The use of e-mail in the therapy process

The therapeutic letter has a long history, with roots in psychoanalytic work and continuing application in family therapy. The advent of e-mail has allowed another form for therapeutic written communication which, while incorporating the benefits of therapeutic letters, adds to these. It has also opened up some potential risks. This article incorporates a brief review of the literature covering therapeutic written communication and offers a case example where e-mail was used as an adjunct in face-to-face therapy with a client who experienced attachment difficulties. This therapy was informed by systemic and psychoanalytic traditions. The authors explore a variety of technical matters including the timing and Crafting of e-mail responses, the integration of written communication with face-to-face therapy, impact on the therapeutic relationship and management of crisis. Ethical issues such as confidentiality and duty of care are also considered.

Differences in mail and telephone responses to self-rated health: use of multiple imputation in correcting for response bias

Objectives: To estimate differences in self-rated health by mode of administration and to assess the value of multiple imputation to make self-rated health comparable for telephone and mail. Methods: In 1996, Survey 1 of the Australian Longitudinal Study on Women's Health was answered by mail. In 1998, 706 and 11,595 mid-age women answered Survey 2 by telephone and mail respectively. Self-rated health was measured by the physical and mental health scores of the SF-36. Mean change in SF-36 scores between Surveys 1 and 2 were compared for telephone and mail respondents to Survey 2, before and after adjustment for socio-demographic and health characteristics. Missing values and SF-36 scores for telephone respondents at Survey 2 were imputed from SF-36 mail responses and telephone and mail responses to socio-demographic and health questions. Results: At Survey 2, self-rated health improved for telephone respondents but not mail respondents. After adjustment, mean changes in physical health and mental health scores remained higher (0.4 and 1.6 respectively) for telephone respondents compared with mail respondents (-1.2 and 0.1 respectively). Multiple imputation yielded adjusted changes in SF-36 scores that were similar for telephone and mail respondents. Conclusions and Implications: The effect of mode of administration on the change in mental health is important given that a difference of two points in SF-36 scores is accepted as clinically meaningful. Health evaluators should be aware of and adjust for the effects of mode of administration on self-rated health. Multiple imputation is one method that may be used to adjust SF-36 scores for mode of administration bias.

A distributed systems approach to secure Internet mail

One of the obstacles to improved security of the Internet is ad hoc development of technologies with different design goals and different security goals. This paper proposes reconceptualizing the Internet as a secure distributed system, focusing specifically on the application layer. The notion is to redesign specific functionality, based on principles discovered in research on distributed systems in the decades since the initial development of the Internet. Because of the problems in retrofitting new technology across millions of clients and servers, any options with prospects of success must support backward compatibility. This paper outlines a possible new architecture for internet-based mail which would replace existing protocols by a more secure framework. To maintain backward compatibility, initial implementation could offer a web browser-based front end but the longer-term approach would be to implement the system using appropriate models of replication. (C) 2005 Elsevier Ltd. All rights reserved.

Vehicle routing and crew scheduling for metropolitan mail distribution at Australia Post

This paper presents a new multi-depot combined vehicle and crew scheduling algorithm, and uses it, in conjunction with a heuristic vehicle routing algorithm, to solve the intra-city mail distribution problem faced by Australia Post. First we describe the Australia Post mail distribution problem and outline the heuristic vehicle routing algorithm used to find vehicle routes. We present a new multi-depot combined vehicle and crew scheduling algorithm based on set covering with column generation. The paper concludes with a computational investigation examining the affect of different types of vehicle routing solutions on the vehicle and crew scheduling solution, comparing the different levels of integration possible with the new vehicle and crew scheduling algorithm and comparing the results of sequential versus simultaneous vehicle and crew scheduling, using real life data for Australia Post distribution networks.

Incremental learning for interactive e-mail filtering

In this article, we propose a framework, namely, Prediction-Learning-Distillation (PLD) for interactive document classification and distilling misclassified documents. Whenever a user points out misclassified documents, the PLD learns from the mistakes and identifies the same mistakes from all other classified documents. The PLD then enforces this learning for future classifications. If the classifier fails to accept relevant documents or reject irrelevant documents on certain categories, then PLD will assign those documents as new positive/negative training instances. The classifier can then strengthen its weakness by learning from these new training instances. Our experiments’ results have demonstrated that the proposed algorithm can learn from user-identified misclassified documents, and then distil the rest successfully.

An analysis of the images attached to referral messages in an e-mail based telemedicine system for developing countries

Little is known about the quality of the images transmitted in email telemedicine systems. The present study was designed to survey the quality of images transmitted in the Swinfen Charitable Trust email referral system. Telemedicine cases were examined for a 3 month period in 2002 and a 3 month period in 2006. The number of cases with images attached increased from 8 (38%) to 37 (53%). There were four types of images (clinical photographs, microscope pictures, notes and X-ray images) and the proportion of radiology images increased from 27 to 48%. The cases in 2002 came from four different hospitals and were associated with seven different clinical specialties. In 2006, the cases came from 19 different hospitals and 20 different specialties. The 46 cases (from both study periods) had a total of 159 attached images. The quality of the images was assessed by awarding each image a score in four categories: focus, anatomical perspective, composition and lighting. The images were scored on a five-point scale (1 = very poor to 5 =very good) by a qualified medical photographer. In comparing image quality between the two study periods, there was some evidence that the quality had reduced, although the average size of the attached images had increased. The median score for all images in 2002 was 16 (interquartile range 14-19) and the median score in 2006 was 15 (13-16). The difference was significant (P < 0.001, Mann-Whitney test).