Design and implementation of an automatic message-routing system for low-cost telemedicine

Email has been used for some years as a low-cost telemedicine medium to provide support for developing countries. However, all operations have been relatively small scale and fairly labour intensive to administer. A scalable, automatic message-routing system was constructed which automates many of the tasks. During a four-month study period in 2002, 485 messages were processed automatically. There were 31 referrals from eight hospitals in three countries. These referrals were handled by 25 volunteer specialists from a panel of 42. Two system operators, located 10 time zones apart, managed the system. The median time from receipt of a new referral to its allocation to a specialist was 1.0 days (interquartile range 0.7-2.4). The median interval between allocation and first reply was 0.7 days (interquartile range 0.3-2.3). Automatic message handling solves many of the problems of manual email telemedicine systems and represents a potentially scalable way of doing low-cost telemedicine in the developing world.

Proof Explanation in the DR-DEVICE System

Trust is a vital feature for Semantic Web: If users (humans and agents) are to use and integrate system answers, they must trust them. Thus, systems should be able to explain their actions, sources, and beliefs, and this issue is the topic of the proof layer in the design of the Semantic Web. This paper presents the design and implementation of a system for proof explanation on the Semantic Web, based on defeasible reasoning. The basis of this work is the DR-DEVICE system that is extended to handle proofs. A critical aspect is the representation of proofs in an XML language, which is achieved by a RuleML language extension.

Improving wheat simulation capabilities in Australia from a cropping systems perspective - II. Testing simulation capabilities of wheat growth

To simulate cropping systems, crop models must not only give reliable predictions of yield across a wide range of environmental conditions, they must also quantify water and nutrient use well, so that the status of the soil at maturity is a good representation of the starting conditions for the next cropping sequence. To assess the suitability for this task a range of crop models, currently used in Australia, were tested. The models differed in their design objectives, complexity and structure and were (i) tested on diverse, independent data sets from a wide range of environments and (ii) model components were further evaluated with one detailed data set from a semi-arid environment. All models were coded into the cropping systems shell APSIM, which provides a common soil water and nitrogen balance. Crop development was input, thus differences between simulations were caused entirely by difference in simulating crop growth. Under nitrogen non-limiting conditions between 73 and 85% of the observed kernel yield variation across environments was explained by the models. This ranged from 51 to 77% under varying nitrogen supply. Water and nitrogen effects on leaf area index were predicted poorly by all models resulting in erroneous predictions of dry matter accumulation and water use. When measured light interception was used as input, most models improved in their prediction of dry matter and yield. This test highlighted a range of compensating errors in all modelling approaches. Time course and final amount of water extraction was simulated well by two models, while others left up to 25% of potentially available soil water in the profile. Kernel nitrogen percentage was predicted poorly by all models due to its sensitivity to small dry matter changes. Yield and dry matter could be estimated adequately for a range of environmental conditions using the general concepts of radiation use efficiency and transpiration efficiency. However, leaf area and kernel nitrogen dynamics need to be improved to achieve better estimates of water and nitrogen use if such models are to be use to evaluate cropping systems. (C) 1998 Elsevier Science B.V.

Optimising fed-batch production of recombinant proteins using the baculovirus expression vector system

Fed-batch culture can offer significant improvement in recombinant protein production compared to batch culture in the baculovirus expression vector system (BEVS), as shown by Nguyen et al. (1993) and Bedard et al. (1994) among others. However, a thorough analysis of fed-batch culture to determine its limits in improving recombinant protein production over batch culture has yet to be performed. In this work, this issue is addressed by the optimisation of single-addition fed-batch culture. This type of fed-batch culture involves the manual addition of a multi-component nutrient feed to batch culture before infection with the baculovirus. The nutrient feed consists of yeastolate ultrafiltrate, lipids, amino acids, vitamins, trace elements, and glucose, which were added to batch cultures of Spodoptera frugiperda (Sf9) cells before infection with a recombinant Autographa californica nuclear polyhedrosis virus (Ac-NPV) expressing beta-galactosidase (beta-Gal). The fed-batch production of beta-Gal was optimised using response surface methods (RSM). The optimisation was performed in two stages, starting with a screening procedure to determine the most important variables and ending with a central-composite experiment to obtain a response surface model of volumetric beta-Gal production. The predicted optimum volumetric yield of beta-Gal in fed-batch culture was 2.4-fold that of the best yields in batch culture. This result was confirmed by a statistical analysis of the best fed-batch and batch data (with average beta-Gal yields of 1.2 and 0.5 g/L, respectively) obtained from this laboratory. The response surface model generated can be used to design a more economical fed-batch operation, in which nutrient feed volumes are minimised while maintaining acceptable improvements in beta-Gal yield. (C) 1998 John Wiley & Sons, Inc.

Work domain analysis for training-system definition and acquisition

Training-needs analysis is critical for defining and procuring effective training systems. However, traditional approaches to training-needs analysis are not suitable for capturing the demands of highly automated and computerized work domains. In this article, we propose that work domain analysis can identify the functional structure of a work domain that must be captured in a training system, so that workers can be trained to deal with unpredictable contingencies that cannot be handled by computer systems. To illustrate this argument, we outline a work domain analysis of a fighter aircraft that defines its functional structure in terms of its training objectives, measures of performance, basic training functions, physical functionality, and physical context. The functional structure or training needs identified by work domain analysis can then be used as a basis for developing functional specifications for training systems, specifically its design objectives, data collection capabilities, scenario generation capabilities, physical functionality, and physical attributes. Finally, work domain analysis also provides a useful framework for evaluating whether a tendered solution fulfills the training needs of a work domain.

Tuberculosis and health sector reform: experience of integrating tuberculosis services into the district health system in rural South Africa

SETTING: Hlabisa health district, South Africa. OBJECTIVE: To describe the integration of a vertical tuberculosis control programme into an emerging 'horizontal' district health system, within the context of health sector reform. DESIGN: Descriptive account of the process of integration of the programme into the health system. RESULTS: A highly 'vertical' system of delivering tuberculosis treatment (with poor programme outcomes) was converted into a (horizontal' team, integrated within the district health system, that used available resources such as village clinics and community health workers, with improved programme outcomes. CONCLUSIONS: In some settings at least, integration of tuberculosis 'programmes' into the district health system as tuberculosis 'teams' is feasible, and may produce highly cost-effective outcomes.

Accessibility to general practitioners in rural South Australia - A case study using geographic information system technology

Objective: To demonstrate the potential of GIS (geographic information system) technology and ARIA (Accessibility/Remoteness Index for Australia) as tools for medical workforce and health service planning in Australia. Design: ARIA is an index of remoteness derived by measuring road distance between populated localities and service centres. A continuous variable of remoteness from 0 to 12 is generated for any location in Australia. We created a GIS, with data on location of general practitioner services in non-metropolitan South Australia derived from the database of HUMPS (Rural Undergraduate Medical Placement System), and estimated, for the 1170 populated localities in South Australia, the accessibility/inaccessibility of the 109 identified GP services. Main outcome measures: Distance from populated locality to GP services. Results: Distance from populated locality to GP service ranged from 0 to 677 km (mean, 58 km). In all, 513 localities (43%) had a GP service within 20 km (for the majority this meant located within the town). However, for 173 populated localities (15%), the nearest GP service was more than 80 km away. There was a strong correlation between distance to GP service and ARIA value for each locality (0.69; P<0.05). Conclusions: GP services are relatively inaccessible to many rural South Australian communities. There is potential for GIS and for ARIA to contribute to rational medical workforce and health service planning. Adding measures of health need and more detailed data on types and extent of GP services provided will allow more sophisticated planning.

A hybrid, inverse approach to the design of magnetic resonance imaging magnets

This paper describes a hybrid numerical method of an inverse approach to the design of compact magnetic resonance imaging magnets. The problem is formulated as a field synthesis and the desired current density on the surface of a cylinder is first calculated by solving a Fredholm equation of the first, kind. Nonlinear optimization methods are then invoked to fit practical magnet coils to the desired current density. The field calculations are performed using a semi-analytical method. The emphasis of this work is on the optimal design of short MRI magnets. Details of the hybrid numerical model are presented, and the model is used to investigate compact, symmetric MRI magnets as well as asymmetric magnets. The results highlight that the method can be used to obtain a compact MRI magnet structure and a very homogeneous magnetic field over the central imaging volume in clinical systems of approximately 1 m in length, significantly shorter than current designs. Viable asymmetric magnet designs, in which the edge of the homogeneous region is very close to one end of the magnet system are also presented. Unshielded designs are the focus of this work. This method is flexible and may be applied to magnets of other geometries. (C) 2000 American Association of Physicists in Medicine. [S0094-2405(00)00303-5].