's path under critical conditions.
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Directory of Open Access Journals (Sweden)
Anderson Diogo Spacek
2017-07-01
Full Text Available This work has the objective of developing a methodology for the evaluation of indoor natural lighting systems, which, with speed and practicality, provides from real conditions of use a reliable result about the quality and performance of the proposed system. The methodology is based on the construction of two real-size test environments, which will be subjected to a natural light system through reflexive tubes made from recycled material, and to a commercial system already certified and consolidated, creating the possibility of comparison. Furthermore, the data acquired in the test environments will be examined in light of the values of solar radiation obtained from a digital meteorological station, such that it is possible to stipulate the lighting capacity of the systems at different times of the year.
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Current Landscape of Telemedicine Practice in Inflammatory Bowel Disease.
Patil, Seema A; Cross, Raymond K
2018-04-28
Inflammatory bowel disease (IBD), comprised of Crohn's disease and ulcerative colitis, affects 1.6 million people in the United States. Although effective medical treatments exist to treat the disease, outcomes are still suboptimal. The reasons for poor outcomes vary but include nonadherence to therapy, inadequate monitoring of patients, limited access to IBD specialty care, concurrent psychiatric disease, limited patient knowledge of the disease and treatments, and patient provider discordance. Telemedicine is a candidate intervention that can be used to improve patient outcomes through more frequent monitoring, patient self-management, delivery of education (patient and provider), and to increase access to multidisciplinary IBD care. Telemedicine includes remote monitoring, telehealth, teleconsultation, and teleconferencing.Telemedicine systems have been used in patients with IBD with widespread patient acceptance of the technology. However, early clinical trials demonstrated high attrition rates among intervention patients. In general, use of telemedicine systems have been associated with improved quality of life, improved patient knowledge, and decreased utilization of health care resources. Early studies evaluating telehealth visits report high patient satisfaction, decreased indirect costs to patients, and no decrease in quality of care delivered.Due to widespread access to computers and smart phones among patients, telemedicine will continue to expand in the care of patients with IBD. To optimize use and effectiveness of telemedicine, barriers for use including concerns over increased liability, need for informed consent, licensure restrictions to providing interstate telehealth visits, and cybersecurity need to be addressed.
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An Evaluation of a Proposed Ventilation System for Melbourne's CH2 Building
Directory of Open Access Journals (Sweden)
Lu Aye
2012-11-01
Full Text Available The understanding of ventilation requirements in commercial buildings has been significantly revised in the last 10-15 years. A link between health, productivity and increased fresh air use has been established by some research and this understanding underpins the ventilation philosophy adopted for the CH2 building. The ventilation system design for CH2 that has been evaluated in this paper envisages a mechanically driven system during the day, using the displacement technique to distribute filtered air. All introduced air will be drawn from outside and no recycling of air will occur. Natural ventilation will be employed at night using the stack effect, enhanced by turbine ventilators. This paper critiques the proposed ventilation system in the light of international experience and the particular conditions of the building's location. The evidence suggests that natural ventilation sometimes may be inadequate to achieve the desired objectives. Minimization of indoor pollutants, adequate filtration and high levels of ventilation should, however, ensure satisfactory air quality during occupied hours.
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Proposal for a Visualization System of Purchase Relationship Using ID-POS Data
Directory of Open Access Journals (Sweden)
Ko Hashimoto
2017-08-01
Full Text Available In recent years, big data analysis is gaining immense credence in the fields of academics and business. Businesses such as management and marketing have demonstrated a strong inclination and interest in data analytics. However, many businesses are unable to utilize data even if they have access to it. The main reason for that is the lack of familiarity with data analytics procedures. Hence, a system needs to be developed that can perform data analytics and demonstrate its benefits. In this study, we use point of sales data obtained from a supermarket chain to analyze and show the relationship between purchase goods at the same time. A supermarket is one of the ideal places to demonstrate data analysis because retail stores have many purchase records and are always conducting various marketing activities. We propose an easy-to-handle visualization system to show the goods that are inter-related. By using our system, a store manager can obtain information about the item sales easily and interactively.
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Energy Technology Data Exchange (ETDEWEB)
NONE
2011-07-01
Electric motor-driven system is the largest single energy end use accounting for more than 40% of global electricity consumption. This paper sets out an ambitious but achievable target with the global work plan to improve the energy efficiency of electric motor-driven system by 10% to 15% based on the finding of working paper ''Energy-Efficiency Policy Opportunities for Electric Motor-Driven Systems (Waide et al., 2011)''. If governments commit to the proposed work plan immediately and maintain resourcing levels, this could be achieved by 2030 and it would be equivalent to reducing total global electricity use by around 5%. The proposed work plan of this paper is to align regulatory settings within a globally applicable scheme. The IEA believes this target can only be achieved through global co-operation leading to aligned national policy settings that countries can unlock the economies of scale that will result from using more energy efficient EMDS.
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2011-12-15
... DEPARTMENT OF TRANSPORTATION Federal Aviation Administration 14 CFR Parts 91, 121, 125, 129, and 135 Proposed Provision of Navigation Services for the Next Generation Air Transportation System (Next...) navigation infrastructure to enable performance-based navigation (PBN) as part of the Next Generation Air...
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Hoenig, Helen; Tate, Latoya; Dumbleton, Sarina; Montgomery, Christy; Morgan, Michelle; Landerman, Lawrence R; Caves, Kevin
2013-05-01
To determine whether conditions for use of clinical video telehealth technology might affect the accuracy of measures of physical function. Repeated measures. Veterans Administration Medical Center. Three healthy adult volunteers for a sample size of n=30 independent trials for each of 3 physical function tasks. None. Three tasks capturing differing aspects of physical function: fine-motor coordination (number of finger taps in 30s), gross-motor coordination (number of gait deviations in 10ft [3.05m]), and clinical spatial relations (identifying the proper height for a cane randomly preset ±0-2in [5.1cm] from optimal), with performance simultaneously assessed in person and video recorded. Interrater reliability and criterion validity were determined for the measurement of these 3 tasks scored according to 5 methods: (1) in person (community standard), (2) slow motion review of the video recording (criterion standard), and (3-5) full speed review at 3 Internet bandwidths (64kps, 384kps, and 768kps). Fine-motor coordination-Interrater reliability was variable (r=.43-.81) and criterion validity was poor at 64kps and 384kps, but both were acceptable at 768kps (reliability r=.74, validity β=.81). Gross-motor coordination-Interreliability was variable (range r=.53-.75) and criterion validity was poor at all bandwidths (β=.28-.47). Motionless spatial relations-Excellent reliability (r=.92-.97) and good criterion validity (β=.84-.89) at all the tested bandwidths. Internet bandwidth had differing effects on measurement validity and reliability for the fine-motor task, the gross-motor task, and spatial relations, with results for some tasks at some transmission speeds well below acceptable quality standards and community standards. Copyright © 2013 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.
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Predicting IVF Outcome: A Proposed Web-based System Using Artificial Intelligence.
Siristatidis, Charalampos; Vogiatzi, Paraskevi; Pouliakis, Abraham; Trivella, Marialenna; Papantoniou, Nikolaos; Bettocchi, Stefano
2016-01-01
To propose a functional in vitro fertilization (IVF) prediction model to assist clinicians in tailoring personalized treatment of subfertile couples and improve assisted reproduction outcome. Construction and evaluation of an enhanced web-based system with a novel Artificial Neural Network (ANN) architecture and conformed input and output parameters according to the clinical and bibliographical standards, driven by a complete data set and "trained" by a network expert in an IVF setting. The system is capable to act as a routine information technology platform for the IVF unit and is capable of recalling and evaluating a vast amount of information in a rapid and automated manner to provide an objective indication on the outcome of an artificial reproductive cycle. ANNs are an exceptional candidate in providing the fertility specialist with numerical estimates to promote personalization of healthcare and adaptation of the course of treatment according to the indications. Copyright © 2016 International Institute of Anticancer Research (Dr. John G. Delinassios), All rights reserved.
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da Silva de Queiroz Pierre, Raisa; Kawada, Tarô Arthur Tavares; Fontes, André Guimarães
2012-01-01
Develop a proposal of digital interface for the system of the remote control, that functions as support system during the manipulation of air conditioner adjusted for the users in general, from ergonomic parameters, objectifying the reduction of the problems faced for the user and improving the process. 20 people with questionnaire with both qualitative and quantitative level. Linear Method consists of a sequence of steps in which the input of one of them depends on the output from the previous one, although they are independent. The process of feedback, when necessary, must occur within each step separately.
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Laboratory information management system proposal
Energy Technology Data Exchange (ETDEWEB)
Brown, B.; Schweitzer, S.; Adams, C.; White, S. [Tennessee Univ., Knoxville, TN (United States)
1992-08-01
The objectives of this paper is design a user friendly information management system using a relational database in order to: allow customers direct access to the system; provide customers with direct sample tracking capabilities; provide customers with more timely, consistent reporting; better allocate costs for analyses to appropriate customers; eliminate cumbersome and costly papertrails; and enhance facility utilization by laboratory personnel. The resultant savings through increased efficiency provided by this system should more than offset its cost in the long-term.
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Laboratory information management system proposal
Energy Technology Data Exchange (ETDEWEB)
Brown, B.; Schweitzer, S.; Adams, C.; White, S. (Tennessee Univ., Knoxville, TN (United States))
1992-01-01
The objectives of this paper is design a user friendly information management system using a relational database in order to: allow customers direct access to the system; provide customers with direct sample tracking capabilities; provide customers with more timely, consistent reporting; better allocate costs for analyses to appropriate customers; eliminate cumbersome and costly papertrails; and enhance facility utilization by laboratory personnel. The resultant savings through increased efficiency provided by this system should more than offset its cost in the long-term.
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A Simple and Reliable Health Monitoring System For Shoulder Health: Proposal
Lee, Yann-Long
2014-01-01
Background The current health care system is complex and inefficient. A simple and reliable health monitoring system that can help patients perform medical self-diagnosis is seldom readily available. Because the medical system is vast and complex, it has hampered or delayed patients in seeking medical advice or treatment in a timely manner, which may potentially affect the patient’s chances of recovery, especially those with severe sicknesses such as cancer, and heart disease. Objective The purpose of this paper is to propose a methodology in designing a simple, low cost, Internet-based health-screening platform. Methods This health-screening platform will enable patients to perform medical self-diagnosis over the Internet. Historical data has shown the importance of early detection to ensure patients receive proper treatment and speedy recovery. Results The platform is designed with special emphasis on the user interface. Standard Web-based user-interface design is adopted so the user feels ease to operate in a familiar Web environment. In addition, graphics such as charts and graphs are used generously to help users visualize and understand the result of the diagnostic. The system is developed using hypertext preprocessor (PHP) programming language. One important feature of this system platform is that it is built to be a stand-alone platform, which tends to have better user privacy security. The prototype system platform was developed by the National Cheng Kung University Ergonomic and Design Laboratory. Conclusions The completed prototype of this system platform was submitted to the Taiwan Medical Institute for evaluation. The evaluation of 120 participants showed that this platform system is a highly effective tool in health-screening applications, and has great potential for improving the medical care quality for the general public. PMID:24571980
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A simple and reliable health monitoring system for shoulder health: proposal.
Liu, Shuo-Fang; Lee, Yann-Long
2014-02-26
The current health care system is complex and inefficient. A simple and reliable health monitoring system that can help patients perform medical self-diagnosis is seldom readily available. Because the medical system is vast and complex, it has hampered or delayed patients in seeking medical advice or treatment in a timely manner, which may potentially affect the patient's chances of recovery, especially those with severe sicknesses such as cancer, and heart disease. The purpose of this paper is to propose a methodology in designing a simple, low cost, Internet-based health-screening platform. This health-screening platform will enable patients to perform medical self-diagnosis over the Internet. Historical data has shown the importance of early detection to ensure patients receive proper treatment and speedy recovery. The platform is designed with special emphasis on the user interface. Standard Web-based user-interface design is adopted so the user feels ease to operate in a familiar Web environment. In addition, graphics such as charts and graphs are used generously to help users visualize and understand the result of the diagnostic. The system is developed using hypertext preprocessor (PHP) programming language. One important feature of this system platform is that it is built to be a stand-alone platform, which tends to have better user privacy security. The prototype system platform was developed by the National Cheng Kung University Ergonomic and Design Laboratory. The completed prototype of this system platform was submitted to the Taiwan Medical Institute for evaluation. The evaluation of 120 participants showed that this platform system is a highly effective tool in health-screening applications, and has great potential for improving the medical care quality for the general public.
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Space-based multifunctional end effector systems functional requirements and proposed designs
Mishkin, A. H.; Jau, B. M.
1988-01-01
The end effector is an essential element of teleoperator and telerobot systems to be employed in space in the next decade. The report defines functional requirements for end effector systems to perform operations that are currently only feasible through Extra-Vehicular Activity (EVA). Specific tasks and functions that the end effectors must be capable of performing are delineated. Required capabilities for forces and torques, clearances, compliance, and sensing are described, using current EVA requirements as guidelines where feasible. The implications of these functional requirements on the elements of potential end effector systems are discussed. The systems issues that must be considered in the design of space-based manipulator systems are identified; including impacts on subsystems tightly coupled to the end effector, i.e., control station, information processing, manipulator arm, tool and equipment stowage. Possible end effector designs are divided into three categories: single degree-of-freedom end effectors, multiple degree of freedom end effectors, and anthropomorphic hands. Specific design alternatives are suggested and analyzed within the individual categories. Two evaluations are performed: the first considers how well the individual end effectors could substitute for EVA; the second compares how manipulator systems composed of the top performers from the first evaluation would improve the space shuttle Remote Manipulator System (RMS) capabilities. The analysis concludes that the anthropomorphic hand is best-suited for EVA tasks. A left- and right-handed anthropomorphic manipulator arm configuration is suggested as appropriate to be affixed to the RMS, but could also be used as part of the Smart Front End for the Orbital Maneuvering Vehicle (OMV). The technical feasibility of the anthropomorphic hand and its control are demonstrated. An evolutionary development approach is proposed and approximate scheduling provided for implementing the suggested
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International Nuclear Information System (INIS)
Nishihara, Tetsuo; Hada, Kazuhiko; Shiozawa, Syusaku
1996-03-01
Among key issues of the safety design for an HTGR-hydrogen production system is to ensure the safety of the nuclear reactor against fire and explosion accidents in the hydrogen production plant. The fire and explosion accidents in the hydrogen production plant are categorized into the following two cases; Accidents inside the reactor building (R/B) and accidents outside the R/B. Against accidents inside the R/B, the proposed safety design concept is to prevent the occurrence of the accidents based on the defence in depth concept. The piping system and/or heat transfer tubes which have the potential possibility of combustible materials ingress into the R/B due to the failure are designed at the highest aseismic level to prevent the failure against severe earthquake. Even if the failure occurs, the piping trench and related compartments are fulfilled with nitrogen so as to prevent the occurrence of accidents. The proposed safety design concept for the accidents outside the R/B is the mitigation of effects of accidents. Proposed countermeasures is to take the safe distance between the hydrogen production plant and the items important to safety in the nuclear plant. We showed that the anticipated accidents to estimate the safe distance are large scale pool burning, fireball, pressure vessel burst and vapor cloud explosion. Especially, new estimating concept to establish the safe distance is proposed for the vapor cloud explosion. To reduce the safe distance, we proposed the underground non-pressurized storage tank and ventilation system for the storage of large amount of combustible liquid. (author). 61 refs
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Bosteels, Michel; Haider, S
2001-01-01
Both LHCb RICH will be operated with fluorocarbon as gas radiator. RICH 1 will be filled with 4m^3 of C4F10 and RICH 2 with 100m^3 of CF4. The gas systems will run as a closed loop circulation and a gas recovery system within the closed loop is planned for RICH 1, where the recovery of the CF4 will only be realised during filling and emptying of the detector. Inline gas purification is foreseen for the gas systems in order to limit water and oxygen impurities.
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Training digital divide seniors to use a telehealth system: a remote training approach.
Lai, Albert M; Kaufman, David R; Starren, Justin
2006-01-01
As the use of health information technologies continues to proliferate amongst seniors, many of whom lack computer experience, there is a need to develop effective training approaches to foster basic competencies. This paper describes the REmote Patient Education in a Telemedicine Environment (REPETE) system, a component of the IDEATel telemedicine architecture. The REPETE architecture supports simultaneous visual and audio teaching modes over low bandwidth connections. This paper presents an in-depth qualitative analysis of two patients being trained to use the IDEATel patient web portal. The results indicate that this method of instruction was useful in facilitating patients' use of the web application. However, the observations suggest that there is learning curve for the trainer to use the resources effectively to establish common ground and foster competencies in the patient.
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2010-10-01
... Waste Management System; Identification and Listing of Hazardous Waste; Proposed Rule AGENCY... exclude (or delist) a certain solid waste generated by its Beaumont, Texas, facility from the lists of hazardous wastes. EPA used the Delisting Risk Assessment Software (DRAS) Version 3.0 in the evaluation of...
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International Nuclear Information System (INIS)
Barsotti, E.; Booth, A.; Bowden, M.; Swoboda, C.; Lockyer, N.; Vanberg, R.
1990-01-01
A new era of high-energy physics research is beginning requiring accelerators with much higher luminosities and interaction rates in order to discover new elementary particles. As a consequence, both orders of magnitude higher data rates from the detector and online processing power, well beyond the capabilities of current high energy physics data acquisition systems, are required. This paper describes a proposed new data acquisition system architecture which draws heavily from the communications industry, is totally parallel (i.e., without any bottlenecks), is capable of data rates of hundreds of Gigabytes per second from the detector and into an array of online processors (i.e., processor farm), and uses an open systems architecture to guarantee compatibility with future commercially available online processor farms. The main features of the proposed Scalable Parallel Open Architecture data acquisition system are standard interface ICs to detector subsystems wherever possible, fiber optic digital data transmission from the near-detector electronics, a self-routing parallel event builder, and the use of industry-supported and high-level language programmable processors in the proposed BCD system for both triggers and online filters. A brief status report of an ongoing project at Fermilab to build a prototype of the proposed data acquisition system architecture is given in the paper. The major component of the system, a self-routing parallel event builder, is described in detail
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Presence of radioactivity in a sewage system: a proposal for radioactivity control
International Nuclear Information System (INIS)
Serradell, Vicente; Ballesteros, Luisa; Ortiz, Josefina
2008-01-01
Most hospitals use radioisotopes in diagnostics and to a lesser extent in therapy. The liquid residues thus generated are usually subjected to treatment before being discharged into the sewage system. Nevertheless, a certain amount of these residues escape from the treatment system and are poured directly into the sewer. In addition, other radioactive products used for research and industrial purposes may also be disposed of in the same way. The waste waters in many sewage systems can therefore be expected to be radiologically contaminated and the need for at least a basic control system in such situations seems obvious. When designing a procedure to measure radioactivity, certain conditions should be borne in mind: 1) The control program has to be simple and inexpensive; 2) Samples must be taken from the appropriate places; 3) Short life radionuclides will probably be present in significant amounts, so that specific recipes should be prepared; 4) Iodine is also frequently present. Special precautions should be taken to keep it in solution. In recent years, the Environmental Radioactivity Laboratory of the Universidad Politecnica de Valencia (Spain) has carried out a series of tests on the Valencia city sewage system and sewage treatment plant in order to design a permanent program to control radioactive contamination of the city's sewage system. This paper presents a proposal which we believe can provide the answer to this problem. (author)
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Health care professionals’ perception of security of personal health devices
Directory of Open Access Journals (Sweden)
Ondiege B
2017-04-01
Full Text Available Brian Ondiege, Malcolm Clarke Department of Computer Science, College of Engineering, Design and Physical Sciences, Brunel University London, UK Abstract: With the rapid advances in the capabilities of telehealth devices and their increasing connection to the Internet, security is becoming an issue of major concern. Therefore, the perceptions of the health care professionals regarding security are of interest, as the patients trust them to make informed decisions on issues concerning their privacy, data, and health. Eight health care professionals were interviewed to determine their perceptions and knowledge of security in health care. The research further examines one specific aspect of security which is considered of significant concern: the authenticity of a device being from the actual manufacturer and not a counterfeit. This research proposes device registration together with digital signatures and one-time passwords to address the issue of counterfeit remote patient-monitoring devices and identify and authenticate the user of the device. Keywords: telehealth security, health care professionals’ perception, personal health device, authentication
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Directory of Open Access Journals (Sweden)
Nazareth Arguedas-Zumbado
2016-08-01
Full Text Available Due to a change in environmental paradigm and the production increase, this document is a proposal for remodeling the CONCREPAL’s settler located in Barranca, Costa Rica. It is presented as an eco-efficient alternative that simultaneously enables compliance with current legislation on landfill and wastewater reuse. Initially, an environmental diagnosis of the characteristics and performance of the current sedimentation tank was made. Subsequently, the design of the proposed remodeling of the treatment system, incorporating the recirculation of treated water in the breaker material production process, was developed. Finally, a life-size settler model was created in a test environment in order to start measurements tests and determine the functionality; successfully, after all tests, positive results within the range allowed by national legislation on total suspended-solids concentration (40 ± 0.01 mg/l were obtained. Thanks to the cost-benefit and environmental management analysis, a new settler system can be implemented with positive short and long term results for the company.
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Imam, Bita; Finlayson, Heather C; Eng, Janice J; Payne, Michael WC; Jarus, Tal; Goldsmith, Charles H; Mitchell, Ian M
2014-01-01
Background The number of older adults living with lower limb amputation (LLA) who require rehabilitation for improving their walking capacity and mobility is growing. Existing rehabilitation practices frequently fail to meet this demand. Nintendo Wii Fit may be a valuable tool to enable rehabilitation interventions. Based on pilot studies, we have developed “Wii.n.Walk”, an in-home telehealth Wii Fit intervention targeted to improve walking capacity in older adults with LLA. Objective The objective of this study is to determine whether the Wii.n.Walk intervention enhances walking capacity compared to an attention control group. Methods This project is a multi-site (Vancouver BC, London ON), parallel, evaluator-blind randomized controlled trial. Participants include community-dwelling older adults over the age of 50 years with unilateral transtibial or transfemoral amputation. Participants will be stratified by site and block randomized in triplets to either the Wii.n.Walk intervention or an attention control group employing the Wii Big Brain cognitive software. This trial will include both supervised and unsupervised phases. During the supervised phase, both groups will receive 40-minute sessions of supervised group training three times per week for a duration of 4 weeks. Participants will complete the first week of the intervention in groups of three at their local rehabilitation center with a trainer. The remaining 3 weeks will take place at participants’ homes using remote supervision by the trainer using Apple iPad technology. At the end of 4 weeks, the supervised period will end and the unsupervised period will begin. Participants will retain the Wii console and be encouraged to continue using the program for an additional 4 weeks’ duration. The primary outcome measure will be the “Two-Minute Walk Test” to measure walking capacity. Outcome measures will be evaluated for all participants at baseline, after the end of both the supervised and
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ETSON proposal on the European operational experience feedback system
International Nuclear Information System (INIS)
Maqua, Michael; Bertrand, Remy; Gelder, Pieter de
2007-01-01
The new IAEA Safety Fundamentals states regarding the operating experience feedback: The feedback of operating experience from facilities and activities - and, where relevant, from elsewhere - is a key means of enhancing safety. Processes must be put in place for the feedback and analysis of operating experience, including initiating events, accident precursors, near misses, accidents and unauthorized acts, so that lessons may be learned, shared and acted upon. This presentation deals with the proposal of the ETSON (European TSO Network) to optimize the European operating experiences feedback (OEF). It is generally recognized that the efficiency of nuclear safety supervision by public authorities is based on two key requirements: - the existence of a competent authority at national level, benefiting from an appropriate legislative and regulatory basis, from adequate (quantitatively and qualitatively) human resources, particularly for inspection purposes, - the availability of resources devoted to highly specialised independent technical expertise, in order to provide competent authorities with pertinent technical opinions on: -- the safety files provided by operators, for the purpose of licensing corresponding activities, -- the exploitation for regulatory purposes of the operating experience feed back from licensed nuclear installations. There are two worldwide systems intended to learn lessons from experience: the WANO (World Association of Nuclear Operators) system established by the licensees with access restricted to operating organizations and the IRS system jointly operated by IAEA and OECD/NEA accessible to regulators and to some other users nominated by the regulators in their countries. The IRS itself is dedicated to the analysis of safety significant operating events. NEA/CNRA runs a permanent working group on operating experience (WGOE). WGOE provides among other things also generic reports on safety concerns related to operating experiences and
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2011-01-28
... will dispose of the leachate at a publicly owned treatment works or at an industrial waste disposal... classification of listed waste pursuant to Sec. Sec. 261.31 and 261.32. Specifically, in its petition, Gulf West... Waste Management System; Identification and Listing of Hazardous Waste; Proposed Rule AGENCY...
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3D Information System of Historical Site – Proposal and Realisation of a Functional Prototype
Directory of Open Access Journals (Sweden)
J. Hodač
2005-01-01
Full Text Available The development of methods for 3D data acquisition, together with progress in information technologies raises the question of creating and using 3D models and 3D information systems (IS of historical sites and buildings. This paper presents the current state of the “Live Theatre” project. The theme of the project is the proposal and realisation of a 3D IS of the baroque theatre at Eeský Krumlov castle (UNESCO site.The project is divided into three main stages – creation of a 3D model, proposal of a conception for a 3D IS, and realisation of a functional prototype. 3D data was acquired by means of photogrammetric and surveying methods. An accurate 3D model (photo-realistic, textured was built up with MicroStation CAD system. The proposal of a conception of a 3D IS was the main outcome of the author’s dissertation. The essential feature of the proposed conception is the creation of subsystems targeted on three spheres – management, research and presentation of the site. The functionality of each subsystem is connected with its related sphere; however, each subsystem uses the same database. The present stage of the project involves making a functional prototype (with sample data. During this stage we are working on several basic technological topics. At present we are concerned with 3D data, its formats, format conversions (e.g. DGN _ VRML and its connection to other types of data. After that, we will be seeking a convenient technical solution based on network technologies (Internet and an appropriate layout for the data (database. The project is being carried out in close co-operation with the administration of the castle and some other partners. This stage of the project will be completed in December 2005.A functional prototype and the information acquired by testing it will form the basis for the final proposal of a complex IS of a historical site. The final proposal and appropriate technology will be the outcome of the project. The
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Four proposals for market-based health care system reform.
Sumner, W
1994-08-01
A perfectly free, competitive medical market would not meet many social goals, such as universal access to health care. Micromanagement of interactions between patients and providers does not guarantee quality care and frequently undermines that relationship, to the frustration of all involved. Furthermore, while some North American health care plans are less expensive than others, none have reduced the medical inflation rate to equal the general inflation rate. Markets have always fixed uneven inflation rates in other domains. The suggested reforms could make elective interactions between patients and providers work more like a free market than did any preceding system. The health and life insurance plan creates cost-sensitive consumers, informed by a corporation with significant research incentives and abilities. The FFEB proposal encourages context-sensitive pricing, established by negotiation processes that weigh labor and benefit. Publication of providers' expected outcomes further enriches the information available to consumers and may reduce defensive medicine incentives. A medical career ladder would ease entry and exit from medical professions. These and complementary reforms do not specifically cap spending yet could have a deflationary impact on elective health care prices, while providing incentives to maintain quality. They accomplish these ends by giving more responsibility, information, incentives, and choice to citizens. We could provide most health care in a marketlike environment. We can incorporate these reforms in any convenient order and allow them to compete with alternative schemes. Our next challenge is to design, implement, and evaluate marketlike health care systems.
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International Nuclear Information System (INIS)
Nagamatsu, Takashi; Otsuji, Tomoo; Yoshikawa, Hidekazu; Shiba, Shigenari
2004-01-01
A framework for solving human factors of artificial systems is proposed in this study, where a whole system of machines and the human organization that involves in the operation and management of machines is defined as an 'artificial system'. Five aspects of human factors in the artificial system are first discussed, and the types of artificial system with respect to the human factors are divided into three levels from a viewpoint of complexity. A framework that can treat artificial systems by unified methodology has been proposed for treating both the complexity level and the different kinds of human factors. As a concrete example of this framework application, a prototype system has been developed for advanced plant maintenance support by using ES-HMD (Eye Sensing-Head Mounted Display). This is a remote communication system of cooperative maintenance work between the expert in a remote support center and the maintenance worker at a certain machine in the plant site to conduct a complicated task without committing human error. It was confirmed by laboratory experiment that the expert would instruct the worker so that he or she could perform the task successfully, by observing the worker's eye gazing point and by pointing the right place of action on the transferred display of the worker's eyesight through the ES-MHD. (author)
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Directory of Open Access Journals (Sweden)
Lluís Codina
2014-05-01
Full Text Available Throughout this article, we are presenting a proposal to conduct digital media studies as one of the first deliverables of an ongoing research project. This proposal, which we are calling “Articulated System to Analyse Digital Media” (ASADM: consists of a set of concepts presented through specific terminology, and of a group of articulated elements allowing to determine what we call the what (parameters and how (indicators of any future study regarding online newspapers or digital media. Thus, we obtain an operative analysis protocol as a deliverable. In between, we characterize the typical context of the sort of studies that constitute the context for our proposal.
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Berkowitz, Murray R
2013-01-01
Current information systems for use in detecting bioterrorist attacks lack a consistent, overarching information architecture. An overview of the use of biological agents as weapons during a bioterrorist attack is presented. Proposed are the design, development, and implementation of a medical informatics system to mine pertinent databases, retrieve relevant data, invoke appropriate biostatistical and epidemiological software packages, and automatically analyze these data. The top-level information architecture is presented. Systems requirements and functional specifications for this level are presented. Finally, future studies are identified.
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A Proposal of a Color Music Notation System on a Single Melody for Music Beginners
Kuo, Yi-Ting; Chuang, Ming-Chuen
2013-01-01
Music teachers often encounter obstructions in teaching beginners in music reading. Conventional notational symbols require beginners to spend significant amount of time in memorizing, which discourages learning at early stage. This article proposes a newly-developed color music notation system that may improve the recognition of the staff and the…
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International Nuclear Information System (INIS)
Su, Bosheng; Han, Wei; Jin, Hongguang
2017-01-01
Highlights: •A novel CCHP system with biogas steam reforming using solar energy is raised. •Chemical and physical energy of biogas is efficiently used in a cascaded way. •The energy quality of concentrating solar heat is promoted in the system. •A parametric analysis is adopted to optimize the thermodynamic performance. •A typical-day study is conducted to explore the general operation features. -- Abstract: The conventional way to utilize biogas either is energy-intensive due to biogas upgrading or causes huge waste of energy grade and environmental pollution by direct burning. This paper proposes a biogas and solar energy-assisted combined cooling, heating and power (BSCCHP) system that upgrades the caloric value of biogas before combustion by introducing a thermochemical conversion process that is driven by solar heat. Adopting commercially established technologies including steam reforming and parabolic dish concentrators, the system exhibits an enhanced system exergy efficiency, and the technology considerably reduces the direct CO 2 footprint and saves depletable fossil fuel. With a solar thermal share of 22.2%, the proposed system not only has a high net solar-to-product thermal and exergy efficiency of 46.80% and 26.49%, respectively, but also results in a commensurate 18.27% reduction of the direct CO 2 footprint compared with the reference individual systems. The effect of critical parameters in the biogas steam reforming process on the system performance was studied. A proper selection of the steam/carbon ratio leads to the optimal direct CO 2 footprint and system exergy efficiency. Pursuing a very high conversion of biogas by improving the reforming temperature is not a wise choice from a system perspective. Finally, a typical-day dynamic simulation was conducted to preliminarily explore the general operation features. This study may provide a new way to efficiently use the renewable energy in the distributed energy system.
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A proposed classification system for high-level and other radioactive wastes
International Nuclear Information System (INIS)
Kocher, D.C.; Croff, A.G.
1987-06-01
This report presents a proposal for quantitative and generally applicable risk-based definitions of high-level and other radioactive wastes. On the basis of historical descriptions and definitions of high-level waste (HLW), in which HLW has been defined in terms of its source as waste from reprocessing of spent nuclear fuel, we propose a more general definition based on the concept that HLW has two distinct attributes: HLW is (1) highly radioactive and (2) requires permanent isolation. This concept leads to a two-dimensional waste classification system in which one axis, related to ''requires permanent isolation,'' is associated with long-term risks from waste disposal and the other axis, related to ''highly radioactive,'' is associated with shorter-term risks due to high levels of decay heat and external radiation. We define wastes that require permanent isolation as wastes with concentrations of radionuclides exceeding the Class-C limits that are generally acceptable for near-surface land disposal, as specified in the US Nuclear Regulatory Commission's rulemaking 10 CFR Part 61 and its supporting documentation. HLW then is waste requiring permanent isolation that also is highly radioactive, and we define ''highly radioactive'' as a decay heat (power density) in the waste greater than 50 W/m 3 or an external radiation dose rate at a distance of 1 m from the waste greater than 100 rem/h (1 Sv/h), whichever is the more restrictive. This proposal also results in a definition of Transuranic (TRU) Waste and Equivalent as waste that requires permanent isolation but is not highly radioactive and a definition of low-level waste (LLW) as waste that does not require permanent isolation without regard to whether or not it is highly radioactive
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Clarke, Malcolm; Mars, Maurice
2015-02-01
We investigated the use of third-generation (3G) mobile communications to provide telehealth services in remote health clinics in rural KwaZulu-Natal, South Africa. We specified a minimal set of services as our use case that would be representative of typical activity and to provide a baseline for analysis of network performance. Services included database access to manage chronic disease, local support and management of patients (to reduce unnecessary travel to the hospital), emergency care (up to 8 h for an ambulance to arrive), e-mail, access to up-to-date information (Web), and teleclinics. We made site measurements at a representative set of health clinics to determine the type of coverage (general packet radio service [GPRS]/3G), its capabilities to support videoconferencing (H323 and Skype™ [Microsoft, Redmond, WA]) and audio (Skype), and throughput for transmission control protocol (TCP) to gain a measure of application performance. We found that none of the remote health clinics had 3G service. The GPRS service provided typical upload speed of 44 kilobits per second (Kbps) and download speed of 64 Kbps. This was not sufficient to support any form of videoconferencing. We also observed that GPRS had significant round trip time (RTT), in some cases in excess of 750 ms, and this led to slow start-up for TCP applications. We found audio was always so broken as to be unusable and further observed that many applications such as Web access would fail under conditions of very high RTT. We found some health clinics were so remote that they had no mobile service. 3G, where available, had measured upload speed of 331 Kbps and download speed of 446 Kbps and supported videoconferencing and audio at all sites, but we frequently experienced 3G changing to GPRS. We conclude that mobile communications currently provide insufficient coverage and capability to provide reliable clinical services and would advocate dedicated wireless services where reliable
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Huang, Yu
Solar energy becomes one of the major alternative renewable energy options for its huge abundance and accessibility. Due to the intermittent nature, the high demand of Maximum Power Point Tracking (MPPT) techniques exists when a Photovoltaic (PV) system is used to extract energy from the sunlight. This thesis proposed an advanced Perturbation and Observation (P&O) algorithm aiming for relatively practical circumstances. Firstly, a practical PV system model is studied with determining the series and shunt resistances which are neglected in some research. Moreover, in this proposed algorithm, the duty ratio of a boost DC-DC converter is the object of the perturbation deploying input impedance conversion to achieve working voltage adjustment. Based on the control strategy, the adaptive duty ratio step size P&O algorithm is proposed with major modifications made for sharp insolation change as well as low insolation scenarios. Matlab/Simulink simulation for PV model, boost converter control strategy and various MPPT process is conducted step by step. The proposed adaptive P&O algorithm is validated by the simulation results and detail analysis of sharp insolation changes, low insolation condition and continuous insolation variation.
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Proposed revision of the Cumberland System Power Marketing Policy and subsequent contracts
International Nuclear Information System (INIS)
1992-01-01
Southeastern Power Administration has prepared an Environmental Assessment (DOE/EA-0811) evaluating the proposed revision of the Cumberland System Power Marketing Policy and Subsequent Contracts. The findings of the Environmental Assessment (EA) are: the only significant change from the existing policy will be the term of the contracts executed under the revised policy; and there will be no addition of major new generation resources; there will be no new loads; there will be no major changes in the operating parameters of power generation resources. This paper discusses the need for action, the alternative and the environmental impacts
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Telemedicine and the mini-mental state examination: assessment from a distance.
Ciemins, Elizabeth L; Holloway, Barbara; Coon, Patricia Jay; McClosky-Armstrong, Thelma; Min, Sung-Joon
2009-06-01
The objective of this study was to determine the reliability of the Mini-Mental State Examination (MMSE) administration via telehealth with a focus on the auditory and visual test components. Reliability was assessed through use of an in-person collaborator and by assessment of faxed test copies. The MMSE was administered via telehealth with the assistance of a face-to-face collaborator. Patient responses were recorded by both the remote and in-person nurse and compared item by item; total scores for each subject were also compared. Visual items were assessed through a blinded separate scoring of a faxed copy. Percent agreement per item and total score were calculated and correlations between scores were determined by Pearson correlation coefficients. Mean score differences and associated 95% confidence intervals were calculated. Eighty percent of individual items demonstrated remote to in-person agreement of >95% and all items were >85.5% in agreement. Pearson correlation coefficients demonstrated high correlations (>0.86) between 80% of the items examined. Mean differences in scored test items were not significantly different from zero. This study demonstrates the utility of using telehealth for cognitive assessment by MMSE. It supports the use of telehealth to improve healthcare access among patients for whom distance, cost, and mobility are potential barriers to attending face-to-face clinical visits. Continued validation and reliability testing is warranted to ensure that all healthcare provided via telehealth maintains an equal quality level to that of in-person care.
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Energy Technology Data Exchange (ETDEWEB)
Murthy, N.V.S.N. [Ingersoll-Rand (I) Ltd., Bangalore (India)
1996-12-31
A new approach for hardenability evaluation and its application to heat treatable steels will be discussed. This will include an overview and deficiencies of the current methods and discussion on the necessity for a new approach. Hardenability terminology will be expanded to avoid ambiguity and over-simplification as encountered with the current system. A new hardenability definition is proposed. Hardenability specification methods are simplified and rationalized. The new hardenability evaluation system proposed here utilizes a test specimen with varying diameter as an alternative to the cylindrical Jominy hardenability test specimen and is readily applicable to the evaluation of a wide variety of steels with different cross-section sizes.
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International Nuclear Information System (INIS)
Qu Jingyuan; Wang Xingyu; Xue Dazhi; Shi Zhongqi; Xi Shuren; Cao Jianzhu
2003-01-01
As an important part of Chinese three-level nuclear emergency management system, decision support/accident consequence assessment systems have primarily been established at national, provincial and licensee levels. Valuable experience has been accumulated in the development, operation and maintenance of these systems. At the same time, more and more attention has been paid to their performance regarding to accurate judgment and forecast as well as the application of the information provided by them in a decision-making in the event of an accident. This paper briefly presents current status of the development and application of the systems in China. Then it discusses the need to establish a comprehensive network of decision support/accident consequence assessment systems based on the current systems built up at national, provincial and licensee levels. Finally, the way by which this ultimate goal can be achieved is proposed in this paper
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Energy Technology Data Exchange (ETDEWEB)
Pardo Martinez, C.I.; Alfonso, W.H
2016-07-01
In last decades, scientific culture has become a key element of Governance of Science, Technology and Innovation in the countries where it is important to determine measurement to analysis trends on scientific culture. Research questions that guide this paper are the following: i. What are information needs on scientific culture in Colombia?; ii. How can be measured scientific culture?; iii. What is the adequate structure for indicators of scientific culture?. In order to answer these questions, a mix of methodologies is used. First, we review the literature on scientific culture and indicators related to this topic. Second, we made a series of interviews with staff members of Colciencias to determine requirements of measurement on scientific culture. Third, with this information, we built an information matrix to prioritise information and determine indicators with respective metrics, and sources according to relevance and cost-effectiveness of estimation. Fourth, from indicators formulated and an indicator system is proposed determining for every dimension of scientific culture indicators related to inputs, process, and outputs designed indicator sheets that includes definition, objective, sources aggregation levels, time series, and calculation methods for indicators proposed. This study achieves formulate an indicator system from the definition of scientific culture a and its dimension proposing around 60 indicators through a multidimensional model that integrates different elements of scientific culture such as the individual and society establishing indicators to measure inputs, process and outputs in general form and specific initiatives for Colciencias. (Author)
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The costs and risks of doing business with the proposed monitored retrievable storage system
International Nuclear Information System (INIS)
Rhodes, S.H.; Stucker, J.J.
1985-01-01
During the three and a half years that the Nuclear Waste Policy Act has been law, the Department of Energy (DOE) has been proceeding, albeit with some delays in its schedule, with its responsibility to establish a permanent repository for the disposal of this country's high-level nuclear wastes. As an adjunct to its responsibility, the DOE has recently proposed a major new program objective. A Monitored Retrievable Storage (MRS) facility has been suggested to relieve utility responsibility for spent fuel storage in 1996, two years prior to the most optimistic current plans for the opening of a permanent repository. The MRS would operate in conjunction with a proposed ''integrated packaging and handling system'' which would accomplish rod consolidation of most spent fuel before permanent emplacement in the repository. This large-scale MRS facility, if approved by Congress and successfully licensed, would mark the beginning of an unnecessary and expensive large-scale federally sponsored temporary storage program for civilian nuclear wastes. Furthermore, the MRS proposal could be expected to divert DOE attention from the permanent repository program which DOE is charged by law to implement
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Marceglia, S; Fontelo, P; Rossi, E; Ackerman, M J
2015-01-01
Mobile health Applications (mHealth Apps) are opening the way to patients' responsible and active involvement with their own healthcare management. However, apart from Apps allowing patient's access to their electronic health records (EHRs), mHealth Apps are currently developed as dedicated "island systems". Although much work has been done on patient's access to EHRs, transfer of information from mHealth Apps to EHR systems is still low. This study proposes a standards-based architecture that can be adopted by mHealth Apps to exchange information with EHRs to support better quality of care. Following the definition of requirements for the EHR/mHealth App information exchange recently proposed, and after reviewing current standards, we designed the architecture for EHR/mHealth App integration. Then, as a case study, we modeled a system based on the proposed architecture aimed to support home monitoring for congestive heart failure patients. We simulated such process using, on the EHR side, OpenMRS, an open source longitudinal EHR and, on the mHealth App side, the iOS platform. The integration architecture was based on the bi-directional exchange of standard documents (clinical document architecture rel2 - CDA2). In the process, the clinician "prescribes" the home monitoring procedures by creating a CDA2 prescription in the EHR that is sent, encrypted and de-identified, to the mHealth App to create the monitoring calendar. At the scheduled time, the App alerts the patient to start the monitoring. After the measurements are done, the App generates a structured CDA2-compliant monitoring report and sends it to the EHR, thus avoiding local storage. The proposed architecture, even if validated only in a simulation environment, represents a step forward in the integration of personal mHealth Apps into the larger health-IT ecosystem, allowing the bi-directional data exchange between patients and healthcare professionals, supporting the patient's engagement in self
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Proposal of a system of indicators to assess the training of experts in a high-tech organization
International Nuclear Information System (INIS)
Elías Hardy, Lidia Lauren; González Olaguive, Elizabeth Vicenta; Martínez Martínez, Elisa
2015-01-01
Objective: present a proposal of a system of indicators to assess actions aimed at the training and development of experts in a high-tech organization. Methods: an analysis was conducted of the various theories dealing with the training and development of experts, examining their features and components. Design of the system of indicators was based on surveys and direct observation. The system of indicators thus designed was validated with the Delphi method, the application of the Likert scale and the statistical treatment of answers provided by experts, using median and interquartile range values to establish the consensus of experts. Results: a working definition is proposed of the concept expert based on two dimensions: qualification and performance, and individual and collective variables, indicators and measurement criteria. Cronbach's alpha coefficient (0,8655) showed the internal consistency of the tool used. The median and interquartile range values obtained made it possible to establish the consensus of participants in the validation of the system of indicators. Conclusions: the system of indicators developed and its two dimensions make it possible to assess the training and development of experts at the Cuban Neuroscience Center, as well as the system of actions performed. The indicator showing the lowest results is that of productivity of experts in the training of human resources of high academic level. (author)
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Berry phase and entangled systems: a proposal for an experimental realization with neutrons
International Nuclear Information System (INIS)
Bertlmann, R.A.; Durstberger, K.; Hiesmayr, B.C.; Hasegawa, Y.
2003-01-01
Full text: The Berry phase - a geometric object - is included into an entangled spin-1/2 system. We discuss the case, where only one part of the Hilbert space is affected by the geometric phase. We are able to cancel the effects of the dynamical phase by using the 'spin-echo' method. With this modified state we establish a CHSH-inequality to test locality and study how the geometry effects the entanglement. We suggest an experimental realization of the proposed set-up using neutron interferometry, which is an almost ideal tool to investigate the evolution of a two-level system, e.g., spin-1/2. We see that the theoretical predictions can be tested within this set-up, where we have to deal with contextuality rather than locality. (author)
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Beck, Susan L; Eaton, Linda H; Echeverria, Christina; Mooney, Kathi H
2017-10-01
SymptomCare@Home, an integrated symptom monitoring and management system, was designed as part of randomized clinical trials to help patients with cancer who receive chemotherapy in ambulatory clinics and often experience significant symptoms at home. An iterative design process was informed by chronic disease management theory and features of assessment and clinical decision support systems used in other diseases. Key stakeholders participated in the design process: nurse scientists, clinical experts, bioinformatics experts, and computer programmers. Especially important was input from end users, patients, and nurse practitioners participating in a series of studies testing the system. The system includes both a patient and clinician interface and fully integrates two electronic subsystems: a telephone computer-linked interactive voice response system and a Web-based Decision Support-Symptom Management System. Key features include (1) daily symptom monitoring, (2) self-management coaching, (3) alerting, and (4) nurse practitioner follow-up. The nurse practitioner is distinctively positioned to provide assessment, education, support, and pharmacologic and nonpharmacologic interventions to intensify management of poorly controlled symptoms at home. SymptomCare@Home is a model for providing telehealth. The system facilitates using evidence-based guidelines as part of a comprehensive symptom management approach. The design process and system features can be applied to other diseases and conditions.
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Transient analysis for lead-bismuth-cooled accelerator-driven system proposed by JAEA
International Nuclear Information System (INIS)
Sugawara, T.; Nishihara, K.; Tsujimoto, K.
2015-01-01
It is supposed that an Accelerator-driven System (ADS) is safer than conventional critical reactors since an ADS is driven by the external neutron source in the subcritical state. In this study, the transient analyses for the lead-bismuth cooled ADS proposed by JAEA were performed using the SIMMER-III and RELAP5/mod3.2 codes to investigate the possibility of core damage. In this research, 3 accidents: the protected loss of heat sink, the protected overcooling and the unprotected blockage accident were considered as typical ADS accidents. Through these calculations, it was confirmed that all calculation results, except for the protected loss of heat sink, fulfilled the no-damage criteria. In the protected loss of heat sink, the cladding tube temperature reached its melting temperature after 18-21 hours, although the calculation condition was very conservative. These results have led to requirements to design a safety system of the ADS to decrease the frequencies of accidents. (authors)
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Proposal of a concept and reliability analysis for a fusion plant magnet protection system
International Nuclear Information System (INIS)
Schnauder, H.; Pamfilie, E.
1993-05-01
The unavailability for the current switch down in case of a demand in the magnet coils of a fusion demonstration plant must be decreased by a few orders of magnitude as compared to the one of experimental facilities. The safety requirements to prevent initiation of event sequences which might lead to the release of radioactivity and energy by the plant must be fulfilled with the same standards as applied in a normally applicable plant. On the basis of this proven technology a general usable magnet protection system will be proposed, which achieves some considerable improvements in the failure detectability as compared to the conventional protection systems. It will be demonstrated by fault tree analysis that the principal demands on safety can be satisfied by that approach. The improvements are achieved by the use of an additional microprocessor supported system for failure detection without being used for initiation of any safety related actions. An influence on a safety action by the additional system therefore is excluded. (orig.) [de
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Medina, I.; Garcia-Dominguez, A.; Aguayo, F.; Sevilla, L.; Marcos, M.
2009-11-01
As envisioned by Intelligent Manufacturing Systems (IMS), Next Generation Manufacturing Systems (NGMS) will satisfy the needs of an increasingly fast-paced and demanding market by dynamically integrating systems from inside and outside the manufacturing firm itself into a so-called extended enterprise. However, organizing these systems to ensure the maximum flexibility and interoperability with those from other organizations is difficult. Additionally, a defect in the system would have a great impact: it would affect not only its owner, but also its partners. For these reasons, we argue that a service-oriented architecture (SOA) would be a good candidate. It should be designed following a methodology where services play a central role, instead of being an implementation detail. In order for the architecture to be reliable enough as a whole, the methodology will need to help find errors before they arise in a production environment. In this paper we propose using SOA-specific testing techniques, compare some of the existing methodologies and outline several extensions upon one of them to integrate testing techniques.
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78 FR 23811 - Privacy Act of 1974; Proposed New Routine Uses and System of Records Alterations
2013-04-22
... Commissioner of Social Security, and, (c) Investigating issues of fraud or violations of civil rights by... property interests, risk of identity theft or fraud, or harm to the security or integrity of this system or... SOCIAL SECURITY ADMINISTRATION [Docket No. SSA-2013-0015] Privacy Act of 1974; Proposed New...
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2010-04-01
...) Life cycle analysis. For new construction and substantial rehabilitation, the criteria to be used in equipping the proposed development with heating and cooling systems, which shall include a life-cycle cost... 24 Housing and Urban Development 4 2010-04-01 2010-04-01 false Proposal. 941.606 Section 941.606...
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Adherence in pediatric kidney transplant recipients: solutions for the system.
Steinberg, Elizabeth A; Moss, Mary; Buchanan, Cindy L; Goebel, Jens
2018-03-01
Non-adherence remains a significant problem among pediatric (and adult) renal transplant recipients. Non-adherence among solid organ transplant recipients results in US$15-100 million annual costs. Estimates of non-adherence range from 30 to 70% among pediatric patients. Research demonstrates that a 10% decrement in adherence is associated with 8% higher hazard of graft failure and mortality. Focus has begun to shift from patient factors that impact adherence to the contributing healthcare and systems factors. The purpose of this review is to describe problems within the systems implicated in non-adherence and potential solutions that may be related to positive adherence outcomes. Systems issues include insurance and legal regulations, provider and care team barriers to optimal care, and difficulties with transitioning to adult care. Potential solutions include recognition of how systems can work together to improve patient outcomes through improvements in insurance programs, a multi-disciplinary care team approach, evidence-based medical management, pharmacy-based applications and interventions to simplify medication regimens, improved transition protocols, and telehealth/technology-based multi-component interventions. However, there remains a significant lack of reliability in the application of these potential solutions to systems issues that impact patient adherence. Future efforts should accordingly focus on these efforts, likely by leveraging quality improvement and related principles, and on the investigation of the efficacy of these interventions to improve adherence and graft outcomes.
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International Nuclear Information System (INIS)
Kanungo, Jitendra; Dasgupta, S.
2014-01-01
We analyze the energy performance of a complete adiabatic circuit/system including the Power Clock Generator (PCG) at the 90 nm CMOS technology node. The energy performance in terms of the conversion efficiency of the PCG is extensively carried out under the variations of supply voltage, process corner and the driver transistor's width. We propose an energy-efficient singe cycle control circuit based on the two-stage comparator for the synchronous charge recovery sinusoidal power clock generator (PCG). The proposed PCG is used to drive the 4-bit adiabatic Ripple Carry Adder (RCA) and their simulation results are compared with the adiabatic RCA driven by the reported PCG. We have also simulated the logically equivalent static CMOS RCA circuit to compare the energy saving of adiabatic and non-adiabatic logic circuits. In the clock frequency range from 25 MHz to 1GHz, the proposed PCG gives a maximum conversion efficiency of 56.48%. This research work shows how the design of an efficient PCG increases the energy saving of adiabatic logic. (semiconductor integrated circuits)
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AN EXCEL-BASED DECISION SUPPORT SYSTEM FOR SCORING AND RANKING PROPOSED R&D PROJECTS
ANNE DE PIANTE HENRIKSEN; SUSAN W. PALOCSAY
2008-01-01
One of the most challenging aspects of technology management is the selection of research and development (R&D) projects from among a group of proposals. This paper introduces an interactive, user-friendly decision support system for evaluating and ranking R&D projects and demonstrates its application on an example R&D program. It employs the scoring methodology developed by Henriksen and Traynor to provide a practical technique that considers both project merit and project cost in the evalua...
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Directory of Open Access Journals (Sweden)
Francesco Colace
2014-03-01
Full Text Available The E-Learning is becoming an effective approach for the improving of quality of learning. Many institutions are adopting this approach both to improve their traditional courses both to increase the potential audience. In the last period great attention is paid in the introduction of methodologies and techniques for the adaptation of learning process to the real needs of students. In this scenario the Adaptive Educational Hypermedia System can be an effective approach. Adaptive hypermedia is a promising area of research at the crossroads of hypermedia and adaptive systems. One of the most important fields where this approach can be applied is just the e-Learning. In this context the adaptive learning resources selection and sequencing is recognized as among one of the most interesting research questions. An Adaptive Educational Hypermedia System is composed by services for the management of the Knowledge Space, the definition of a User Model, the observation of student during his learning period and, as previously said, the adaptation of the learning path according to the real needs of the students. In particular the use of ontologyཿs formalism for the modeling of the ཿknowledge space related to the course can increase the sharable of learning objects among similar courses or better contextualize their role in the course. This paper addresses the design problem of an Adaptive hypermedia system by the definition of methodologies able to manage each its components, In particular an original user, learning contents, tracking strategies and adaptation model are developed. The proposed Adaptive Educational Hypermedia System has been integrated in an e-Learning platform and an experimental campaign has been conducted. In particular the proposed approach has been introduced in three different blended courses. A comparison with traditional approach has been described and the obtained results seem to be very promising.
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A proposed new classification for the renal collecting system of cattle.
Pereira-Sampaio, Marco A; Bagetti Filho, Helio J S; Carvalho, Francismar S; Sampaio, Francisco J B; Henry, Robert W
2010-11-01
To evaluate the intrarenal anatomy of kidneys obtained from cattle and to propose a new classification for the renal collecting system of cattle. 37 kidneys from 20 adult male mixed-breed cattle. Intrarenal anatomy was evaluated by the use of 3-D endocasts made of the kidneys. The number of renal lobes and minor renal calyces in each kidney and each renal region (cranial pole, caudal pole, and hilus) was quantified. The renal pelvis was evident in all casts and was classified into 2 types (nondilated [28/37 {75.7%}] or dilated [9/37 {24.3%}]). All casts had a major renal calyx associated with the cranial pole and the caudal pole. The number of minor renal calices per kidney ranged from 13 to 64 (mean, 22.7). There was a significant correlation between the number of renal lobes and the number of minor renal calices for the entire kidney, the cranial pole region, and the hilus region; however, there was not a similar significant correlation for the caudal pole region. Major and minor renal calices were extremely narrow, compared with major and minor renal calices in pigs and humans. The renal collecting system of cattle, with a renal pelvis and 2 major renal calices connected to several minor renal calices by an infundibulum, differed substantially from the renal collecting system of pigs and humans. From a morphological standpoint, the kidneys of cattle were not suitable for use as a model in endourologic research and training.
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Godisov, O N; Yudkin, M I; Gerasimov, S F; Feofilov, G A
1994-01-01
Contradictory demands raised by the application of different types of sensitive detectors in 5 layers of the Inner Tracking System (ITS) for ALICE stipulate the simultaneous use of different schemes of heat drain: gaseous cooling of the 1st layer (uniform heat production over the sensitive surface) and evaporative cooling for the 2nd-5th layers (localised heat production). The last system is also a must for the thermostabilization of Si-drift detectors within 0.1 degree C. Theoretical estimates of gaseous, evaporative and liquid cooling systems are done for all ITS layers. The results of the experiments done for evaporative and liquid heat drain systems are presented and discussed. The major technical problems of the evaporative systems' design are being considered: i) control of liquid supply; ii) vapour pressure control. Two concepts of the evaporative systems are proposed: 1) One channel system for joint transfer of two phases (liquid + gas); 2) Two channels system with separate transfer of phases. Both sy...
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The U.S. Environmental Protection Agency (EPA) conducted a Health Impact Assessment (HIA) of proposed code changes regarding residential onsite sewage disposal systems (OSDS) in Suffolk County, New York. Of the approximately 569,000 housing units in Suffolk County, 365,000 are no...
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Tricarico, Christopher; Peters, Robert; Som, Avik; Javaherian, Kavon; Ross, Will
2017-01-01
Background Medication adherence remains a difficult problem to both assess and improve in patients. It is a multifactorial problem that goes beyond the commonly cited reason of forgetfulness. To date, eHealth (also known as mHealth and telehealth) interventions to improve medication adherence have largely been successful in improving adherence. However, interventions to date have used time- and cost-intensive strategies or focused solely on medication reminding, leaving much room for improvem...
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PROPOSAL OF VOIVODESHIP ROAD SAFETY IMPROVEMENT PROGRAMME
Tomasz SZCZURASZEK; Jan KEMPA
2016-01-01
The article presents a proposal of the ‘GAMBIT KUJAWSKO-POMORSKI’ Road Safety Improvement Programme. The main idea of the Programme is to establish and initiate systems that will be responsible for the most important areas of activity within road safety, including road safety control, supervision, and management systems in the whole Voivodeship. In total, the creation and start of nine such systems has been proposed, namely: the Road Safety Management, the Integrated Road Rescue Service, the ...
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Proposed experiment addressing CP and CPT violation in the K0-K-bar0 system
International Nuclear Information System (INIS)
Dunietz, I.; Hauser, J.; Rosner, J.L.
1987-01-01
An experiment utilizing the decay phi→K/sub S/K/sub L/ is proposed for measuring the ratio ε'/ε of CP-violating parameters in the kaon system. It appears one can probe values of ε'/ε down to 10/sup -3/ with 10 9 phi's. An asymmetry measurement of the relative times of π + π - and π 0 π 0 decays is capable of testing the phase difference phi/sub +-/-phi/sub 00/ to +- 1.6 0 (3σ), with 10/sup 10/ phi's. Far fewer phi's (perhaps 10 8 ) can be useful in constraining some parameters of the kaon system associated with CPT violations
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Energy Technology Data Exchange (ETDEWEB)
Giner, Emmanuel, E-mail: gnrmnl@unife.it; Angeli, Celestino, E-mail: anc@unife.it [Dipartimento di Scienze Chimiche e Famaceutiche, Universita di Ferrara, Via Fossato di Mortara 17, I-44121 Ferrara (Italy)
2016-03-14
The present work describes a new method to compute accurate spin densities for open shell systems. The proposed approach follows two steps: first, it provides molecular orbitals which correctly take into account the spin delocalization; second, a proper CI treatment allows to account for the spin polarization effect while keeping a restricted formalism and avoiding spin contamination. The main idea of the optimization procedure is based on the orbital relaxation of the various charge transfer determinants responsible for the spin delocalization. The algorithm is tested and compared to other existing methods on a series of organic and inorganic open shell systems. The results reported here show that the new approach (almost black-box) provides accurate spin densities at a reasonable computational cost making it suitable for a systematic study of open shell systems.
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Proposed system for the use of evaluation factors in the source selection of service contractors
Pingel, Richard Douglas
1981-01-01
Approved for public release; distribution is unlimited Technical personnel are increasingly being required to perform vital functions as proposal evaluators in the source selection process for which they have not been properly trained. This research effort provides a comprehensive system for source selection using price and other factors in a form aimed at the technical professionals that support field acquisition activities. All examples selected are from the general acquisition area of...
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Directory of Open Access Journals (Sweden)
Cai Na
2016-01-01
Full Text Available Long evacuation time is a key fire safety concern when a supertall building is on fire. The elevator system can be an effective alternative. The performance of a design of fire safe elevator system combining the refuge place with fire safe elevator is studied. An example building based on this proposed design is considered. Smoke spread to the system is studied by the Computational Fluid Dynamics (CFD code Fire Dynamics Simulator (FDS. Different arrangements of smoke extraction with pressurization systems are evaluated by analysing the smoke dispersion and pressure distributions in this fire safe elevator system. Numerical results were compared with that by theoretical equations. The results show that a smoke extraction system with a four-floor approach pressurization system can be an efficient method for smoke control in elevator system for supertall buildings.
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2012-02-13
... recent difficulties in mortgage finance markets indicated reduced availability of housing credit in rural... System has been a source of consistent and reliable credit for rural homeowners and that the ability to... afoul of the Administration's proposal to reduce government involvement in the housing finance market...
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International Nuclear Information System (INIS)
2007-01-01
Several points, specific to France, must be taken into consideration for the long term strategic choice of future nuclear systems, in particular: taking the best profit of the progress potentialities of water reactors, optimizing the opportunities offered by the renewal of power plants in operation, integrating the consequences and the implementation of a strategy of optimized management of radioactive wastes, and looking for improvements that would make nuclear energy an active contributor to sustainable development. The prospective researches carried out by the CEA and its industrial partners have led to propose a R and D strategy with 3 complementary goals: search for innovations for water reactors, development of fast neutron reactors with closed fuel cycle (sodium fast reactor (SFR), gas fast reactor (GFR)), and development of key-technologies for nuclear hydrogen production (very high temperature reactor (VHTR)). The R and D effort concerns also the subcritical systems devoted to transmutation, the new cycle processes for a global management of actinides, and some other nuclear systems like the molten salt reactors (MSR) and the supercritical water reactors (SCWR). This paper presents the R and D strategy for each technology with its priorities, steps, financial means and collaborations. (J.S.)
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A proposed classification system for high-level and other radioactive wastes
International Nuclear Information System (INIS)
Kocher, D.C.; Croff, A.G.
1989-01-01
On the basis of the definition of high-level wastes (HLW) in the Nuclear Waste Policy Act of 1982 and previous descriptions of reprocessing wastes, a definition is proposed based on the concept that HLW is any waste which is highly radioactive and requires permanent isolation. This conceptual definition of HLW leads to a two-dimensional waste classification system in which one axis, related to 'highly radioactive', is associated with shorter-term risks from waste management and disposal due to high levels of decay heat and external radiation, and the other axis, related to 'requires permanent isolation', is associated with longer-term risks from waste disposal. Wastes that are highly radioactive are defined quantitatively as wastes with a decay heat (power density) greater than 50 W/m 3 or an external dose-equivalent rate greater than 100 rem/h (1 Sv/h) at a distance of 1 m from the waste, whichever is more restrictive. Wastes that require permanent isolation are defined quantitatively as wastes with concentrations of radionuclides greater than the Class-C limits that are generally acceptable for near-surface land disposal, as obtained from the Nuclear Regulatory Commission's 10 CFR Part 61 and its associated methodology. This proposal leads to similar definitions of two other waste classes: transuranic (TRU) waste and equivalent is any waste that requires permanent isolation but is not highly radioactive; and low-level waste (LLW) is any waste that does not require permanent isolation, without regard to whether or not it is highly radioactive. 31 refs.; 3 figs.; 4 tabs
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International Nuclear Information System (INIS)
Walderhaug, T.; Rikisins, G.
1996-11-01
The EKO-4.2 project involves investigating approaches to setting up a new reliable system based on computer internet technology for exchange of information between the Nordic countries. According to the project plans this information exchange is to be based on bulletin board systems in the different countries. It was required that the system should not set any restriction of type of data or information to be exchanged, nor should it involve any standardization of data, and above all, it was not intended as an alert system. A bulletin board system is passive in the sense that no information is actually sent, instead it is the receiver who is responsible for approaching the information and transferring it to own system. This feature makes the system unsuitable for alert purposes. Since a potential system will have to be implemented by the authorities in the respective countries, the first part of the project was to survey their interest and emphasis. This was done in meetings in the different countries. The conclusion from those meetings was an overall interest in establishing a system as described, and several requirements concerning security and reliability of the system were proposed. The implication of the requirements by the authorities is discussed and a practical solution of an information exchange system based on the World Wide Web (WWW), the File Transfer Protocol (FTP), and the Internet is outlined. The continuation of the project must be based on operable servers in the different countries, whose configuration and connection with the local network are the responsibility of the institution owning the server. The selected system will depend on hardware and on the overall security policy of the institution involved. It is proposed that further work concentrates on a general testing of the system, standardizing of server user interfaces and testing of encryption software for transfer of passwords. (au)
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Fixing the system: An analysis of alternative proposals for the reform of international tax
Grubert, Harry; Altshuler, Rosanne
2013-01-01
We evaluate proposals for the reform of the U.S. system of taxing cross-border income including dividend exemption, full current inclusion, a Japanese type version of dividend exemption with an effective tax rate test subject to an exception for an active business, dividend exemption combined with a minimum tax, and repeal of check-the-box. We consider two versions of dividend exemption with a minimum tax: one in which the minimum tax is imposed on a country by country basis and another in wh...
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A proposed power assisted system of manual wheelchair based on universal design for eldery
Susmartini, Susy; Pryadhitama, Ilham; Herdiman, Lobes; Wahyufitriani, Cindy
2017-11-01
Difficulties in walking is high percentage case in the limitations mobility of the elderly. An assisted technology commonly used to help the elderly who have walking difficulty is a manual wheelchair. However, the elderly frequently experiences difficulties in operating manual wheelchair due to gradually degradation of their physical condition. Preliminary study results showed that the average grip strength of the hands of seven elderly subjects was 13.8 ± 6.96 kg and the value is relatively weak. In addition, the mean maximum speed of 7 elderly subjects when doing to round the wheelchair is 0.6 ± 0.2m / s. This value is only 56.4% compared with an average speed of 20-23-year age group (8 males), which is 1.1 ± 0.1 m / s. This shows that the elderly who have walking difficulty have low grip strength and speed in operating a wheelchair. On the other hand, manual wheelchairs suffer an inadequate technology solution to solve the problem. Therefore, an assistive technology is proposed to create mobility aid to accommodate the elderly needs. One approach used is Universal Design. This paper proposes a system of intervention in the manual wheelchair through the 7 principles of Universal Design approach. The preliminary principle has not been able to accommodate the needs of the elderly will become a reference in the proposed design of this study.
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Proposed high speed pellet injection system 'HIPEL' for Large Helical Device
International Nuclear Information System (INIS)
Sudo, S.; Kanno, M.; Kaneko, H.; Saka, S.; Shirai, T.; Baba, T.
1993-11-01
From the results of the simulation study including pellet ablation and 1-D transport code, it is found that a high speed pellet injector with pellet velocity of more than 3 km/s is necessary for the penetration of the pellet with diameter of 3 mm into the core region under the expected plasma condition of Large Helical Device (LHD) of heliotron/stellarator type with superconducting coils at NIFS in Japan. Therefore, a two stage pellet injector was constructed and tested successfully in order to obtain the pellet velocity range of 3 km/s. Based upon the above results, a high speed flexible multiple-pellet injection system 'HIPEL' for LHD is proposed. HIPEL consists of independent (1) 10 two-stage gun barrels and (2) 10 single-stage gun barrels. It has multi purposes such as refueling and flexible density profile control, diagnostics and the other functions. (author)
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Energy Technology Data Exchange (ETDEWEB)
Li, H.Q.; Hong, H.; Jin, H.G.; Cai, R.X. [Chinese Academy of Sciences, Beijing (China). Inst. of Engineering Thermophysics
2008-07-01
Biomass is getting increasing attention as a potential source of renewable energy as a result of global issues such as sustainable energy and reduction of greenhouse gases. Biomass is an abundant feedstock containing mainly carbon, oxygen, hydrogen, and volatile matter. The purpose of this paper was to propose a new biomass-natural gas based polygeneration system, with partial recycling unreacted syngas and without the shift process for methanol production and power generation. The paper identified the features of the proposed system and that determine the exergy ratio of chemical production and thermodynamic performance of the system. The paper provided an introduction to individual systems such as the natural gas to methanol system and biomass to methanol system. The paper also presented the suggested polygeneration system based on biomass and natural gas as co-feed. Processes that were described included syngas preparation; distillation process; and power generation. System evaluation criteria and performance were identified. It was concluded that bio-energy made the best utilization and overcame the disadvantages of the polygeneration system, partly taking the place of natural gas which is non-renewable. Bio-energy could reduce carbon dioxide emission for it is carbon neutrality. 18 refs., 3 tabs., 9 figs.
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McPhy-Energy’s proposal for solid state hydrogen storage materials and systems
Energy Technology Data Exchange (ETDEWEB)
Jehan, Michel, E-mail: michel.jehan@mcphy.com [McPhy Energy SA, ZA Retière, 26190 La Motte-Fanjas (France); Fruchart, Daniel, E-mail: daniel.fruchart@grenoble.cnrs.fr [McPhy Energy SA, ZA Retière, 26190 La Motte-Fanjas (France); Institut Néel and CRETA, CNRS, 25 Avenue des Martyrs, BP 166, 38042 Grenoble Cedex 9 (France)
2013-12-15
Highlights: •Mechanical alloying with nano-structurizing highly reactive magnesium metal hydrides particles. •Solid reversible hydrogen storage at scale of kg to tons of hydrogen using MgH{sub 2} composite discs. •Natural Expanded Graphite draining heat of reaction during sorption. •Change Phase Material storing reversibly heat of reaction within tank storage as adiabatic system. •Technology fully adapted for renewable energy storage and network energy peak shavings through H{sub 2}. -- Abstract: The renewable resources related, for instance, to solar energies exhibit two main characteristics. They have no practical limits in regards to the efficiency and their various capture methods. However, their intermittence prevents any direct and immediate use of the resulting power. McPhy-Energy proposes solutions based on water electrolysis for hydrogen generation and storage on reversible metal hydrides to efficiently cover various energy generation ranges from MW h to GW h. Large stationary storage units, based on MgH{sub 2}, are presently developed, including both the advanced materials and systems for a total energy storage from ∼70 to more than 90% efficient. Various designs of MgH{sub 2}-based tanks are proposed, allowing the optional storage of the heat of the Mg–MgH{sub 2} reaction in an adjacent phase changing material. The combination of these operations leads to the storage of huge amounts of hydrogen and heat in our so-called adiabatic-tanks. Adapted to intermittent energy production and consumption from renewable sources (wind, sun, tide, etc.), nuclear over-production at night, or others, tanks distribute energy on demand for local applications (on-site domestic needs, refueling stations, etc.) via turbine or fuel cell electricity production.
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Energy Technology Data Exchange (ETDEWEB)
LaCommare, Kristina [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States); Larsen, Peter [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States); Eto, Joseph [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States)
2017-01-01
Policymakers and regulatory agencies are expressing renewed interest in the reliability and resilience of the U.S. electric power system in large part due to growing recognition of the challenges posed by climate change, extreme weather events, and other emerging threats. Unfortunately, there has been little or no consolidated information in the public domain describing how public utility/service commission (PUC) staff evaluate the economics of proposed investments in the resilience of the power system. Having more consolidated information would give policymakers a better understanding of how different state regulatory entities across the U.S. make economic decisions pertaining to reliability/resiliency. To help address this, Lawrence Berkeley National Laboratory (LBNL) was tasked by the U.S. Department of Energy Office of Energy Policy and Systems Analysis (EPSA) to conduct an initial set of interviews with PUC staff to learn more about how proposed utility investments in reliability/resilience are being evaluated from an economics perspective. LBNL conducted structured interviews in late May-early June 2016 with staff from the following PUCs: Washington D.C. (DCPSC), Florida (FPSC), and California (CPUC).
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Wang, Jing-Houng; Kee, Kwong-Ming; Lin, Chih-Yun; Hung, Chao-Hung; Chen, Chien-Hung; Lee, Chuan-Mo; Lu, Sheng-Nan
2015-02-01
Based on up-to-seven criteria and Child-Pugh score, four substages of Barcelona Clinic Liver Cancer (BCLC) intermediate hepatocellular carcinoma (HCC) were proposed. The purpose of this study was to validate and modify this proposal. Between January 2002 and February 2011, newly diagnosed intermediate HCC patients underwent transarterial embolization (TAE) were enrolled. Patients were stratified into four (B1-B4) substages and followed up until death or end of 2012. Patients' survivals and discriminatory ability of substaging systems were compared. Five-hundred and eighty patients were enrolled. There were 56.6%, 33.8%, 7.4%, and 2.2% in substage B1, B2, B3, and B4. The 5-year survival rate was 21.4%, 13.9%, 7.4%, and 7.7% with median survival time of 2.4, 1.3, 0.5, and 0.8 years (P 200 ng/mL, B1 was classified into B1a and B1b, and B2 into B2a and B2b. There were no differences in survivals between B1b and B2a (P = 0.174), and B2b and B3 (P = 0.785). Patients were re-classified into modified (m)B1 (B1a), mB2 (B1b + B2a), mB3 (B2b + B3). The modified substages (mB1-mB3) showed a more desirable substaging system. For BCLC intermediate HCC patients, substages B1-B4 were useful in predicting survival after TAE. However, modified substaging system provided better prognostic prediction. © 2014 Journal of Gastroenterology and Hepatology Foundation and Wiley Publishing Asia Pty Ltd.
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A proposed strategy for power optimization of a wind energy conversion system connected to the grid
International Nuclear Information System (INIS)
Taraft, S.; Rekioua, D.; Aouzellag, D.; Bacha, S.
2015-01-01
Highlights: • Wind energy conversion based doubly fed induction generator controlled by matrix converter. • Operation at both sub and super-synchronous regions is possible with the proposed drive system. • Double the power generated by the DFIG at a twice of speed rated. • Sliding mode control is used to achieve active and reactive power control. - Abstract: Many strategies have been developed in last decade to optimize power extracted from wind energy conversion system where many of them can produce only 30% more than the rated power. With the considered strategy, the generated wind power can reach twice its nominal value using a fast and reliable fully rugged electrical control. Indeed, by employing a suitable control technique where the produced power in super-synchronous mode is derived from both the stator and the rotor. Also, the rotor provided power in this case grows up 100% comparing to stator rated power. However, this solution permits to maintain the wind energy conversion system operation in its stable area. The considered system consists of a double fed induction generator whose stator is connected directly to the grid and its rotor is supplied by matrix converter. In this paper, the sliding mode approach to achieve active and reactive power control is used. This latter is combined with de Perturbation and Observation Maximum Power Point Tracking used in the second operation zone. The obtained simulations results are assessed and carried out using Matlab/Simulink package and show the performance and the effectiveness of the proposed control
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Directory of Open Access Journals (Sweden)
Sieglinde Kindl da Cunha
2005-07-01
Full Text Available This article proposes a model to measure tourism cluster impact on local development with a view to assessing tourism cluster interaction, competitiveness and sustainability impacts on the economy, society and the environment. The theoretical basis for this model is founded on cluster concept and typology adapting and integrating the systemic competitiveness and sustainability concepts within economic, social, cultural, environmental and political dimensions. The proposed model shows a holistic, multidisciplinary and multi-sector view of local development brought back through a systemic approach to the concepts of competitiveness, social equity and sustainability. Its results make possible strategic guidance to agents responsible for public sector tourism policies, as well as the strategies for competitiveness, competition, cooperation and sustainability in private companies and institutions.