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.

First- and second-order stimulus length selectivity in New World monkey striate cortex

Motion is a powerful cue for figure-ground segregation, allowing the recognition of shapes even if the luminance and texture characteristics of the stimulus and background are matched. In order to investigate the neural processes underlying early stages of the cue-invariant processing of form, we compared the responses of neurons in the striate cortex (V1) of anaesthetized marmosets to two types of moving stimuli: bars defined by differences in luminance, and bars defined solely by the coherent motion of random patterns that matched the texture and temporal modulation of the background. A population of form-cue-invariant (FCI) neurons was identified, which demonstrated similar tuning to the length of contours defined by first- and second-order cues. FCI neurons were relatively common in the supragranular layers (where they corresponded to 28% of the recorded units), but were absent from layer 4. Most had complex receptive fields, which were significantly larger than those of other V1 neurons. The majority of FCI neurons demonstrated end-inhibition in response to long first- and second-order bars, and were strongly direction selective, Thus, even at the level of V1 there are cells whose variations in response level appear to be determined by the shape and motion of the entire second-order object, rather than by its parts (i.e. the individual textural components). These results are compatible with the existence of an output channel from V1 to the ventral stream of extrastriate areas, which already encodes the basic building blocks of the image in an invariant manner.

Options for guaranteeing the effective management of the world's protected areas

A rapid increase in the number and size of protected areas has prompted interest in their effectiveness and calls for guarantees that they are providing a good return on investment by maintaining their values. Research reviewed here suggests that many remain under threat and a significant number are already suffering deterioration. One suggestion for encouraging good management is to develop a protected-area certification system: however this idea remains controversial and has created intense debate. We list a typology of options for guaranteeing good protected-area management, and give examples, including: danger lists; self-reporting systems against individual or standardised criteria; and independent assessment including standardised third-party reporting, use of existing certification systems such as those for forestry and farming and certification tailored specifically to protected areas. We review the arguments for and against certification and identify some options, such as: development of an accreditation scheme to ensure that assessment systems meet minimum standards; building up experience from projects that are experimenting with certification in protected areas; and initiating certification schemes for specific users such as private protected areas or institutions like the World Heritage Convention.

Resolving the organization of the New World monkey third visual complex: The dorsal extrastriate cortex of the marmoset (Callithrix jacchus)

We tested current hypotheses on the functional organization of the third visual complex, a particularly controversial region of the primate extrastriate cortex. In anatomical experiments, injections of retrograde tracers were placed in the dorsal cortex immediately rostral to the second visual area (V2) of New World monkeys (Callithrix jacchus), revealing the topography of interconnections between the third tier cortex and the primary visual area (V1). The data indicate the presence of a dorsomedial area (DM), which represents the entire upper and lower quadrants of the visual field, and which receives strong, topographically organized projections from the superficial layers of V1. The visuotopic organization and boundaries of DM were confirmed by electrophysiological recordings in the same animals and by architectural characteristics which were distinct from those found in ventral extrastriate cortex rostral to V2. There was no electrophysiological or histological evidence for a transitional area between V2 and DM. In particular, the central representation of the upper quadrant in DM was directly adjacent to the representation of the horizontal meridian that marks the rostral border of V2. The present results argue in favor of the hypothesis that the third visual complex in New World monkeys contains different areas in its dorsal and ventral components: area DM, near the dorsal midline, and a homolog of area 19 of other mammals, located more lateral and ventrally. The characteristics of DM suggest that it may correspond to visual area 6 (V6) of Old World monkeys. (C) 2005 Wiley-Liss, Inc.

Bad apples in bad barrels revisited: Cognitive moral development, just world beliefs, rewards, and ethical decision-making

In this study, we test the interactive effect on ethical decision-making of (1) personal characteristics, and (2) personal expectancies based on perceptions of organizational rewards and punishments. Personal characteristics studied were cognitive moral development and belief in a just world. Using an in-basket simulation, we found that exposure to reward system information influenced managers' outcome expectancies. Further, outcome expectancies and belief in a just world interacted with managers' cognitive moral development to influence managers' ethical decision-making. In particular, low-cognitive moral development managers who expected that their organization condoned unethical behavior made less ethical decisions while high cognitive moral development managers became more ethical in this environment. Low cognitive moral development managers also behaved less ethically when their belief in a just world was high.

Determining the specification of a control system from that of its environment

Well understood methods exist for developing programs from given specifications. A formal method identifies proof obligations at each development step: if all such proof obligations are discharged, a precisely defined class of errors can be excluded from the final program. For a class of closed systems such methods offer a gold standard against which less formal approaches can be measured. For open systems -those which interact with the physical world- the task of obtaining the program specification can be as challenging as the task of deriving the program. And, when a system of this class must tolerate certain kinds of unreliability in the physical world, it is still more challenging to reach confidence that the specification obtained is adequate. We argue that widening the notion of software development to include specifying the behaviour of the relevant parts of the physical world gives a way to derive the specification of a control system and also to record precisely the assumptions being made about the world outside the computer.

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.