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.

Protocols for listing threatened species can forecast extinction

Risk-ranking protocols are used widely to classify the conservation status of the world's species. Here we report on the first empirical assessment of their reliability by using a retrospective study of 18 pairs of bird and mammal species (one species extinct and the other extant) with eight different assessors. The performance of individual assessors varied substantially, but performance was improved by incorporating uncertainty in parameter estimates and consensus among the assessors. When this was done, the ranks from the protocols were consistent with the extinction outcome in 70-80% of pairs and there were mismatches in only 10-20% of cases. This performance was similar to the subjective judgements of the assessors after they had estimated the range and population parameters required by the protocols, and better than any single parameter. When used to inform subjective judgement, the protocols therefore offer a means of reducing unpredictable biases that may be associated with expert input and have the advantage of making the logic behind assessments explicit. We conclude that the protocols are useful for forecasting extinctions, although they are prone to some errors that have implications for conservation. Some level of error is to be expected, however, given the influence of chance on extinction. The performance of risk assessment protocols may be improved by providing training in the application of the protocols, incorporating uncertainty in parameter estimates and using consensus among multiple assessors, including some who are experts in the application of the protocols. Continued testing and refinement of the protocols may help to provide better absolute estimates of risk, particularly by re-evaluating how the protocols accommodate missing data.

AMS dating of rock art in the Laura Region, Cape York Peninsula, Australia - protocols and results of recent research

The authors describe rock art dating research in Australia using the oxalate method While the array of dates obtained (which range from c. 1200 to c. 25000 BP) show a satisfactory correlation with other archaeological data, there are mismatches which suggest that some motifs were often imitated by later artists, and/or that the mineral accretions continued to form periodically, perhaps continuously, as a regional phenomenon over a long period of time.

The consistency of extinction risk classification protocols

Systematic protocols that use decision rules or scores arc, seen to improve consistency and transparency in classifying the conservation status of species. When applying these protocols, assessors are typically required to decide on estimates for attributes That are inherently uncertain, Input data and resulting classifications are usually treated as though they arc, exact and hence without operator error We investigated the impact of data interpretation on the consistency of protocols of extinction risk classifications and diagnosed causes of discrepancies when they occurred. We tested three widely used systematic classification protocols employed by the World Conservation Union, NatureServe, and the Florida Fish and Wildlife Conservation Commission. We provided 18 assessors with identical information for 13 different species to infer estimates for each of the required parameters for the three protocols. The threat classification of several of the species varied from low risk to high risk, depending on who did the assessment. This occurred across the three Protocols investigated. Assessors tended to agree on their placement of species in the highest (50-70%) and lowest risk categories (20-40%), but There was poor agreement on which species should be placed in the intermediate categories, Furthermore, the correspondence between The three classification methods was unpredictable, with large variation among assessors. These results highlight the importance of peer review and consensus among multiple assessors in species classifications and the need to be cautious with assessments carried out 4), a single assessor Greater consistency among assessors requires wide use of training manuals and formal methods for estimating parameters that allow uncertainties to be represented, carried through chains of calculations, and reported transparently.

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.

A naturalistic comparison of two right unilateral electroconvulsive therapy dosing protocols: 2-3X seizure threshold versus fixed high-dose

The aim of this study was to compare the outcomes associated with two differing right unilateral (RUL) electroconvulsive therapy (ECT) dosing protocols: 2-3X seizure threshold (2-3X ST) and fixed high dose (FHD) at 353 mC. A retrospective chart review was performed to compare patient outcomes during the implementation of two different dosing protocols: 2-3X ST from October 2000 to May 2001 and FHD from June 2001 to February 2002. A total of 56 patients received ECT under the 2-3X ST protocol, and 46 received ECT under the FHD protocol. In total, 13.6% of patients receiving ECT according to the 2-3X ST protocol received more than 12 ECT, whereas none of the FHD group received more than 12 ECT. The mean number of ECT per treatment course reduced significantly from 7.6 to 5.7 following the switch from the 2-3X ST protocol to the FHD protocol. There were no significant differences between the two groups in the incidence of adverse cognitive effects. ECT practitioners adhered to the 2-3X ST protocol for only 51.8% of ECT courses, with protocol adherence improving to 87% following introduction of the FHD protocol. Although this naturalistic retrospective chart survey had significant methodological limitations, it found that practitioners are more likely to correctly adhere to a fixed dose protocol, therefore, increasing its 'real world' effectiveness in comparison to titrated suprathreshold dosing techniques. The FHD protocol was associated with shorter courses of ECT than the 2-3X ST protocol, with no significant difference between the two protocols in clinically discernable adverse cognitive effects.

The emergence of order in random walk resource discovery protocols

While others have attempted to determine, by way of mathematical formulae, optimal resource duplication strategies for random walk protocols, this paper is concerned with studying the emergent effects of dynamic resource propagation and replication. In particular, we show, via modelling and experimentation, that under any given decay (purge) rate the number of nodes that have knowledge of particular resource converges to a fixed point or a limit cycle. We also show that even for high rates of decay - that is, when few nodes have knowledge of a particular resource - the number of hops required to find that resource is small.

A Z based approach to verifying security protocols

Security protocols preserve essential properties, such as confidentiality and authentication, of electronically transmitted data. However, such properties cannot be directly expressed or verified in contemporary formal methods. Via a detailed example, we describe the phases needed to formalise and verify the correctness of a security protocol in the state-oriented Z formalism.

Formal verification of type flaw attacks in security protocols

Security protocols are often modelled at a high level of abstraction, potentially overlooking implementation-dependent vulnerabilities. Here we use the Z specification language's rich set of data structures to formally model potentially ambiguous messages that may be exploited in a 'type flaw' attack. We then show how to formally verify whether or not such an attack is actually possible in a particular protocol using Z's schema calculus.

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.