A review of the first year's experience with an automatic message-routing system for low-cost telemedicine

The Swinfen Charitable Trust has used email for some years as a low-cost telemedicine medium to provide consultant support for doctors in developing countries. A scalable, automatic message-routing system was constructed which automates many of the tasks involved in message handling. During the first 12 months of its use, 1510 messages were processed automatically. There were 128 referrals from 18 hospitals in nine countries. Of these 128 queries, 89 (70%) were replied to within 72 h; the median delay was 1.1 day. The 39 unanswered queries were sent to backup specialists for reply and 36 of them (92%) were replied to within 72 h. In the remaining three cases, a second-line (backup) specialist was required. The referrals were handled by 54 volunteer specialists from a panel of over 70. 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 0.2 days (interquartile range, IQR, 0.1-0.8). The median interval between receipt of a new referral and first reply was 2.6 days (IQR 0.8-5.9). 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.

Low-cost real-time gesture recognition

A major impediment to developing real-time computer vision systems has been the computational power and level of skill required to process video streams in real-time. This has meant that many researchers have either analysed video streams off-line or used expensive dedicated hardware acceleration techniques. Recent software and hardware developments have greatly eased the development burden of realtime image analysis leading to the development of portable systems using cheap PC hardware and software exploiting the Multimedia Extension (MMX) instruction set of the Intel Pentium chip. This paper describes the implementation of a computationally efficient computer vision system for recognizing hand gestures using efficient coding and MMX-acceleration to achieve real-time performance on low cost hardware.

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.

Teledermatology can produce high-quality care at low cost

Teledermatology can provide both accurate and reliable specialist care at a distance. This article reviews current data on the quality of care that teledermatology provides, as well as the societal cost benefits involved in the implementation of the technique. Teledermatology is most suited to patients unable to access specialist. services for geographical or social reasons. Patients are generally satisfied with the overall care that teledermatology provides. Real-time teledermatology is more expensive than conventional care for health services. However, significant savings can be expected from the patient's perspective due to reduced travel. Appropriate patient selection, improved technology and adequate clinical workloads may improve both the quality and cost effectiveness of this service.

Merging of low-mass systems and the origin of the Fundamental Plane

We present a new set of dissipationless N-body simulations to examine the feasibility of creating bright ellipticals (following the Kormendy relation, hereafter KR) by hierarchically merging present-day early-type dwarf galaxies, and to study how the encounter parameters affect the location of the end product in the (mu(e))-R-e plane. We investigate the merging of one-component galaxies of both equal and different masses, the merging of two-component galaxy models to explore the effect of dark haloes on the final galaxy characteristics, and the merging of ultracompact dwarf galaxies. We find that the increase of (mu(e)) with R-e is attributable to an increase in the initial orbital energy. The merger remnants shift down in the (mu(e))-R-e plane and fail to reach the KR. Thus, the KR is not reproducible by mergers of dwarf early-type systems, rendering untenable the theory that present-day dwarfs are responsible for even a small fraction of the present-day ellipticals, unless a considerable amount of dissipation is invoked. However, we do find that present-day dwarfs can be formed by the merger of ultracompact dwarfs.

Trial of low-cost teledermatology in primary care

We examined the feasibility of a low-cost, store-and-forward teledermatology service for general practitioners (GPs) in regional Queensland. Digital pictures and a brief case history were transmitted by email. A service coordinator carried out quality control checks and then forwarded these email messages to a consultant dermatologist. On receiving a clinical response from the dermatologist, the service coordinator returned the message to the referring GP. The aim was to provide advice to rural Gps within one working day. Over six months, 63 referrals were processed by the teledermatology service, covering a wide range of dermatological conditions. In the majority of cases the referring doctors were able to treat the condition after receipt of email advice from the dermatologist; however, in 10 cases (16%) additional images or biopsy results were requested because image quality was inadequate. The average time between a referral being received and clinical advice being provided to the referring GPs was 46 hours. The number of referrals in the present study, 1.05 per month per site, was similar to that reported in other primary care studies. While the use of low-cost digital cameras and public email is feasible, there may be other issues, for example remuneration, which will militate against the widespread introduction of primary care teledermatology in Australia.

Integration of sulphate reduction, autotrophic denitrification and nitrification to achieve low-cost excess sludge minimisation for Hong Kong sewage

An integrated anaerobic-aerobic treatment system of sulphate-laden wastewater was proposed here to achieve low sludge production, low energy consumption and effective sulphide control. Before integrating the whole system, the feasibility of autotrophic denitrification utilising dissolved sulphide produced during anaerobic treatment of sulphate rich wastewater was studied here. An upflow anaerobic sludge blanket reactor was operated to treat sulphate-rich synthetic wastewater (TOC = 100 mg/L and sulphate = 500 mg/L) and its effluent with dissolved sulphide and external nitrate solution were fed into an anoxic biofilter. The anaerobic reactor was able to remove 77-85% of TOC at HRT of 3 h and produce 70-90 mg S/L sulphide in dissolved form for the subsequent denitrification. The performance of anoxic reactor was stable, and the anoxic reactor could remove 30 mg N/L nitrate at HRT of 2 h through autotrophic denitrification. Furthermore, sulphur balance for the anoxic filter showed that more than 90% of the removed sulphide was actually oxidised into sulphate, thereby there was no accumulation of sulphur particles in the filter bed. The net sludge productions were approximately 0.15 to 0.18 g VSS/g COD in the anaerobic reactor and 0.22 to 0.31 g VSS/g NO3--N in the anoxic reactor. The findings in this study will be helpful in developing the integrated treatment system to achieve low-cost excess sludge minimisation.

A low-cost, easy-to-use, real-time power system simulator

We present the design rationale and basic workings of a low-cost, easy-to-use power system simulator developed to support investigations into human interface design for a hydropower plant. The power system simulator is based on three important components: models of power system components, a data repository, and human interface elements. Dynamic Data Exchange (DDE) allows simulator components to communicate with each other within the simulator. To construct the modules of the simulator we have combined the advantages of commercial software such as Matlab/Simulink, ActiveX Control, Visual Basic and Excel and integrated them in the simulator. An important advantage of our approach is that further components of the simulator now can be developed independently. An initial assessment of the simulator indicates it is fit for intended purpose.