An editor's view of telemedicine

Should an editor hold a view about telemedicine, or should an editor be entirely disinterested? The editorial role has been defined by the International Committee of Medical journal Editors and a long list of editorial responsibilities has been set out by the World Association of Medical Editors. This represents something of a counsel of perfection, although clearly an editor should not have a personal view, in the sense of promoting telemedicine or dismissing it. Since telemedicine editors are almost bound to be active in research, they should take particular care with manuscripts involving their own work, for example standing aside from the editorial process and delegating editorial decisions to other members of the editorial staff. At the beginning of the 1990s, there were few publications about telemedicine in the peer-reviewed literature. The subsequent years have seen a rapid growth in numbers of articles and the emergence of two specialist journals. These are all healthy signs. However, there have been remarkably few studies of telemedicine's cost-effectiveness, which must represent a sign of its immaturity. On balance, the evidence seems to indicate that telemedicine research is in a healthy state.

Paediatric palliative home care with Internet-based video-phones: lessons learnt

We have designed and tested an Internet-based video-phone suitable for use in the homes of families in need of paediatric palliative care services. The equipment uses an ordinary telephone line and includes a PC, Web camera and modem housed in a custom-made box. In initial field testing, six clinical consultations were conducted in a one-month trial of the videophone with a family in receipt of palliative care services who were living in the outer suburbs of Brisbane. Problems with variability in call quality-namely audio and video freezing, and audio break-up-prompted further laboratory testing. We completed a programme of over 250 test calls. Fixing modem connection parameters to use the V.34 modulation protocol at a set bandwidth of 24 kbit/s improved connection stability and the reliability of the video-phone. In subsequent field testing 47 of 50 calls (94%) connected without problems. The freezes that did occur were brief (with greatly reduced packet loss) and had little effect on the ability to communicate, unlike the problems arising in the home testing. The low-bandwidth Internet-based video-phone we have developed provides a feasible means of doing telemedicine in the home.

Automatic message handling for a national counselling service

An automatic email handling system (AutoRouter) was introduced at a national counselling service in Australia. In 2003, counsellors responded to a total of 7421 email messages. Over nine days in early May 2004 the administrator responsible for the management of the manual email counselling service recorded the time spent on managing email messages. The AutoRouter was then introduced. Since the implementation of the AutoRouter the administrator's management role has become redundant, an average of 12 h 5 min per week of staff time has been saved. There have been further savings in supervisor time. Counsellors were taking an average of 6.2 days to respond to email messages (n=4307), with an average delay of 1.2 days from the time counsellors wrote the email to when the email was sent. Thus the response was sent on average 7.4 days after receipt of the original client email message. A significant decrease in response time has been noted since implementation of the AutoRouter, with client responses now taking an average of 5.4 days, a decrease of 2.0 days. Automatic message handling appears to be a promising method of managing the administration of a steadily increasing email counselling service.

Echocardiographic parameters in 14 healthy English Bull Terriers

Objective To determine the range of various cardiac parameters using echocardiography in apparently normal, healthy English Bull Terriers. Design Fourteen English Bull Terriers were selected for study. Cardiac auscultation of the parents of these dogs was normal. Echocardiographic examination of one parent of each animal showed: no mitral or aortic valve abnormalities; no myocardial lesions; no two dimensional evidence of fixed or dynamic left ventricular outflow tract obstruction; and no systolic aortic or left ventricular outflow tract turbulence on colour flow Doppler examination. The 14 selected dogs did not have arrhythmias or murmurs, and on echocardiographic examination had similar findings to their parents. Systolic blood pressure was measured in all dogs and they had no clinical evidence of Bull Terrier polycystic kidney disease or Bull Terrier hereditary nephritis. Procedure All dogs were auscultated and subjected to a sequential global echocardiographic assessment of the heart, including two dimensional long and short axis, and colour flow Doppler interrogation of the mitral and aortic valves. Dimensional measurements, including those from the left atrium, aortic annulus and left ventricle, were taken from a right parasternal window, and derived values such as fractional shortening, stroke volume and left atrial to aortic annulus ratio were calculated. Peak systolic aortic velocity was measured from the left parasternal window using two dimensional-guided pulsed wave Doppler with angle correction. Systolic blood pressure was measured using a Doppler monitor. The absence of Bull Terrier polycystic kidney disease was determined using renal ultrasonography, and of Bull Terrier hereditary nephritis using urinary protein to creatinine ratio. Results These 14 dogs had greater left ventricular wall thickness and smaller aortic root diameters than those reported as normal for other breeds of comparable body size. Left atrial dimensions were also larger, however this may have been due to the maximising method of measurement. These apparently normal English Bull Terriers also had higher aortic velocities than those reported for other breeds, possibly due to a smaller aortic root diameter or other anatomic substrate of the left ventricular outflow tract, lower systemic vascular resistance, or breed-specific normal left ventricular hypertrophy. While these dogs were selected to be as close to normal as possible, the breed may have a particular anatomy that produces abnormal left ventricular echocardiographic parameters. Conclusion These echocardiographic parameters may be used to diagnose left ventricular outflow tract obstruction and left ventricular hypertrophy, and inaccurate diagnoses may result if breed-specific values are not used.

On systems thinking, systems biology and the in Silico Plant

The recent summary report of a Department of Energy Workshop on Plant Systems Biology (P.V. Minorsky [2003] Plant Physiol 132: 404-409) offered a welcomed advocacy for systems analysis as essential in understanding plant development, growth, and production. The goal of the Workshop was to consider methods for relating the results of molecular research to real-world challenges in plant production for increased food supplies, alternative energy sources, and environmental improvement. The rather surprising feature of this report, however, was that the Workshop largely overlooked the rich history of plant systems analysis extending over nearly 40 years (Sinclair and Seligman, 1996) that has considered exactly those challenges targeted by the Workshop. Past systems research has explored and incorporated biochemical and physiological knowledge into plant simulation models from a number of perspectives. The research has resulted in considerable understanding and insight about how to simulate plant systems and the relative contribution of various factors in influencing plant production. These past activities have contributed directly to research focused on solving the problems of increasing biomass production and crop yields. These modeling approaches are also now providing an avenue to enhance integration of molecular genetic technologies in plant improvement (Hammer et al., 2002).

The Evolving Nature of Small-Scale Forestry in Australia

Two forms of small-scale forestry are developing in Australia, each with different impacts on rural communities. One is based on growing short-rotation Eucalyptus globulus (blue gum) for pulp and the other on production of higher-value products from longer-rotation native hard-woods. Several impediments exist to further development of small-scale forestry, including the lack of a small-scale forestry culture, concerns over harvest rights, lack of market development, the long wait for returns, and satisfaction with current land uses. Nevertheless, the rapid increase in farm woodlot establishment in the past five years has paralleled the strong increase in the private industrial plantation estate. As markets develop and hindrances are overcome, landholders not previously interested in small-scale forestry may consider ita worthwhile land use.